高选择性脊神经后根切断术治疗痉挛性脑瘫

Superselective posterior rhizotomy for treatment of spastic cerebral palsy

目的 探讨应用高选择性脊神经后根切断术（SPR）治疗痉挛性脑瘫的疗效.方法 对58例接受SPR治疗的痉挛性脑瘫患者,进行术后8～40个月的随访,并对其术后痉挛情况、交叉腿、尖足情况、肌力、感觉等情况进行评估.结果 14例肌张力Ⅳ级的患者术后平均肌张力降为1.71级,32例肌张力Ⅲ级的患者术后平均肌张力降为1.56级,12例肌张力Ⅱ级的患者术后平均肌张力降为1.16级.30例剪刀步态完全消失（51.72％）,19例明显改善（32.76％）,仍有9例改善不明显（15.51％）.合并尖足者共31例,术后足跟着地者27例.术后随访能独立行走者29例（50％）,需搀扶者18例（31.03％）,不能行走者11例（18.97％）.结论 SPR对解除痉挛、降低肌张力等方面是安全可靠、作用持久的,配合必要的康复训练,可明显改善肢体活动功能,提高生活质量.

Objective The efficacy of superselective posterior rhizotomy （SPR） for treatment of spastic cerebral palsy is investigated.Methods A total of 58 patients with spastic cerebral palsy receiving SPR treatment were followed up for 8 to 40 months to evaluate the postoperative condition of spasm,cross legs,plantar flexion malformation,muscle strength and feeling,etc.Results The Ⅳ muscle tension of 14 patients descended to 1.71 level after operation,Ⅲ muscle tension of 32 patients descended to 1.56 level,and Ⅱ muscle tension of 12 patients descended to 1.16 level after operation.Scissors gait completely disappeared in 30 cases （51.72%）,significant improvement in 19 cases （32.76%）,and no obvious improvement （15.51%） in 9 cases after operation.Twenty seven of 31 cases with plantar flexion malformation were improved after operation.During the long-term follow-up after operation,29 cases （50%） could walk alone,18 cases （31.03%） needed to arm,and 11 cases （18.97%） were still unable to walk.Conclusion SPR is a safe and reliable method to relief cramnps and decrease muscle tension,therefore it can improve the quality of life and the physical activity with the necessary rehabilitation training.