显微神经外科手术治疗痉挛型脑瘫738例临床观察  

Microneurosurgical treatment for relief of spasticity of cerebral palsy patients(738 Cases)

作　　者：于炎冰[1] 张黎[1] 伍成奇[2] 李伟 马延山[4] 张文伟 郭京[1] 左焕琮[6] 

机构地区：[1]卫生部中日友好医院神经外科,北京100029 [2]河南南阳市中心医院外科 [3]辽宁省海城市中心医院神经外科 [4]北京市丰台区医院神经外科 [5]内蒙古临河市妇幼保健院 [6]清华大学医学院

出　　处：《中华神经外科杂志》2004年第1期59-62,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨显微神经外科手术治疗痉挛型脑瘫的疗效。方法回顾分析2000年3月至2003年3月显微神经外科手术治疗的738例痉挛型脑瘫病例,根据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、颈段和腰骶段脊神经后根。结果全部病人平均随访19个月。98.6%病人术后立即感痉挛状态缓解,随访期间缓解率为89.5%。术后6周内运动功能改善率为75.0%,随访期间为87%。生活质量提高率在随访期间为90.2%。术后发生肢体感觉障碍199侧(21.7%),肌无力123侧(13.4%),随访期间均见好转。术后肢体痉挛状态不同程度复发83例(9.1%)。结论选择性周围神经部分切断术是治疗痉挛型脑瘫安全有效的手术方法。选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键。Objective To study the effectiveness of microneurosurgical treatment for relief of spasticity in cerebral palsy patients. Methods 738 cases of cerebral palsy patients with spasticity of limbs were treated by microsurgical selective peripheral neurotomy from March 2000 to March 2003. The peripheral nerves included: tibial sciatic musculocutaneous median cervical and lumbosacral spinal nerves. Results With a period of follow up (mean duration: 19 months,)this study showed that 98.6% cases experienced disappearance or notable regression of the spasticity right after operation,and the percentage at follow-up was 89.5%. The improved motor capacities within 6 weeks after operation were found in 75.0% cases while 87% at follow-up. 90.2% cases had better quality of life by follow-up studying. Operative complication included dysaesthesias of limbs in 199 limbs 21.7% muscle weakness in 123 13.4%. There were 83 limbs 9.1% of recurrence of spasticity. Conclusions Selective peripheral neurotomy is an effective and safe microsurgical method for the treatment of spasticity of limbs in cerebral palsy patients. The proper choice of casesunderstanding of regional anatomy microsurgical techniques and postoperative rehabilitation are keys points for good results.

关 键 词：显微神经外科手术 治疗 痉挛型脑瘫 临床观察 

分 类 号：R651.1[医药卫生—外科学]