跳跃式椎板切除选择性脊神经后根切断治疗脑瘫性下肢痉挛9例

Selective Posterior Rhizotomy with skipping laminectomy for treating the lower limbs spastic cerebral palsy（reports of 9 cases）

目的：探讨跳跃式椎板切除选择性脊神经后根切断治疗下肢痉挛性脑瘫的应用与疗效。方法我们对9例下肢痉挛性脑瘫患儿采取跳跃式、限制性椎板切除，仅切除L3、L5椎板，保留L4椎板和棘突；为L2、L3、L5、S1（或含S2）后根分束，在神经肌电图监测下选择性切断脊神经后根。结果9例患儿手术顺利，经随访9～24个月，肌张力均有下降，疗效显著；无脊柱畸形等远期并发症。结论跳跃式、限制性椎板切除选择性脊神经后根切断术治疗下肢痉挛性脑瘫具有一定的可行性，术中应注意选择合适的麻醉深度以及神经肌电监测。

Objetive To explore the application and effects of Selective Posterior Rhizotomy with skip-ping laminectomy in treating the lower limbs spastic cerebral palsy by anesthesia depth controling and intraoper-ative electrophysiological monitoring. Methods 9 cases of lower limbs spastic cerebral palsy were treated with skipping-restrictive laminectomy in which only L3 and L5 underwent the laminectomy,and the posterior roots, including L2、L3、L5 and S1 （or S2）,were divided into several pieces and then the selective posterior rhizotomy was carried with intraoperative EMG monitoring. Results Each patient received a 9-24 months follow-up. Muscle tension of 9 patients was found reduced,especially 8 of them. Complication like spinal deformities were not found.Conclusion The skipping-restrictive laminectomy is feasible in treating the lower limb spastic cerebral palsy;desirable anesthesia depth and intraoperative electrophysiological monitoring are necessary.