腰骶段选择性脊神经后根切断术治疗脑性瘫痪下肢痉挛的疗效分析

Selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy

目的探讨腰骶段选择性脊神经后根切断术(SPR)对脑性瘫痪(简称脑瘫)患者下肢痉挛状态的有效性。方法回顾性纳入2013年1月至2015年1月辽宁省人民医院神经外科行SPR治疗的48例痉挛性脑瘫患者,分析其术后的肌张力变化、运动功能、生命质量以及流涎情况。肌张力变化情况采用改良Ashworth量表(mAS)评估,运动功能采用粗大运动功能分级系统(GMFCS)评估,生命质量的评估采用日常生活活动能力(ADL)评分,流涎情况采用教师流涎分级法(TDS)进行评估。结果所有患者随访12~30个月,平均(18.2±6.5)个月。与术前相比,随访6个月、12个月以及末次随访时左侧髋内收肌、腘绳肌、踝跖屈肌的mAS评分均明显降低(均P<0.05),GMFCS分级改善(Z=-5.19,P<0.01),ADL评分明显改善(F=1.89,均P<0.05)。流涎改善比例为5/15。患者的术后GMFCS分级与其年龄(r=-0.44,P=0.009)、体质量(r=-0.22,P=0.006)呈负相关,与性别、治疗前GMFCS分级、受累肢体的数量无相关性(均P>0.05)。术后并发症中,下肢感觉障碍的发生率为7.3%(7/96),下肢肌无力为9.4%(9/96),随访期间均有好转;术后发生一过性尿潴留2例(4.2%),一过性大便困难1例(2.1%);术后痉挛状态的复发率为2.1%(1/48)。结论采用腰骶段SPR能够安全、有效地改善脑性瘫痪下肢痉挛,提高患者的生命质量。

Objective To study the effectiveness of selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy. Methods A total of 48 patients of spastic cerebral palsy who had undergone SPR at Department of Neurosurgery, The People's Hospital of Liaoning Province from January 2013 to January 2015 were followed-up with limb spasticity, gait and quality of life. The changes of muscle tone were evaluated by the modified Ashworth scale (mAS), the motor function was assessed by the gross motor function classification system (GMFCS), the quality of life was assessed by the activity of daily living(ADL) score, and the salivation condition was assessed by the teacher salivation grading method (TDS). Results All patients were followed up for 12-30 months with a mean duration of 18.2±6.5 months. Compared with the preoperative results, mAS scores of the left hips, knees and ankles of the 96 patients at 6 months, 12 months and the last follow-up were lower with statistically significant differences (all P<0.05). GMFCS score(Z=-5.19, P<0.01) and ADL score were significantly improved (F=1.89, all P<0.05), and salivation improvement proportion was 5/15. Postoperative GMFCS grades were negatively correlated with the patient's age (r=-0.44, P=0.009), weight (r=-0.22, P=0.006), and there was no correlation with gender, GMFCS grade before treatment, or number of affected limbs (all P>0.05). Among postoperative complications, the incidence of lower limb sensory disorder and muscle weakness was 7.3%(7/96)and 9.4%(9/96), respectively, both of which were improved during follow-up. Two (4.2%) cases of transient urinary retention and 1 (2.1%) case of dysmenorrhea occurred post operation. The postoperative recurrence rate of spasm was 2.1% (1/48). Conclusion Lumbosacral SPR is a safe and effective way to treat spasticity of lower limbs in cerebral palsy patients and improve their quality of life.