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作 者:葛立可 朱俞岚 郭辉[3] Ge Like;Zhu Yulan;Guo Hui(Department of Medicine,Qingdao University,Qingdao 266071,China;Department of Rehabilitation,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurosurgery,Shanghai Deji Hospital,Shanghai Clinical Medical College,Qingdao University,Shanghai 200331,China)
机构地区:[1]青岛大学医学部,青岛266071 [2]复旦大学附属华山医院康复科,上海200040 [3]青岛大学上海临床医学院上海德济医院神经外科,上海200331
出 处:《中华神经医学杂志》2020年第6期591-595,共5页Chinese Journal of Neuromedicine
摘 要:目的观察选择性脊神经背根切断术(SDR)联合多模式技术治疗痉挛型脑瘫(SCP)的疗效和安全性。方法选择青岛大学上海临床医学院上海德济医院神经外科自2016年6月至2019年6月采用单椎板入路的SDR联合术中肌电监测、显微神经外科等微创、精准的多模式技术治疗的31例SCP患者,所有患者术后接受规律的物理治疗。评估并比较患者术前及术后1个月、3个月、6个月的徒手肌力检查(MMT)分级、改良Ashworth分级(MAS)、Berg平衡量表(BBS)评分、粗大运动功能评估表(GMFM)-88评分、功能独立性量表(FIM)评分。结果与术前比较,术后1、3、6个月患者的MMT分级增加,MAS分级降低,GMFM-88评分增加,BBS评分增加,FIM评分增加,差异有统计学意义(P<0.05)。与术后1个月比较,术后6个月患者的MMT分级增加,MAS分级降低,GMFM-88评分增加,FIM评分增加,差异有统计学意义(P<0.05)。与术后3个月比较,术后6个月患者的MAS分级降低,差异有统计学意义(P<0.05)。31例患者术后均出现下肢一过性肌无力、感觉麻木。结论SDR联合微创、精准的多模式技术是治疗SCP有效、安全的外科治疗方法。Objective To observe the clinical efficacy and safety of selective dorsal rhizotomy(SDR)combined with multi-modal techniques in spastic cerebral palsy(SCP).Methods Thirty-one SCP patients,admitted to our hospital from June 2016 to June 2019,were chosen in our study;these patients received SDR combined with multi-modal techniques(single-level laminectomy,and intraoperative electromyography monitoring combined with micro-neurosurgery);and all patients received regular physical therapy postoperatively.Grading of manual muscle test(MMT)and grading modified Ashworth scale(MAS),and scores of Gross Motor Function Measure-88(GMFM-88),Berg balance scale(BBS)and Functional Independence Measure(FIM)before surgery,and one,three,and 6 months after surgery were evaluated and compared.Results As compared with those before surgery,significantly increased MMT grading,statistically decreased MAS grading,and significantly increased GMFM-88 scores,BBS scores,and FIM scale scores one,3,and 6 months after surgery were recorded in these patients(P<0.05).As compared with those one month after surgery,significantly increased MMT grading,statistically decreased MAS grading,and significantly increased GMFM-88 scores and FIM scores 6 months after surgery were recorded in these patients(P<0.05).As compared with those 3 months after surgery,statistically decreased MAS grading 6 months after surgery were recorded in these patients(P<0.05).There were no severe complications as CNS infection,cerebrospinal fluid leakage,incontinence,spondylolisthesis or spinal deformity,but only transient muscle weakness and numbness of lower limbs.Conclusion SDR combined with multi-modal techniques is a safe and effective method for patients with SCP,which is minimally invasive,accurate and safe.
关 键 词:选择性脊神经背根切断术 多模式技术 痉挛型脑瘫
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