单侧锁孔微创椎板间入路选择性脊神经后根切断术在痉挛型偏瘫中的应用

Selective posterior rhizotomy through unilateral keyhole microinvasive interlaminar approach in treatment of spastic hemiplegia of lower limbs

目的评估单侧锁孔微创椎板间入路腰骶段选择性脊神经后根切断术(SPR)对下肢痉挛型偏瘫患者的疗效及安全性。方法回顾性分析清华大学玉泉医院神经外科2019年7月—2021年7月收治的23例痉挛型偏瘫患者的临床资料,根据随机化分组结果分别行单侧锁孔微创椎板间入路和经典Peacock腰骶段SPR治疗,术后12个月时进行随访,对患者一般资料、手术前后MAS评分和GMFCS评分等进行分析。结果本组23例患者均可良好暴露脊神经根并进行选择性切断,术后MAS评分及GMFCS评分均较术前明显改善。结论单侧锁孔微创椎板间入路SPR可对神经根进行良好的显露,手术效果与经典Peacock术式相同,且对脊柱结构破坏小,利于术后脊柱稳定性的维持,且不增加手术风险,可明显改善痉挛型偏瘫患者的患侧肌张力和运动功能。

Objective To evaluate the efficacy and safety of selective posterior rhizotomy(SPR)through unilateral keyhole microinvasive interlaminar approach in the treatment of spastic hemiplegia of lower limbs.Methods The clinical data of 23 patients with spastic hemiplegia of the lower extremities were randomly grouped and treated by SPR through unilateral keyhole microinvasive interlaminar approach and Peacock surgery,admitted to Department of Neurosurgery,Yuquan Hospital of Tsinghua University from July 2019 to July 2021,were analyzed retrospectively.The patients were followed up for 1 year.The general data,modified Ashworth score(MAS)and gross motor function classification system score(GMFCS)before and 1 year after surgery were analyzed.Results All 23 patients completed SPR through unilateral keyhole microinvasive interlaminar approach or Peacock surgery.The scores of MAS and GMFCS were significantly improved after operation and 1 year after the operation.Conclusions Unilateral keyhole microinvasive interlaminar approach provides a good exposure for the spinal nerve roots,the efficacy is as well as Peacock surgery.And SPR through unilateral keyhole microinvasive interlaminar approach causes less damage to the bony structure,preserve the stability of the spine,and does not increase the risk of operation.SPR by this approach has good efficacy and safety.