选择性腰3脊神经后根切断术治疗脑瘫性僵直膝的疗效探讨

Application of selective lumbar 3 posterior rhizotomy for stiff knees of spastic cerebral palsy

目的探讨小切口、微损伤选择性腰3脊神经后根切断术治疗痉挛型脑瘫僵直膝的手术疗效。方法收集以膝僵直为主要表现的痉挛型脑瘫患者50例,所有患者均施行选择性腰3脊神经后根切断术,共计85侧。分别采用改良Asworth痉挛量表、Lovett6级评分法、同步动态膝关节测量计及粗大运动功能评分于术前、术后和随访时对患者下肢活动功能进行评估。方差分析比较手术前后患者肌力、肌张力、关节活动度及下肢行走功能的变化。结果 50例患者中随访到47例,失访3例,随访时间10个月～2年8个月,平均随访19.6个月。手术治疗的患者术后和随访时肌张力较术前明显减低(均P<0.05),而肌力与术前比较无显著性差异(均P>0.05);术后和随访时状面膝关节活动度范围和摆动相的屈膝峰值比术前明显增大(均P<0.05);另外,患者术后下肢行走功能的改善率为63.9%,随访时为89.3%。结论本研究通过分析比较脑瘫患者手术前后肌张力、肌力、膝关节活动度及下肢活动功能的变化,证实小切口、微损伤选择性腰3脊神经后根切断术是治疗脑瘫性僵直膝的安全有效的手术方式。

Objective To explore the effectiveness of selective lumbar 3 posterior rhizotomy with small incisions for the treatment of spastic cerebral palsy stiff knees.Methods 50 spastic cerebral palsy patients with stiff knee was underwent selective lumbar 3 posterior rhizotomy on a total 85 sides.The Modified Asworth Scale,Lovett 6 scale,preoperative,postoperative and follow-up.Analysis of Variance was applied to compare muscle strength,muscle tension,knee joint mobility and walking function of lower limbs before and after operations.Results Among the 50 cases,47 patients were followed up and 3 patients were lost.The follow-up time was 10 months to 32 months.The average follow-up period was 19.6 months.Muscle tension of patients treated with surgery postoperative and follow-up was significantly lower than preoperative(both P<0.05).But there was no significant difference in muscle strength between preoperative and postoperative(both P>0.05).Total excursion on sagittal plane and the maximal flexion in swing phase was significantly raised post-operation than those of pre-operation(both P<0.05).Additionally,the GMFM revealed that the average improvement rate of lower limb walking function was 63.9% after operation,and that was 89.3% at follow-up.Conclusion In this study,the changes of muscle tension,muscle strength,knee joint motion and lower limb activities were compared before and after surgery with stiff knee of cerebral palsy patients.It was confirmed that small incision and microdamage selective lumbar 3 posterior rhizotomy is a safe and effective operation for spastic cerebral palsy patients with stiff knee.