选择性脊神经后根切断术治疗非脑瘫性下肢痉挛性瘫痪的临床疗效

Study on clinical effectiveness of lower limb spasticity of non-cerebral palsy treated by selective posterior rhizotomy

目的探讨选择性脊神经后根切断术(SPR)对非脑瘫性下肢痉挛性瘫痪的疗效。方法选择自2008年10月至2011年6月除外脑瘫所致下肢痉挛型瘫痪36例(其中脑血管意外后遗症8例,脑积水4例,脑脊髓损伤后遗症19例,不明原因5例),行选择性脊神经后根切断术。对术前、术后的下肢肌张力,步态分析及肢体功能的变化进行分析。结果所有患者的均获随诊,时间3～18月,平均5.3±1.8月。术后步态分析及行走能力得到明显改善,差异有统计学意义(P<0.01)。所有患者痉挛改善,肌张力评分由术前3.5±0.2分下降至术后1.5±0.5分,差异有统计学意义(P<0.01),肢体功能均有不同程度改善。结论选择性脊神经后根切断治对非脑瘫性下肢痉挛性瘫痪,可改善痉挛,降低肌张力,改善步态。

Objective To study curative effect of selective posterior rhizotomy（SPR） in treatment of lower limb spasticity in patients with non-cerebral palsy.Methods Thirty six cases of non-cerebral lower limb spasticity（8 cases of cerebrovascular accident;4 cases of hydrocephalus;19 cases of cerebral or spinal trauma and 5 cases with other causes） were treated with selective posterior rhizotomy（SPR） during October 2008 to June 2011.Muscle tonicity and gait analysis were measured before and after operation.Results All cases were followed up for 3~18（with mean of 5.3±1.8） months.Gait analysis and walking ability were significantly improved after treatment.Reduction of spasticity was obtained in every case,and their muscle tonicity was reduced from 3.5 ± 0.2 pre-operation to 1.5 ± 0.5 post-operation,hence their movement had been improved.Conclusion SPR is an effective method for treatment of non-cerebral lower limb spasticity.It can remit the spasticity and muscle tonicity,and then it may improve the gait.