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目的:探讨脊髓圆锥部施行L1-S1选择性脊神经后根部分切断术(selective posteri-or rhizotomySPR)治疗痉挛型脑瘫(cerebral palsy,CP)的临床价值。方法:2010年10月～2011年12月我们在脊髓圆锥部行SPR治疗70例痉挛型CP。术前和术后不同时间按Ashworth痉挛评分法对下肢肌肉不同肌群的痉挛情况进行评分。结果:术后2周、4周、和6个月的Ashworth痉挛评分,下肢痉挛的解除率100%,功能改善率83%,踝阵挛消失率90%,剪刀步均消失,肌力均在3级以上,与术比较均有显著性差异(P<0.01)。除少数患儿出现暂时性下肢麻木、乏力外,未出现括约肌功能障碍等严重并发症。结论:在圆锥部行SPR术具有创伤小,对脊柱稳定性影响小,恢复快等优点。能够有效缓痉挛型CP病人的下肢肌肉痉挛。
Objective: To investigate the clinical value of spinal condyle in the treatment of spastic cerebral palsy (CP) by selective posteri-or rhizotomy SPR. METHODS: From October 2010 to December 2011, we treated 70 patients with spastic CP with SPR in the conus medulla. The Ashworth spasticity score was used to score the spasticity of different muscle groups in lower limbs before and after surgery. Results: The Ashworth spastic score at 2 weeks, 4 weeks and 6 months postoperatively showed 100% lower extremity spasticity, 83% functional improvement, 90% disappearance of ankle clonus, disappearance of scissors and muscle strength Grade 3 or above, with surgery were significantly different (P <0.01). In addition to a small number of children with temporary lower extremity numbness, fatigue, no serious complications such as sphincter dysfunction. CONCLUSIONS: SPR in conus has the advantages of less trauma, less effect on spinal stability and faster recovery. Can effectively slow the spasticity of CP patients with muscle spasm.