改良式选择性脊神经后根切断术十例报告  

Modified selective posterior rhizotomy:10 cases report

作　　者：程钢[1] 朱家恺[1] 刘小林[1] 朱庆棠[1] 刘均墀[1] 劳镇国[1] 

机构地区：[1]中山医科大学第一附属医院显微整形外科

出　　处：《中华显微外科杂志》1999年第2期111-113,共3页Chinese Journal of Microsurgery

摘　　要：目的探索选择性脊神经后根切断术（ＳＰＲ）改进的方法，以期减少手术创伤和对脊柱后柱的破坏，减少术后远期并发症发生的危险。方法利用磁共振定位，切除一个半椎板，在圆锥部马尾发出处鉴别分离出Ｌ２～Ｓ１神经后根，根据电刺激阈值选择性切断部分神经小束，以缓解小儿痉挛性脑瘫病人的痉挛状态。手术的关键在于对脊神经后根的节段鉴别。结果术后随访４～６个月，单纯痉挛型９例病人肌张力均下降、交叉腿解除，关节活动度增加，对肌群的控制能力加强。混合型１例病人休息状态下肌张力下降，关节活动度增加，但主动活动仍有一定困难。７例上肢有痉挛表现的病人术后均有不同程度缓解。结论下肢的脊神经后根在圆锥部发出处相当集中，在此处行ＳＰＲ，只需切除一个半椎板，就能将Ｌ２～Ｓ１神经后根充分暴露，手术安全。Objective To explore the ways to improve surgical techniques in SPR,chiefly to Lessen the injuries to the spine and the incidental rate of long term postoperative complications Methods Laminectomy was performed only in one and a half vertebra on the level of the spinal cone, which was located by MRI before the operation After the dura mater was opened,the posterior roots of the spinal nerve from L 2 to S 1 were discriminated and separated at the level of conus medullaris where the caudal equine originates,Some lower threshold rootlets were incised after the selection of electrical stimulation The key point of the operation depended on the separation of different levels of the posterior roots of the spinal nerve Results Ten cases with spastic paralysis of the limbs,which resulted from cerebral palsy,were treated All were followed up for 4 to 6 months Nine patients with pure spastic palsy had good success Their muscle tone came to normal levels The appearence of scissors gait vanished The ranges of limb movement increased The control of muscular movement improved One patient with mixed form of spasticity and athetosis had muscular tone improvement in the repose situation but still had some difficulty when active Seven patients who had spasticity in the upper limbs before operation had improvement to different extensts after operating Conclusion The posterior roots of the spinal nerves of the lower limbs were concentrated at the plane of cone where they originated When performing SPR at this level,it revealed the posterior roots,which just requried only a one and a half vertebra laminectomy The injuries to the spine and the operating complication were evidently reduced as a resutl

关 键 词：痉挛性脑瘫 脊神经后根切断 SPR 显微外科手术 

分 类 号：R682.220.5[医药卫生—骨科学] R651[医药卫生—外科学]