腰骶部選擇性脊神經后根切斷術治療下肢痙攣性大腦性癱瘓中遠期療效評估_《中國修復重建外科雜志》

作者：

賈擁政 ¹ , 肖玉周 ² , 楊文彬 ¹

1 蒙城縣第一人民醫院骨科（安徽蒙城，233500）;;
2蚌埠醫學院第一附屬醫院骨科;

關鍵詞：

選擇性脊神經后根切斷術下肢痙攣性大腦性癱瘓中遠期療效

DOI：

10.7507/1002-1892.20130292

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目的探討腰骶部選擇性脊神經后根切斷術（selective posterior rhizotomy，SPR）治療下肢痙攣性大腦性癱瘓（簡稱腦癱）的中遠期療效。方法回顧性分析1997年1月－2008年1月行腰骶部SPR，隨訪超過5年且臨床資料完整的27例下肢痙攣性腦癱患者臨床資料。男14例，女13例；年齡4～19歲，平均10.1歲。雙側17例，單側10例。記錄患者手術前后的肌力、肌張力、尖足、交叉腿、膝反射、踝陣攣、Babinski 征以及下肢運動功能，并進行統計分析，以評估手術療效。結果27例均獲隨訪，隨訪時間5～16年，平均9.6年。術后患者腰椎前屈、后伸、側屈無明顯受限，未見脊柱滑脫、后凸畸形發生。末次隨訪時患者髖伸肌、髖屈肌和膝伸肌肌力較術前提高，比較差異有統計學意義（P lt; 0.05）；髖展肌、髖收肌、膝屈肌、跖屈肌和跖伸肌肌力與術前比較無明顯變化（P gt; 0.05）。患者髖屈肌、髖收肌、膝屈肌和跖屈肌異常增高的肌張力均不同程度降低，與術前比較差異有統計學意義（P lt; 0.05）；髖伸肌、髖展肌、膝伸肌和跖伸肌肌張力與術前比較差異無統計學意義（P gt; 0.05）。末次隨訪時膝反射明顯改善，與術前比較差異有統計學意義（Z= —7.404，P=0.000）；Babinski征為陰性31側，陽性13側，與術前比較差異有統計學意義（Z= —6.897，P=0.000）；尖足現象均為陰性；交叉腿現象均消失；步行能力明顯改善，根據Holden步行能力分級標準分級，與術前比較差異有統計學意義（Z= —4.111，P=0.000）。結論腰骶部SPR可長期有效解除下肢痙攣性腦癱患者異常增高的肌張力，改善患者下肢運動功能。

引用本文： 賈擁政,肖玉周,楊文彬. 腰骶部選擇性脊神經后根切斷術治療下肢痙攣性大腦性癱瘓中遠期療效評估. 中國修復重建外科雜志, 2013, 27(11): 1345-1349. doi: 10.7507/1002-1892.20130292 復制

1.	Bialik GM, Givon U. Cerebral palsy: classification and etiology. Acta Orthop Traumatol Turc, 2009, 43(2): 77-80.
2.	Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl, 2007, 109: 8-14.
3.	Langerak NG, Hillier SL, Verkoeijen PP, et al. Level of activity and participation in adults with spastic diplegia 17-26 years after selective dorsal rhizotomy. J Rehabil Med, 2011, 43(4): 330-337.
4.	Peacock WJ, Staudt LA. Selective posterior rhizotomy: evolution of theory and practice. Pediatr Neurosurg, 1991-1992, 17(3): 128-134.
5.	Nordmark E, Josenby AL, Lagergren J, et al. Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatrics, 2008, 8: 54.
6.	Cole GF, Farmer SE, Roberts A, et al. Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience. Arch Dis Child, 2007, 92(9): 781-785.
7.	陳澤峰, 崔麗英. 關于肌力分級評定的探討. 中華神經科雜志, 2010, 43(2): 86.
8.	Sindou MP, Simon F, Mertens P, et al. Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst, 2007, 23(9): 957-970.
9.	胡濤, 金俏, 李學謙. 減重步行訓練對脊髓損傷患者下肢行走能力的影響. 青海醫藥雜志, 2008, 38(5): 12-13.
10.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京: 人民軍醫出版社, 2012: 1687.
11.	Pakula AT, Van Naardden Braun K, Yearqin-Allsopp M. Cerebral palsy: classsification and epidemiology. Phys Med Rehabil Clin N Am, 2009, 20(3): 425-452.
12.	Bialik GM, Givon U. Cerebral palsy: classification and etiology. Acta Orthop Traumatol Turc, 2009, 43(2): 77-80.
13.	陳蘭, 趙新. 神經肌電圖監測在選擇性脊神經后根切除術中的應用. 腦與神經疾病雜志, 2008, 16(1): 45-46.
14.	于炎冰, 張黎, 徐曉利, 等. 選擇性閉孔神經切斷術治療腦癱性大腿內收肌群痙攣. 中國臨床神經外科雜志, 2007, 12(2): 68-69, 72.
15.	Gorton GE 3rd, Abel MF, Oeffinger DJ, et al. A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy. J Pediatr Orthop, 2009, 29(8): 903-909.
16.	Houlden H, Charlton P, Singh D. Neurology and orthopaedics. J Neurol Neurosurg Psychiatry, 2007, 78 (3): 224-232.
17.	Tedroff K, Löwing K, Jacobson DN, et al. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizatomy in cerebral palssy. Dev Med Child Neurol, 2011, 53(8): 724-729.
18.	Shabalov VA, Dekopov AV, Tomski? AA, et al. Posterior selective rhizotomy in the treatment of severe spastic syndrome in cerebral palsy. Zh Vopr Neirokhir Im N N Burdenko, 2010, (2): 14-18.
19.	van Schie PE, Schothorst M, Dallmeijer AJ, et al. Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatrics, 2011, 7(5): 557-562.
20.	Farmer JP, Sabbagh AJ. Selective dorsal rhizotomy in treatment of spasticity related to cerebral palsy. Childs Nerv Syst, 2007, 23(9): 991-1002.
21.	吳洪亮, 孫貴才, 劉明海, 等. 高選擇性脊神經后根切斷術治療痙攣性腦癱346例療效觀察. 實用臨床醫學, 2009, 10(11): 67, 74.

