选择性坐骨神经分支部分切断术治疗脑瘫患儿膝部屈曲痉挛

Selective sciatic neurotomy for relief of spasticity focalized to the knees in children with cerebral palsy

目的 探讨选择性坐骨神经分支部分切断术治疗脑瘫患儿膝部屈曲痉挛的治疗效果。方法 回顾分析显微手术治疗的42例病人共计60支膝屈曲痉挛状态,全部采用选择性坐骨神经分支部分切断术。结果 全部病人平均随访20个月。100％病人术后立即感膝部痉挛状态缓解,随访期间缓解率为90％。术后2周内步态功能改善率为100％。随访期间为93％。生活质量提高率在随访期间为100％ 术后发生小腿感觉障碍6例, 8例发生肌无力,随访期间均见好转。结论 选择性坐骨神经分支部分切断术是治疗脑瘫患儿膝部屈曲痉挛安全有效的显微外科手术方法。

Objective To study the effectiveness of selective sciatic neurotomy for relief of spasticity focalized to the knees in children with cerebral palsy. Methods 60 legs of 42 patients with knee spasticity were treated by microsurgical selective sciatic neurotomy. Results According to follow up evaluation ( mean duration=20months) . it was showed that 100% cases experienced disappearance or notable regression of the spasticity right affer operation, and the improvement percentage at follow-up was 90%. The improved motor capacities right affer operation were found in 100% cases, while 93% at follow-up. 100% cases had better quality of life by follow-up studying. Post-operative complications were few, including dysaesthesias of leg in 6 cases and muscle weakness in 8 cases. Conclusions Selective sciatic neurotomy is an effective and safe microsurgical procedure for the treatment of knee spasticity in children with cerebral palsy.