改良选择性脊神经后根切断术与传统术式治疗痉挛性脑瘫的对比研究  

Comparative study on modified selective posterior rhiotomy and traditional selective posterior rhiotomy in the treatment of spastic cerebral palsy

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 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363-366,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的评价改良选择性脊神经后根切断术与传统脊神经后根切断术治疗痉挛性脑瘫的疗效和并发症。方法回顾性分析52例痉挛性脑瘫患者临床资料,其中23例采用传统选择性脊神经后根切断术,29例采用改良选择性脊神经后根切断术。比较两组手术时间、出血量、术中切断脊神经后根的比例、术后并发症以及术后1年痉挛指数、踝阵挛、Holden步行能力的变化情况。结果改良选择性脊神经后根切断术手术时间长于传统术式(P<0.05),两组的术中出血量、术后并发症、术后1年痉挛指数、Holden步行能力方面无统计学差异(P>0.05)。改良组术中切断脊神经后根的比例小于传统组(P<0.05),踝阵挛消失优于传统组(P<0.05)。结论改良选择性脊神经后根切断术在消除踝阵挛方面更有优势。术中实时评判肌张力和踝阵挛变化情况来定量切断脊神经后根,可以减少术中切断脊神经后根的比例,为减少手术并发症保留了解剖和功能基础。Objective To compare the application of modified selective posterior rhiotomy of spinal nerve with traditional rhiotomy in the treatment of spastic cerebral palsy and to evaluate the efficacy and complications of the two surgical methods.Methods The clinical data of 52 patients with spastic cerebral palsy were analyzed retrospectively.Among them 23 cases were treated with traditional selective posterior rhiotomy and the remaining 29 cases with modified selective posterior rhiotomy.Operation time,amount of blood loss,proportion of root after spinal nerve amputation,postoperative complications,spasm index,ankle clonus,and Holden walking ability at 1 year after operation were compared between the two groups.Results The operation time of modified selective posterior rhiotomy was longer than that of conventional surgery(P<0.05).There was no difference in intraoperative blood loss,postoperative complications,spasm index one year after surgery,or Holden walking ability between the two groups(P>0.05).The proportion of root was smaller in the modified group than in the traditional group(P<0.05).The improved group was superior to the traditional group in the disappearance of ankle clonus(P<0.05).Conclusion Modified selective posterior rhiotomy has more advantages in eliminating ankle clonus.It is a safe and effective surgical improvement method to evaluate the changes of muscle tension and ankle clonus to quantitatively cut the posterior root of spinal nerve during the operation.This can reduce the proportion of the posterior root of spinal nerve during the operation,and keep the anatomical and functional basis for reducing the occurrence of surgical complications.

关 键 词：痉挛性脑瘫 选择性脊神经后根切断术 方法改进 

分 类 号：R651.3[医药卫生—外科学]