SPR治疗成人脑外伤后下肢痉挛的步态分析及诱发电位研究(附47例术后6年随访分析)

A STUDY OF EVOKED POTENTIAL AND GAIT ANALYSIS OF SPASTIC LIMBS SELECTIVE POSTERIOR RHIZOTOMY IN PATIENTS WITH CEREBRAL INJURY

采用选择性脊神经后根切断术 (SPR)治疗成人脑外伤后下肢痉挛 16例 ,并对 47例术后 6年病人进行随访。 16例患者术前3天进行步态分析及诱发电位测定 ,将痉挛下肢的L2 ～S1的脊神经后根进行分束 ,以电刺激仪测定阈值 ,将阈值较低的神经束切断。结合肌张力、肌力、体重及肌群功能对神经根切断比例进行量比 ,均小于 30 %。 16例随访 4年 ,痉挛解除率为 90 % ,功能改善率为 80 %。术后步态明显改善(P <0 0 1)。手术前后诱发电位测定支持肌张力调节的“大、小环路”理论 ,47例术后 6年随访结果疗效满意。提示选择性脊神经后根切断术能较有效的治疗成人脑外伤后肢体痉挛。

Selective posterior rhizotomy was performed for the treatment of spastic limbs in patients with brain injury, and evoked potential and gait analysis were used to study its effect. The posterior roots of L 2～S 1 were separated from anterior roots and they were split into funiculi. Electric stimulation of the fumiculi was done.Those with low threshold were sectioned. Evoked potential and gait analysis were performed preoperatively and postoperatively. Selective posterior rhizotomy had been performed in 16 cases.They were followed up for 4 years. The result of the treatment was satisfactory.The rate of reduction in spasticity was 90 percent, and the rate of functional improvement was 80 percent.The study of evoked potential and gait analysis also showed that the effect of the operation was satisfactory.The results of selective posterior rhizotomy in the treatment of spastic limbs as a sequela of brain injury is promising,as judged by evoked potential and gait analysis.