80例痉挛型脑瘫患者的显微手术治疗  

Clinical study of 80 patients with spasmodic cerebral palsy undergoing microsurgery

作　　者：廉民学[1] 王宁[1] 鲍刚[1] 宋千 廉海平[1] 何百祥[1] LIAN Minxue;WANG Ning;BAO Gang;SONG Qian;LIAN Haiping;HE Baixiang(Department of Neurosurgery, The First Affiliated Hospital, Medical School of Xi’an Jiaotong University, Xi’an 710061, China)

机构地区：[1]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第3期359-362,388,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的分析痉挛型脑瘫患者的手术方案选择及疗效评价。方法回顾性收集西安交通大学第一附属医院神经外科手术治疗的80例痉挛型脑瘫病例的手术方式等临床资料,并随访患者,比较术后1年肌张力分级、痉挛指数、关节活动范围、Holden步行能力变化情况及术后并发症情况。结果80例痉挛型脑瘫患者中,采用选择性腰骶脊神经后根切断术+脑瘫肌力肌张力调整术64例,采用选择性周围神经缩窄术+脑瘫肌力肌张力调整术16例。随访期12~52个月,平均随访21.3个月。术后1年肌张力分级、痉挛指数较术前明显下降(P<0.001)。关节活动范围、Holden步行能力均显著提高(P<0.001)。术后发生一过性排尿障碍2例(2.5%),肢体感觉障碍2例(2.5%),3个月内均见好转。足背屈无力1例(1.25%)。结论选择性神经部分切断术是一种安全有效的治疗痉挛型脑瘫的手术方法。术中实时评判肌张力和踝阵挛变化情况是保证术后疗效的重要因素。Objective To discuss and summarize the choice of the operation plan and evaluation of curative effect of spasmodic cerebral palsy.Methods Clinical data of 80 patients with spastic cerebral palsy treated by neurosurgery in The First Affiliated Hospital of Xi’an Jiaotong University were collected retrospectively and analyzed statistically.Eighty patients were followed up for 12 to 52 months,with an average follow-up of 21.3 months.The muscle tension grading,spasm index,range of motion,Holden walking ability and postoperative complications were compared one year after surgery.Results Totally 64 cases received selective posterior rhizotomy(SPR)combined muscle strength muscle tension adjustment method(MMA)and 16 cases selective peripheral neurotomy combined muscle strength muscle tension adjustment method.The grade and spasm index of muscle tension decreased significantly one year after operation(P<0.001).The range of joint motion and Holden walking ability were significantly improved(P<0.001).Transient urination disorder occurred in two cases(2.5%),and limb sensation disorder in two cases(2.5%),all of which were improved within three months.Weakness of dorsiflexion of foot in one case(1.25%).Conclusion Selective partial neurotomy and muscle tension adjustment is a safe and effective surgical method to treat spasmodic cerebral palsy.Real-time evaluation of muscle tension and ankle clonus changes during the operation is an important factor to ensure the postoperative efficacy.

关 键 词：脑性瘫痪 选择性神经部分切断术 痉挛状态 

分 类 号：R651.3[医药卫生—外科学]