痉挛性脑瘫SPR手术及程序化治疗

Selective posterior rhizotomy and procedural treatment on spastic cerebal palsy

目的研究选择性脊神经后根切断术 (SPR)、局部矫形手术及康复训练治疗痉挛性脑瘫的疗效。方法采用L1—S1双侧节段开窗式部分椎板切除 ,将L2 —S1的脊神经后根进行分束 ,电刺激仪测各后根阈值 ,将阈值较低神经束切断。神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化 ,均 <3 0 %。术后下肢部分挛缩畸形未能改善者行局部矫形手术 ,术后行康复训练。结果经随访 ,本组 2 8例患者痉挛解除率 90 % ,功能改善率 80 %。结论选择性脊神经后根切断术 +程序化治疗能有效地改善脑瘫下肢痉挛。

ObjectiveTo evaluate the effect of selective posterior rhizotomy(SPR),local corrective surgery and the training of rehabilitation on the relief of limb spasm secondary to cerebral palsy.MethodsThe 'open window' of bilateral vertebral lamina resection, the the posterior roots of L_2-S_1 were separated from anterior roots and splited into rootlets. The rootlets sensitive to lower threshold of electrical stimulation were sectioned. The ratios of cut root,acorrding to muscle tension, myodynamia, body weight, muscle function,were estimated and all of them <30%. The local plastic operation was performed for nonimprovement of lower limb spasm and the training of rehabilitation began at postoperation. ResultsThe SPR have been performed on 28 cases. The rate of spasticity relief was 90% and the rate of functional improvement was 80% with follow-up. ConclusionsIt is a successful way to treat spastic cerebral palsy with SPR and procedural method.