高选性周围神经肌支切断术治疗痉挛性脑瘫

Highly selective peripheral neurotomy as a treatment of cerebral palsy spasm

目的 痉挛性脑瘫多以大腿内收肌群、后群和小腿后群肌张力增高为主 ,从而与相对应的拮抗肌群形成不平衡状态 ,导致尖足、足内翻与剪刀步等畸形与功能异常。针对此病因 ,通过选择性切断高张力肌群的部分神经束 ,可矫正失衡状态 ,改善功能。方法 在周围神经应用解剖研究的基础上 ,对 38例因肌张力增高失衡为主要原因引起畸形或功能障碍的患儿 ,采用了高选性周围神经切断术 ,其中闭孔神经 2 1例 ,坐骨神经 2 7例 ,胫神经 2 6例。确定高张力肌群是以临床病理生理改变为依据 ,在电刺激监测下确定切断高敏感的神经束支。按肌张力增高程度确定切断神经束的比例。结果 本组获随访的 31例 ,时间 3～ 30个月 ,功能改善有效率为 1 0 0 %。 31例术后患儿肌张力均下降 1级 ,按评定标准 ,优 2 2例 ,良 6例 ,一般 2例 ,差 1例。结论 该术式具有针对性强 ,创伤小 ,疗效确切。

Objective In the patients with spastic cerebral palsy, deformities such as club foot? inversion foot and scissor gait often arise from the imbalance in the adductors muscle group of the thigh and leg and their antagonistic muscle groups. The increased muscular tension of the former constitutes the rationale of neurotomy.Methods Highly selective peripheral neurotomy in 38 children who suffered from lower limb deformity secondary to unequal muscular tension. Twenty one of the children underwent obturator neurotomy, 27 sciatic neurotomy, and 26 tibial neurotomy. Using electric stimulation, the fasciculi involved were decided and severed. The proportion of fasciculi severed depended on the degree of the muscular tension.Results All patients' function improved postoperatively. 80% of the patients experienced significant improvement.Conclusion Selective peripheral neurotomy is not only more effective and it also has less complication than selective posterior rhizotomy (SPR) in treating cerebral palsy spasm.