半椎板显露选择性脊神经后根机械灭活治疗痉挛性脑瘫  

Treatment of spasm cerebral palsy applying selective posterior mechanic inactivation by semi-lamina approach

作　　者：傅中国[1] 姜保国[1] 张殿英[1] 薛峰[1] 王天兵[1] 徐峰[1] 李兵[1] 

机构地区：[1]北京大学人民医院,北京市100044

出　　处：《中华显微外科杂志》2004年第1期32-34,共3页Chinese Journal of Microsurgery

摘　　要：目的　研究减少选择性脊神经后根切断术 (SPR)治疗痉挛性脑瘫的创伤及并发症的方法。　方法　 12例痉挛性脑瘫患儿 ,其中痉挛型 7例 ,僵直型 3例 ,混合性 2例 ,痉挛程度Ashworth5级法 :Ⅲ级 6例 ,Ⅳ级 5例 ,Ⅴ级 1例。单肢瘫 2例 ,截瘫 6例 ,四肢瘫 2例 ,三肢瘫 2例。智力情况基本正常。采用马尾圆锥区半椎板 (7例 )和保留椎板 (5例 )的小开窗选择性脊神经后根非切断性机械灭活阻断治疗痉挛性脑瘫。术后配合采用针对性功能训练的方法 ,部分肢体严重畸形患儿 (4例 )行 2期肢体矫形术改善和恢复患儿的下肢功能。术后随访 15～ 2 8个月。　结果　术后肌张力情况 :1级 9例 ,2级 2例 ,4级 1例。肌张力降低率 10 0 %。功能明显改善 11例 (92 % )。术后不借助支具恢复独立行走9例 ,借助支具独立行走 2例 ,行走率为 91 7%。其中有 9例患儿术后流涎、斜视、语言障碍较术前明显好转。　结论　半椎板显露 ,选择性脊神经机械灭活术也能改善痉挛性脑瘫患者的症状 ,提高患者生活质量 ,但其创伤小特点 ,能够减少SPR的并发症。Objective To reduce impairment and complication of SPR (selective posterior rhizotomies) procedure. Methods Twelves cases of SCP (spasm cerebral palsy) children,7 spasm,3 stiffness and 2 combined,were treated by a SPR-like procedure.According to Ashworth classification,Ⅲ 6,Ⅳ 5,and Ⅴ 1.The intelligence of children were basically normal.This procedure blocked the spinal nerve applying selective posterior mechanic inactivation by semi-lamina approach,but not traditional SPR by cutting down the nerve.Orthopaedic procedure were performed for the 2nd times to improve walk function in 2 patients with severe extremity deformity.Extremity exercises were applied postoperatively.The following-up time average from 15 to 28 months. Results Postoperative muscle tension of all cases decreased,9 case of Ⅰ grade,2 of Ⅱ and 1 of Ⅳ.Function improved obviously in 11 cases (92%).9 cases could walk without brace.2 cases could walk with brace independently.Some SCP symptoms,such as strabismus,sialosis and aphasia took a favorable turn postoperatively. Conclusions Selective posterior mechanic inactivation by semi-lamina approach could alleviate symptoms of SCP patients,jut like SPR procedure,and improves quality life of SCP patients whereas less-invasive procedure could reduce complication of SPR procedure.

关 键 词：选择性脊神经后根切断术 痉挛性脑瘫 机械灭活 下肢功能 肌张力 小儿 

分 类 号：R651.1[医药卫生—外科学]