1. Bialik GM, Givon U. Cerebral palsy: classification and etiology. Acta Orthop Traumatol Turc, 2009, 43(2): 77-80.
2. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl, 2007, 109: 8-14.
3. Langerak NG, Hillier SL, Verkoeijen PP, et al. Level of activity and participation in adults with spastic diplegia 17-26 years after selective dorsal rhizotomy. J Rehabil Med, 2011, 43(4): 330-337.
4. Peacock WJ, Staudt LA. Selective posterior rhizotomy: evolution of theory and practice. Pediatr Neurosurg, 1991-1992, 17(3): 128-134.
5. Nordmark E, Josenby AL, Lagergren J, et al. Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatrics, 2008, 8: 54.
6. Cole GF, Farmer SE, Roberts A, et al. Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience. Arch Dis Child, 2007, 92(9): 781-785.
7. 陳澤峰, 崔麗英. 關于肌力分級評定的探討. 中華神經科雜志, 2010, 43(2): 86.
8. Sindou MP, Simon F, Mertens P, et al. Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst, 2007, 23(9): 957-970.
9. 胡濤, 金俏, 李學謙. 減重步行訓練對脊髓損傷患者下肢行走能力的影響. 青海醫藥雜志, 2008, 38(5): 12-13.
10. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京: 人民軍醫出版社, 2012: 1687.
11. Pakula AT, Van Naardden Braun K, Yearqin-Allsopp M. Cerebral palsy: classsification and epidemiology. Phys Med Rehabil Clin N Am, 2009, 20(3): 425-452.
12. Bialik GM, Givon U. Cerebral palsy: classification and etiology. Acta Orthop Traumatol Turc, 2009, 43(2): 77-80.
13. 陳蘭, 趙新. 神經肌電圖監測在選擇性脊神經后根切除術中的應用. 腦與神經疾病雜志, 2008, 16(1): 45-46.
14. 于炎冰, 張黎, 徐曉利, 等. 選擇性閉孔神經切斷術治療腦癱性大腿內收肌群痙攣. 中國臨床神經外科雜志, 2007, 12(2): 68-69, 72.
15. Gorton GE 3rd, Abel MF, Oeffinger DJ, et al. A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy. J Pediatr Orthop, 2009, 29(8): 903-909.
16. Houlden H, Charlton P, Singh D. Neurology and orthopaedics. J Neurol Neurosurg Psychiatry, 2007, 78 (3): 224-232.
17. Tedroff K, Löwing K, Jacobson DN, et al. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizatomy in cerebral palssy. Dev Med Child Neurol, 2011, 53(8): 724-729.
18. Shabalov VA, Dekopov AV, Tomski? AA, et al. Posterior selective rhizotomy in the treatment of severe spastic syndrome in cerebral palsy. Zh Vopr Neirokhir Im N N Burdenko, 2010, (2): 14-18.
19. van Schie PE, Schothorst M, Dallmeijer AJ, et al. Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatrics, 2011, 7(5): 557-562.
20. Farmer JP, Sabbagh AJ. Selective dorsal rhizotomy in treatment of spasticity related to cerebral palsy. Childs Nerv Syst, 2007, 23(9): 991-1002.
21. 吳洪亮, 孫貴才, 劉明海, 等. 高選擇性脊神經后根切斷術治療痙攣性腦癱346例療效觀察. 實用臨床醫學, 2009, 10(11): 67, 74.

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腰骶部選擇性脊神經后根切斷術治療下肢痙攣性大腦性癱瘓中遠期療效評估

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腰骶部選擇性脊神經后根切斷術治療下肢痙攣性大腦性癱瘓中遠期療效評估

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