改良选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛状态  

Modified selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy

作　　者：张黎[1] 张继武 于炎冰[1] 徐晓利[1] 许骏[1] 李放[1] 刘江[1] 

机构地区：[1]卫生部北京中日友好医院神经外科,100029 [2]山东省郓城县诚信医院神经外科脑瘫治疗中心

出　　处：《中华神经外科杂志》2007年第12期886-888,共3页Chinese Journal of Neurosurgery

基　　金：北京市首发基金重点课题(2005-1053)

摘　　要：目的探讨改良选择性腰骶段脊神经后根部分切断术治疗痉挛型脑瘫下肢痉挛状态的疗效。方法回顾分析显微手术治疗的1455例痉挛型脑瘫患者下肢痉挛状态,全部采用改良选择性腰骶部脊神经后根部分切断术。结果平均随访21.8个月。随访期间痉挛状态缓解率为94.8%,步态功能改善率为85.6%,生活质量提高率为89.7%。6.2%患者存在随访期间未完全缓解的下肢感觉障碍或异常,肌无力者占15.5%,术后发生一过性尿失禁7例(0.5%),一过性尿潴留17例(1.2%)。随访期间无永久性二便障碍发生。术后下肢痉挛状态不同程度复发72例(4.9%)。结论改良选择性腰骶部脊神经后根部分切断术是治疗痉挛型脑瘫下肢痉挛状态安全有效的手术方法。合理选择病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效、减少并发症及复发的关键。Objective To study the effectiveness of modified selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy. Methods 1455 cases of cerebral palsy patients with spasticity of lower limbs were treated by modified selective posterior rhizotomy of lumbosacral region. Results At follow up evaluation （ mean duration： 21.8 months ）, this study showed that 94.8% cases experienced disappearance or notable regression of spasticity in follow-up duration. The improved motor capacities were found in 85.6% cases. 89.7% cases had better quality of life by follow-up studying. Postoperative complication included dysaesthesias of lower limbs（6.2% ）, muscle weakness （ 15. 5% ）, transient urinary incontinence （0. 5% ） , transient uroschesis （ 1.2% ）, and recurrence of spasticity （4.9%）. Conclusions Modified selective posterior rhizotomy of lumbosacral region is an effective and safe microsurgical method for treatment of spasticity of lower limbs in cerebral palsy patients. The proper choice of cases, understanding of regional anatomy, microsurgical techniques and postoperative rehabilitation are the keys to gain good effects and prevent recurrence.

关 键 词：脑性瘫痪 痉挛 显微外科手术 

分 类 号：R742.3[医药卫生—神经病学与精神病学]