腱膜松解术治疗脊髓损伤后四肢痉挛性瘫痪的临床疗效研究

EFFECTIVENESS OF APONEUROSIS BRISEMEN FOR TREATMENT OF SPASTIC PALSY AFTER SPINAL CORD INJURY

目的探讨腱膜松解术治疗脊髓损伤后四肢痉挛性瘫痪的临床疗效。方法回顾分析2006年3月-2012年3月应用腱膜松解术治疗的28例脊髓损伤后四肢痉挛性瘫痪患者临床资料。其中男19例,女9例;年龄17~52岁,平均35.5岁。病程8~16个月,平均12个月。外伤性颈脊髓损伤20例,外伤性胸脊髓损伤5例,胸椎管狭窄减压术医源性损伤3例。共42个肢体,其中上肢26个,下肢16个。均伴肌张力增高及动态肌痉挛或静态挛缩。松解术后患肢石膏固定4周,4周后进行康复训练。手术前后患肢运动功能采用Fugel-Meyer评分法评定,患肢肌张力采用Ashworth分级评定,患者日常生活活动能力采用Barthel指数评定。结果所有手术顺利完成。1例肘关节屈曲畸形因行肱二头肌腱膜松解过度,术后出现屈肘功能障碍,二次手术行肱二头肌肌腱紧缩术,术后屈肘功能恢复。28例均获随防,随访时间1~6年,平均3.5年。术后6个月及末次随访时痉挛肌肉肌张力均较术前明显降低（P〈0.05）。术后6个月痉挛肌肉肌张力与术前比较显效20个部位（47.62%）、有效12个（28.57%）、好转6个（14.29%）、无效4个（9.52%）;末次随访时显效20个部位（47.62%）、有效14个（33.33%）、好转5个（12.02%）、无效3个（7.14%）;术后6个月与末次随访时比较差异无统计学意义（χ2=0.932,P=0.365）。术后6个月及末次随访时患肢运动功能Fugel-Meyer评分和患者日常生活能力Barthel指数均较术前明显提高（P〈0.05）;术后6个月与末次随访时比较差异亦有统计学意义（P〈0.05）。结论腱膜松解术结合术后康复训练治疗脊髓损伤后四肢痉挛性瘫痪安全可行,可明显降低痉挛肌肉肌张力、改善运动功能和自理能力,有效改善患者生活质量。

Objective To study the ef ectiveness of aponeurosis brisemen in treating spastic palsy after spinal cord injury. Methods Between March 2006 and March 2012, 28 patients（42 limbs, including 26 upper limbs and 16 lower limbs） with spastic palsy after spinal cord injury underwent aponeurosis brisemen, and the clinical data were retrospectively analyzed. Of 28 cases, 19 were male and 9 were female with an average age of 35.5 years（range, 17-52 years） and a mean disease duration of 12 months（range, 8-16 months）; there were 20 cases of traumatic cervical spinal cord injury, 5 cases of traumatic thoracic spinal cord injury, and 3 cases of iatrogenic injury after decompressing thoracic spinal stenosis. After aponeurosis brisemen, the limbs were i xed with plaster cast for 4 weeks, then functional exercise was done after removal of plaster cast. Fugel-Meyer scoring system was used to evaluate motor function, the Ashworth classii cation to evaluate the change of muscle tension, and Barthel index to evaluate the activities of daily living. Results The operation was completed successfully in all patients. Elbow l exion dysfunction was caused by excessive release in one limb, which was cured after tightening operation. All patients were followed up 1-6 years（mean, 3.5 years）. At 6 months after operation and last follow-up, the muscle tension was signii cantly decreased（P〈0.05）. At 6 months, the ef ect was excellent in 20 positions（47.62%）, ef ective in 12（28.57%）, improved in 6（14.29%）, inef ective in 4（9.52%）; at last follow-up, the ef ect was excellent in 20 positions（47.62%）, ef ective in 14（33.33%）, improved in 5（12.02%）, inef ective in 3（7.14%）; and no signii cant dif erence was found between at 6 months 2after operation and at last follow-up（χ=0.932, P=0.365）. At 6 months after operation and last follow-up, Fugel-Meyer score and Barthel index were signii cantly increased when compared with preoperative ones（P〈0.05）, signii cant dif erences were also shown between at 6 months after operation and at last follow-up（P〈0.05）. Conclusion Aponeurosis brisemen combined with the functional training is an ef ective and safe procedure for treating spastic palsy after spinal cord injury. It is useful to decrease muscle tension and improve life quality and motor function.