选择性腰骶段脊神经后根切断术治疗脑瘫性下肢痉挛的长期疗效  

Treatment of spasticity of lower limbs in cerebral palsy with the selective lumbosacral posterior rhizotomy： an accompanying long-term efficacy

作　　者：张哲[1] 于炎冰[1] 张黎[1] 袁越[1] 赵奎明[1] 

机构地区：[1]卫生计生委中日友好医院神经外科,100029

出　　处：《中华神经外科杂志》2015年第10期1027-1029,共3页Chinese Journal of Neurosurgery

基　　金：首都特色临床医学技术发展研究基金（Z090507017709005）

摘　　要：目的探讨选择性腰骶段脊神经后根切断术（SPR）治疗脑瘫性下肢痉挛状态的长期疗效。方法回顾分析采用SPR治疗的1455例痉挛型脑瘫下肢痉挛状态患者，对手术后除解除下肢痉挛之外的其他伴随疗效进行长期随访。结果对1455例患者进行平均21．8个月（12～44个月）的随访。随访期间在统计手术解除下肢痉挛状态疗效（总痉挛缓解率为94．8％，步态功能改善率为85．6％）同时发现患者其他伴随症状的改善：流涎改善率64．5％（300／465），口运动及构音障碍改善率39．1％（135／345），上肢痉挛改善率33．3％（240／720），斜视改善率33．3％（225／675）。结论SPR在治疗脑瘫性下肢痉挛的同时可使33．3％-64．5％的患者流涎、口运动及构音障碍、上肢痉挛、斜视等伴随症状有不同程度的改善，其具体机制尚待进一步研究。Objective To investigate the treatment of spasticity of lower limbs in cerebral palsy with the selective lumbosacral posterior rhizotomy （SPR）. Methods The clinical data of 1 455 patients with spastic cerebral palsy with lower limbs pasticity treated by SPR were analyzed retrospectively. In addition to relieving the lower limb spasticity after procedure, the long-term follow-up of other accompanying effects were performed. Results All 1 455 patients were followed up for 21.8 （mean, 12-44） months. While adding up the efficacy of relieving lower limb spasticity with operation （ the total spasm remission rate was 94. 8% and the gait function improvement rate was 85.6% ） during the follow-up period, the improvement of other concomitant symptoms of patients was observed： the improvement rates of salivation, oral dyskinesia and dysarthria, spastieity of upper limbs, and strabismus were 64. 5% （ 300/465 ） , 39. 1% （ 135/345 ） , 33.3% （240/720）, and 33.3% （ 225/675 ）, respectively. Conclusions While in the treatment of spasticity of lower limbs in cerebral palsy, SPR improves the concomitant symptoms, such as salivation, oral dyskinesia and dysarthria, spasticity of upper limbs, and strabismus in different degrees in 33.3 -64. 5% patients. Its specific mechanism needs to be further studied.

关 键 词：痉挛型脑瘫 选择性脊神经后根切断术 疗效 

分 类 号：R651[医药卫生—外科学]