颈动脉鞘交感神经网剥离术治疗手足徐动型脑瘫  

Cervical perivascular sympathectomy for the treatment of athetoid cerebral palsy

作　　者：许世刚[1] 徐林[1] 曹旭[1] 焦勇[1] 

机构地区：[1]北京中医药大学东直门医院骨科,北京100700

出　　处：《中国骨伤》2010年第4期291-293,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:回顾性总结颈动脉鞘交感神经网剥离术治疗手足徐动型脑瘫的效果,并对其治疗机制进行探讨。方法:自1998年至2006年,对560例手足徐动型脑瘫患者施行了颈动脉鞘交感神经网剥离术,其中男391例,女169例,年龄3～25岁,平均10.7岁。术后1周对患者进行观察评估,术后6个月和1年时进行门诊或电话随访。观察评估内容包括头颈部活动、双手协调能力、站立及步态、肌张力、流涎、斜视、眼球运动、语言清晰度等。效果明显者权重值为1分,有改善但不甚满意者权重值为0.5分,无效为0分。结果:术后1年560例患者中308例头颈部活动改善(占55%),403例双手协调能力改善(占72%),229例站立及步态改善(占41%),185例肌张力改善(占33%),252例流涎改善(占45%),174例斜视、眼球运动改善(占31%),251例语言清晰度改善(占45%),310例家长对手术结果总体满意(占55%)。术后6个月有效率高于术后1年。结论:手足徐动型脑瘫患者接受颈动脉鞘交感神经网剥离术治疗后部分患者在手足徐动症状、手指协调能力、肌张力、流涎以及语言发音方面确有改善。其机制可能与减少交感神经兴奋性,脑组织微循环改变及脑潜能神经元激活有关。仍需要长期随访观察。Objective：To retrospectively review the results of cervical perivascular sympathectomy （CPVS） in treating athetoid cerebral palsy and discuss the possible mechanism of the surgery. Methods：From 1998 to 2006,560 patients with athetoid cerebral palsy were treated with cervical perivascular sympathectomy and all had periodical follow up at 1 week,6 months and 1 year postoperatively. Among the 560 patients,there were 391 boys and 169 girls. The age at operation was from 3 to 25 years old with an average of 10.7 years. Results：At 1 year follow up postoperatively,among the 560 cases,athetoid movement of the neck and head improved in 308 patients （55%）,the movement of the hand and fingers improved in 403 patients（72%）,standing and gait improved in 229 patients（41%）,muscle tone reduced in 185 patients（33%）,salvation reduction appeared in 252 patients （45%）,eyeball movement improved in 174 patients （31%）,speaking improved in 251 patients （45%）;310 patients（55%） agreed that the operation had curative effect for the patients. Short term follow up results was better than long term follow up results. Conclusion：Primary results showed that CPVS had a curative effect on athetoid cerebral palsy,especially in improving athetoid movement of the neck and head,hand and fingers,standing and gait,speaking ability,eyeball movement and so on. The possible mechanism of the CPVS in the treatment of athetoid cerebral palsy might be reducing the excitability of sympathetic nerve,improving microcirculation of the brain and eventually activating potential neurons. Long term follow up is necessary.

关 键 词：脑性瘫痪 动脉外膜 颈交感神经切除术 外科手术 

分 类 号：R742.3[医药卫生—神经病学与精神病学]