周围神经选择性部分切断术治疗成人脑源性痉挛状态  

The efficacy of selective peripheral neurotomy in treating cerebral spasticity in adults

作　　者：王明鑫[1] 宗强[1] 韩光良[1] 徐冬云[1] 高秀琴[1] 栾红[1] 李超 张黎[2] Wang Mingxin;Zong Qiang;Han Guangliang;Xu Dongyun;Gao Xiuqin;Luan Hong;Li Chao;Zhang Li(Department of Neurosurgery,Shengli Oilfield Central Hospital,Dongying 257034,China;Department of Neurosurgery ,China-Japan Friendship Hospital ,Beijing 100029,China)

机构地区：[1]胜利油田中,心医院神经外科,山东东营257034 [2]中日友好医院神经外科,北京100029

出　　处：《中华神经外科杂志》2019年第1期43-46,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨周围神经选择性部分切断术(SPN)治疗成人脑源性肢体痉挛的效果。方法选择2015年3月至2017年11月胜利油田中心医院神经外科采用SPN治疗的61例成人脑源性肢体痉挛患者,回顾性分析其术后痉挛程度、肌张力、步态功能及生命质量的改善率,并评估并发症的发生情况。结果61例患者,共计73侧肢体手术。其中上肢5侧,下肢68侧,共涉及94支周围神经。所有患者随访11~26个月,平均(19.5±7.6)个月。术后即刻痉挛程度缓解率为100.0%,随访期间缓解率为91.8%(67/73);术后即刻肌张力下降率为100.0%,随访期间为94.5%(69/73)。术后3个月、6个月步态功能改善率分别为83.6%(51/61)和90.2%(55/61)。随访期间上肢功能改善比例为4/5,生命质量提高率为91.8%(56/61)。73例患者术后6侧(8.2%)肢体发生感觉障碍,3侧(4.1%)肢体肌力下降,随访期间均见好转;随访期间2侧肢体(2.7%)痉挛复发。结论SPN是治疗成人脑源性肢体痉挛状态安全、有效的外科治疗方法。Objective To study the efficacy of selective peripheral neurotomy in treating cerebral spasticity in adults. Methods Sixty-one cerebral spasticity cases in adults treated by selective peripheral neurotomy at Shengli Oilfield Central Hospital from March 2015 to November 2017 were selected. They were analyzed retrospectively in spasticity, muscular tension, gait, quality of life and complication right after operation. Results With a period of follow up for 11-26 months (mean duration: 19.5±7.6 months), 5 upper limbs and 68 lower limbs of 73 limbs of 61 patients involved 94 peripheral nerves all experienced notable alleviation of spasticity right after operation, and the alleviation rate in follow-up duration was 91.8%(67/73). The rate of decrease in muscle tension was 100% and it in follow-up duration was 94.5%(69/73). The improvement rate of motor capacities 3 months after operation was 83.6%(51/61), and was 90.2%(55/61)half year after operation. The rate of improvement in upper limb function was 80.0%(4/5)in follow-up duration. A total of 91.8%(56/61)cases had better quality of life by follow-up studying. Postoperative complications like dysaesthesias of limbs were found in 6 cases (8.2%), muscle weakness in 3 cases (4.1%) and recurrence of spasticity in 2 cases (2.7%). Conclusion Selective peripheral neurotomy is a safe and effective surgical method in treating cerebral spasticity in adults.

关 键 词：肌痉挛状态 脑源性 周围神经选择性部分切断术 成人 

分 类 号：R651.3[医药卫生—外科学]