BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when F...BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.展开更多
Objective To study the general design and practice instages of the treatment of severe cerebral palsy with the combination of selective anterior and posterior rhizotomy with orthomorphy stage II of the lower extremiti...Objective To study the general design and practice instages of the treatment of severe cerebral palsy with the combination of selective anterior and posterior rhizotomy with orthomorphy stage II of the lower extremities. Method To evaluate the disability of the cases, calculate the expectant value and design rehabilitation program in stages before selective anterior and posterior rhizotomy orthomorphy, force line recovering , extremities banlancing, joints stabilization and muscle force rebuilding. Result After treatment in stages the 15 children of cerebral palsy could walk without support. Conclusion It’s most important to practice the combination of the operations in order in rehabilitation of children’s severe cerebral palsy.展开更多
Objective To summarize the anesthesia techniques performed in the selective posterior rhizotomy(SPR) at lumbar and sacral regions(L&R)on juvenile cerebral palsy(CP) patients. Method 144 CP patients below 10 years ...Objective To summarize the anesthesia techniques performed in the selective posterior rhizotomy(SPR) at lumbar and sacral regions(L&R)on juvenile cerebral palsy(CP) patients. Method 144 CP patients below 10 years were successfully performed SPR at L&R under combined intravenous and inhalation anesthesia (CIIA) in prone position with threshold values of each nerve root being measured by means of nerve root electric stimulus (NRES). Result All patients were performed SPR and NRES successfully although blood pressure and heart rate increased significantly while NRES. Conclusion CIIA is safe and effective for juvenile CP patients to be performed SPR at L&R.展开更多
Spasticity is the main disabling clinical manifestation of children with cerebral palsy(CP).Selective dorsal rhizotomy(SDR)has been performed for the treatment of spastic CP in Asia for quite some time from 1990.The p...Spasticity is the main disabling clinical manifestation of children with cerebral palsy(CP).Selective dorsal rhizotomy(SDR)has been performed for the treatment of spastic CP in Asia for quite some time from 1990.The purpose of this review is to discuss the historical origin and development of SDR.Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP,age from 2 to 18 years-old,over 6000 cases,who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center.We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided.Finally,we mention progress made in terms of SDR technical advances and how improvements can be made in the future.In conclusion,SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used.However,more research and technological advancements are needed to help address associated complications.展开更多
目的探讨经皮穴位电刺激(TEAS)对选择性脊神经后根切断术(SPR)患儿苏醒期躁动(EA)的影响。方法选择择期在全麻下行SPR的脑瘫患儿42例,男20例,女22例,年龄6~12岁,BMI 13~24 kg/m^(2),ASAⅠ或Ⅱ级。将患儿随机分为两组:经皮穴位电刺激组(T...目的探讨经皮穴位电刺激(TEAS)对选择性脊神经后根切断术(SPR)患儿苏醒期躁动(EA)的影响。方法选择择期在全麻下行SPR的脑瘫患儿42例,男20例,女22例,年龄6~12岁,BMI 13~24 kg/m^(2),ASAⅠ或Ⅱ级。将患儿随机分为两组:经皮穴位电刺激组(T组)和对照组(C组),每组21例。T组于麻醉诱导前30 min给予TEAS双侧合谷穴及内关穴,持续至手术结束。C组在相同的穴位放置电极片,但不予电刺激。所有患儿均采用全凭静脉麻醉。记录入室时、拔管即刻、拔管后5、15、30 min的HR、MAP。记录术中瑞芬太尼和丙泊酚的用量、手术时间、拔管时间。记录拔管后15 min的Wong-Baker面部疼痛表情(FPS-R)评分和儿童麻醉苏醒期躁动评估量表(PAED)评分,并计算苏醒期躁动(EA)发生率。记录术后恶心呕吐(PONV)发生情况。结果与入室时比较,C组拔管即刻、拔管后5、15 min HR明显增快,拔管即刻、拔管后5、15、30 min MAP明显升高(P<0.05);T组拔管即刻、拔管后5、15 min HR明显增快,MAP明显升高(P<0.05)。与C组比较,T组拔管即刻、拔管后5、15、30 min HR明显减慢,MAP明显降低(P<0.05);术中瑞芬太尼用量明显减少,拔管时间明显缩短,术后FPS-R评分、PAED评分和EA发生率明显降低(P<0.05)。两组手术时间、术中丙泊酚用量和PONV发生率差异无统计学意义。结论TEAS可有效预防行SPR的脑瘫患儿EA发生,有利于维持血流动力学平稳,减少阿片类药物用量,减轻患儿术后疼痛,加快麻醉复苏时间。展开更多
目的探讨选择性脊神经后根切断术(SPR)治疗不同粗大运动功能分级系统(GMFCS)等级脑性瘫痪患者的疗效与安全性差异。方法检索Pubmed、Embase、Web of Science、中国生物医学文献数据库、中国期刊全文数据库(CNKI)、万方数据库、维普数据...目的探讨选择性脊神经后根切断术(SPR)治疗不同粗大运动功能分级系统(GMFCS)等级脑性瘫痪患者的疗效与安全性差异。方法检索Pubmed、Embase、Web of Science、中国生物医学文献数据库、中国期刊全文数据库(CNKI)、万方数据库、维普数据库中相关文献,纳入有关SPR治疗脑性瘫痪的临床试验研究进行Meta分析。由至少2名研究员独立筛选文献、提取数据和评估文献质量,数据分析采用Review Manager 5.4软件。结果共检索到2726篇文献,经过筛选最终纳入8篇。Meta分析结果显示,GMFCS各级脑性瘫痪患者的粗大运动能力、自理能力在术后均改善,肌张力在术后均下降,差异有统计学意义(P<0.05)。对比SPR术前和术后的粗大运动能力改善情况,Ⅱ级、Ⅲ级患者获益最佳,其次为Ⅰ级患者,Ⅳ级、Ⅴ级患者获益较少;在提高自理能力方面,Ⅰ级患者获益最佳,其次为Ⅲ级患者,Ⅱ级、Ⅳ级患者获益较小。既往文献均未报告明显不良反应。结论SPR对于脑性瘫痪患者是相对安全且有效的治疗方案。GFMCSⅡ、Ⅲ级患者SPR的获益最佳,术前身体状态较差的GFMCSⅣ、Ⅴ级患者也能从中获益。展开更多
文摘BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.
