胫-腓总神经侧侧缝合治疗下肢痉挛性脑瘫近期效果观察

Treatment of Spastic Cerebral Palsy by Side-to-side Neurorrhaphy of Peroneal and Tibial Nerves

目的 :提出一种治疗下肢痉挛性脑瘫的新方法并探讨其机制。方法 :6例下肢痉挛性脑瘫患者。将支配痉挛肌群和支配其拮抗肌群的胫神经和腓总神经干进行侧侧缝合 :大腿后侧切口显露两神经干的近端约 5cm后相互靠拢 ,切开两神经相邻面的神经外膜和束膜约 2cm ,切至神经纤维后 ,再相互并拢缝合外膜。 4例患者手术同时辅以内收肌切断或跟腱延长术。结果 :经过 5～ 1 0个月的随访 ,6名患者的肢体痉挛、畸形均有缓解 ,其中 5例患儿在不附加额外刺激的情况下 ,已无痉挛发作 ,恢复了患肢的主要功能。肢体功能尚随着时间的延长而进一步改善。结论 :胫 -腓总神经侧侧缝合后 ,脑瘫患者术后痉挛肌群可获得部分拮抗肌群神经的支配从而通过改变大脑皮层定位来最终缓解肢体痉挛 ,是治疗脑瘫的新的有效方法之一。

Objective: To discuss a new method and its mechanism for the treatment of spastic cerebral palsy. Methods: Six cases were treated. The peroneal nerve was kept abreast of tibial nerve at suitable segment, the epineurium and fascicu of two neighboring area were incised to appear nerve fibers,then side-to-side anastomosed the epineurium each other. Four cases received soft tissue operation at the same time. Result: All the cases were follow-up for 5～12 months. The spastic limb and deformity of all cases have obviously relieved, 5 cases have the main function recovered and no spasm without extra stimulation. Conclusion: Side-to-side neurorrhaphy is one of the new methods to treat spastic cerebral palsy. After operation, the spastic muscle could obtain normal never control, thereby, the cervical orientation area is changed.