选择性脊神经后根切断术对脑瘫患者肢体功能改善的作用

Functional outcome following selective posterior rhizotomy and analysis of the complications

目的:对选择性脊神经后根切断术(SPR)对于痉挛解除、术后患者肢体功能状态,以及手术后并发症进行分析观察。方法:对1990年—2000年收治的825例随访时间超过2年的脑瘫患者,对比观察手术前后的痉挛状态、肢体功能状态,并进行统计分析。结果:肌张力由术前平均3.44级下降至术后1.23级;术前能够独立行走的129例患者中,107例步态有明显改善;借助行走的418例患者中,263例术后可独立行走。爬行278例患者中,91例可以独立行走,52例可以借助站立和行走;癫痫发作减少31例;流涎患者术后49例减轻,21例消失。斜视患者中132例术后减轻。语言功能障碍456例中72例发音改善吐字转变为较清晰。328例伴有上肢痉挛的患者术后67例上肢肌张力有不同程度的减轻。术后痉挛复发2例、腰痛16例、腰部无力41例、下肢无力24例、小腿及足底麻木50例。尿潴留8例。脊柱侧弯15例、腰椎后凸2例。术后发现4例腰椎峡部裂和1例Ⅰ°腰椎滑脱。结论:SPR可以在有效地解除肢体痉挛的同时,达到改善肢体功能的目的且手术并发症少。

Objective:To analyze the outcome of selective posterior rhiztomy(SPR),including relieving of spasticity,func-tional improvement of extremities,and its complications.Method:Eight hundred and twenty five patients at the average of9.5years old were underwent SPR and followed-up at least2years.The muscle tonus and function of extremities were compared pre-and postoperatively.Result:The average muscle tone was decreased from3.44to1.23;among129patients who could walk independently pre-operation107were found amelioration of gait;418patients of walking with assistant be-fore operation,263cases walked as independently after SPR.Among278cases of crawling pre-operation,91patients could walk independently and52can walking with assistant;among those patients who were found spasm of upper limbs,67of328patients were found that the tonus of upper extremities were decreased.Complication:2cases of spasm recurrence,back pain16cases,back weakness41cases,weakness of legs24cases,numbness and tingling of shank and foot50cases,urinary retention8cases,scoliosis15cases with Cobb's angle15°-35°;lumbar lordosis2cases;4cases of spondylolysis and1case ofⅠ°spondylolisthesis.Conclusion:SPR can relieve spasm effectively,and ameliorate function.