选择性脊神经后根切断结合椎板复位术治疗痉挛性脑性瘫痪的并发症分析

Analysis of complications of selective posterior rhizotomy combined with replacement laminoplasty for the treatment of spastic cerebral palsy

目的探讨选择性脊神经后根切断结合椎板复位术(SPR+RL)治疗痉挛性脑性瘫痪的疗效和并发症的发生情况。方法回顾性分析2015年9月至2020年6月首都医科大学附属北京儿童医院功能神经外科行SPR+RL的785例痉挛性脑性瘫痪患儿的临床资料。术后常规给予康复治疗。术后6个月至3年进行随访。疗效评估标准为粗大运动功能评估量表(GMFM)评分和改良Ashworth痉挛量表(MAS)评分。总结并发症的发生情况。结果术后785例患儿的痉挛状态和肢体运动功能均得到不同程度的改善。术前和末次随访的GMFM评分分别为(34.9±5.2)分和(58.9±8.0)分,MAS评分分别为(4.8±0.4)分和(2.9±0.5)分,差异均有统计学意义(均P<0.05)。术后近期(术后1个月内)并发症包括低热(3.18%,25/785)、中度至高热(4.08%,32/785)、头痛(1.91%,15/785)、急性尿潴留(0.38%,3/785)、腹胀或排便困难(4.08%,32/785)、表浅切口愈合不良(3.18%,25/785)、切口深部感染(1.02%,8/785)、脑脊液漏(0.25%,2/785)、肢体感觉障碍(7.77%,61/785);术后远期(术后1个月以上)并发症包括腰背部疼痛(2.04%,16/785)、下肢间断性无力(0.64%,5/785)、脊柱畸形(0.38%,3/785)以及排尿、排便障碍(0.13%,1/785)。各项并发症经对症处理后效果满意。结论SPR+RL结合康复治疗可改善痉挛性脑性瘫痪患儿的痉挛状态和肢体运动功能,术后并发症的发生率较低,且各类并发症经相应处理后效果满意。

Objective To analyze the efficacy and complications of selective posterior rhizotomy(SPR)combined with replacement laminoplasty(RL)for the treatment of spastic cerebral palsy(SCP).Methods The clinical data of 785 children with SCP who underwent SPR+RL at the Department of Functional Neurosurgery of Beijing Children′s Hospital,Capital Medical University from September 2015 to June 2020 were retrospectively analyzed.Postoperative rehabilitation was routinely administered.Follow-up was performed from 6 months to 3 years after surgery.Efficacy evaluation criteria were gross motor function measure(GMFM)and modified Ashworth spasticity scale(MAS).Postoperative complications were summarized.Results The spasticity and limb motor function of 785 children were improved to varying degrees after operation.The GMFM scores at preoperative and last follow-up were 34.9±5.2 and 58.9±8.0 respectively,and the MAS scores were 4.8±0.4 and 2.9±0.5 respectively,and the differences were statistically significant(both P<0.05).Short-term postoperative complications included low-grade fever(3.18%,25/785),moderate to high fever(4.08%,32/785),headache(1.91%,15/785),and acute urinary retention(0.38%,3/785),abdominal distension or difficulty in defecation(4.08%,32/785),poor healing of superficial incision(3.18%,25/785),deep incision infection(1.02%,8/785),cerebrospinal fluid leakage(0.25%,2/785),limb sensory disturbance(7.77%,61/785);postoperative long-term complications included low back pain(2.04%,16/785),intermittent lower extremity weakness(0.64%,5/785),spinal deformity(0.38%,3/785)and defecation disorder(0.13%,1/785).After symptomatic treatment of various complications,the outcomes were satisfactory.Conclusions SPR+RL combined with rehabilitation can improve spasticity and limb motor function in children with SCP.The incidence of postoperative complications is low,and various complications could be treated with satisfactory outcomes.