成人脊髓损伤后肢体痉挛的SPR手术及程序化治疗

SELECTIVE POSTERIOR RHIZOTOMY (SPR) AND PROGRAMMED TREATMENT FOR SPASTIC LIMBS AFTER SPINAL CORD INJURY

采用选择性脊神经后根切断术 (SPR) +程序化治疗 (康复训练 局部矫形手术 再康复训练 )治疗成人脊髓损伤后肢体痉挛36例。术中采用L2 ～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 ,电刺激仪测阈值 ,将阈值较低的神经束切断。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 <30 %。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。本组 36例病人痉挛解除率 90 % ,功能改善率 75 % ,说明选择性脊神经后根切断术

To evaluate the effect of selective posterior rhizotomy and programmed treatment on the relief of limb spasm secondary to the spinal cord injury. The posterior roots of L 2～S 1 were separated from anterior roots and split into funiculi. The funiculi sensitive to lower threshold of electrical stimulation were sectioned. The selective posterior rhizotomy and programmed treatment had been performed on 36 cases, and followed up for 3 years. The results of the treatment were satisfactory. The rate of spasticity relief was 90%, and the rate of functional improvement was 75%. Selective posterior rhizotomy and programmed treatment could be considerered to be the optimal treatment for spasticity of limbs subsequent to spinal cord injury.