选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛的临床观察

Clinical observation of selective posterior rhizotomy for spasticity of lower limbs in patients with cerebral palsy

目的探讨选择性腰骶段脊神经后根部分切断术(SPR)治疗脑瘫性下肢痉挛的疗效。方法回顾性分析406例脑瘫性下肢痉挛病人的临床资料,均行SPR治疗和康复训练,并采用相应量表评估病人临床症状的缓解情况。结果 406例获随访6～36个月,平均28.8个月。随访期间,痉挛状态缓解378例(93.3%),维持术前水平28例(6.7%);肌张力缓解362例(89.2%),维持术前水平44例(10.8%);步态功能改善370例(91.3%),维持术前水平36例(8.7%);生活质量提高378例(93.3%),无明显改善28例(6.7%)。术后发生下肢感觉障碍54例(13.3%),肌力下降72例(17.7%),一过性尿潴留9例(2.2%),一过性体温升高31例(7.6%)。结论 SPR治疗脑瘫性下肢痉挛的疗效确切、创伤小、并发症少,严格掌握适应证且术后坚持长期正规康复训练是保证疗效的关键。

Objective To study the therapeutic efficacy of selective posterior rhizotomy （SPR） for spasticity of lower limbs in patients with cerebral palsy. Methods Clinical data of 406 patients with spasticity of lower limbs due to cerebral palsy were analyzed retrospectively. The SPR and rehabilitation training were performed in all the patients, and the remission of clinical symptoms were evaluated by correlative scales. Results Four hundred and six patients were followed up for mean time of 28.8 months, ranged from 6 to 36 months. During the follow-up period, the spasticity remitted in 378 cases （93.3%） and maintained the preoperative levels in 28 （6.7%）, The dystonia remitted in 362 cases （89.2%） and maintained the preoperative levels in 44 （10.8%）, the gait function improved in 370 cases （91.3%） and maintained the preoperative levels in 36 （8.7%）, and the quality of life improved in 378 cases （93.3%） and not obviously changed in 28 （6.7%）. Postoperative complications included sensory disturbance of lower limbs in 54 cases （13.3%）, muscle strength reduction in 72 （17.7%）, transient urinary retention in 9 （2.2%） and transient temperature elevation in 31 （7.6%）. Conclusions SPR is a effective and less invasive surgical method for the treatment of spasticity of limbs in cerebral palsy patients with less complication. The proper choice of cases and postoperative rehabilitation are key points for good results.