文摘Objective To study the general design and practice instages of the treatment of severe cerebral palsy with the combination of selective anterior and posterior rhizotomy with orthomorphy stage II of the lower extremities. Method To evaluate the disability of the cases, calculate the expectant value and design rehabilitation program in stages before selective anterior and posterior rhizotomy orthomorphy, force line recovering , extremities banlancing, joints stabilization and muscle force rebuilding. Result After treatment in stages the 15 children of cerebral palsy could walk without support. Conclusion It’s most important to practice the combination of the operations in order in rehabilitation of children’s severe cerebral palsy.
文摘Objective To summarize the anesthesia techniques performed in the selective posterior rhizotomy(SPR) at lumbar and sacral regions(L&R)on juvenile cerebral palsy(CP) patients. Method 144 CP patients below 10 years were successfully performed SPR at L&R under combined intravenous and inhalation anesthesia (CIIA) in prone position with threshold values of each nerve root being measured by means of nerve root electric stimulus (NRES). Result All patients were performed SPR and NRES successfully although blood pressure and heart rate increased significantly while NRES. Conclusion CIIA is safe and effective for juvenile CP patients to be performed SPR at L&R.
文摘Spasticity is the main disabling clinical manifestation of children with cerebral palsy(CP).Selective dorsal rhizotomy(SDR)has been performed for the treatment of spastic CP in Asia for quite some time from 1990.The purpose of this review is to discuss the historical origin and development of SDR.Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP,age from 2 to 18 years-old,over 6000 cases,who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center.We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided.Finally,we mention progress made in terms of SDR technical advances and how improvements can be made in the future.In conclusion,SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used.However,more research and technological advancements are needed to help address associated complications.
文摘目的探讨经皮穴位电刺激(TEAS)对选择性脊神经后根切断术(SPR)患儿苏醒期躁动(EA)的影响。方法选择择期在全麻下行SPR的脑瘫患儿42例,男20例,女22例,年龄6~12岁,BMI 13~24 kg/m^(2),ASAⅠ或Ⅱ级。将患儿随机分为两组:经皮穴位电刺激组(T组)和对照组(C组),每组21例。T组于麻醉诱导前30 min给予TEAS双侧合谷穴及内关穴,持续至手术结束。C组在相同的穴位放置电极片,但不予电刺激。所有患儿均采用全凭静脉麻醉。记录入室时、拔管即刻、拔管后5、15、30 min的HR、MAP。记录术中瑞芬太尼和丙泊酚的用量、手术时间、拔管时间。记录拔管后15 min的Wong-Baker面部疼痛表情(FPS-R)评分和儿童麻醉苏醒期躁动评估量表(PAED)评分,并计算苏醒期躁动(EA)发生率。记录术后恶心呕吐(PONV)发生情况。结果与入室时比较,C组拔管即刻、拔管后5、15 min HR明显增快,拔管即刻、拔管后5、15、30 min MAP明显升高(P<0.05);T组拔管即刻、拔管后5、15 min HR明显增快,MAP明显升高(P<0.05)。与C组比较,T组拔管即刻、拔管后5、15、30 min HR明显减慢,MAP明显降低(P<0.05);术中瑞芬太尼用量明显减少,拔管时间明显缩短,术后FPS-R评分、PAED评分和EA发生率明显降低(P<0.05)。两组手术时间、术中丙泊酚用量和PONV发生率差异无统计学意义。结论TEAS可有效预防行SPR的脑瘫患儿EA发生,有利于维持血流动力学平稳,减少阿片类药物用量,减轻患儿术后疼痛,加快麻醉复苏时间。
文摘目的探讨选择性脊神经后根切断术(SPR)治疗不同粗大运动功能分级系统(GMFCS)等级脑性瘫痪患者的疗效与安全性差异。方法检索Pubmed、Embase、Web of Science、中国生物医学文献数据库、中国期刊全文数据库(CNKI)、万方数据库、维普数据库中相关文献,纳入有关SPR治疗脑性瘫痪的临床试验研究进行Meta分析。由至少2名研究员独立筛选文献、提取数据和评估文献质量,数据分析采用Review Manager 5.4软件。结果共检索到2726篇文献,经过筛选最终纳入8篇。Meta分析结果显示,GMFCS各级脑性瘫痪患者的粗大运动能力、自理能力在术后均改善,肌张力在术后均下降,差异有统计学意义(P<0.05)。对比SPR术前和术后的粗大运动能力改善情况,Ⅱ级、Ⅲ级患者获益最佳,其次为Ⅰ级患者,Ⅳ级、Ⅴ级患者获益较少;在提高自理能力方面,Ⅰ级患者获益最佳,其次为Ⅲ级患者,Ⅱ级、Ⅳ级患者获益较小。既往文献均未报告明显不良反应。结论SPR对于脑性瘫痪患者是相对安全且有效的治疗方案。GFMCSⅡ、Ⅲ级患者SPR的获益最佳,术前身体状态较差的GFMCSⅣ、Ⅴ级患者也能从中获益。
