摘要
作者结合对脊髓圆锥解剖研究，在圆锥水平成功的完成了改良式选择性脊神经后根切断术（ｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙＳＰＲ）。经治痉挛性脑瘫３１例，男２５例，女６例，平均年龄８岁（４～２１岁），术后追访时间均超过３个月。全部病例术后３个月复查时，肢体功能均有明显改进且无并发症，仅将追访达一年以上的１０例做总结报道。术前对肌痉挛状态评定仿Ｌａｚａｒｅｆｆ方案定为０～４级；被评定肌群，上肢包括屈肩、肘、腕，下肢髋屈曲、内收，膝屈曲和踝跖屈。１０例术前评级：２级５例，３级４例，４级１例。对后根切断率均结合术前肌力和肌张力制定“个体化”方案，９例后根切断率均限定在４０％～７０％，１例达６０％～８０％。术后每隔３个月定期复查。至术后一年疗效评定：优良率占９０％，步态改善率９０％，痉挛解除率１００％。通过临床实践证实此改良术式具下列优点：（１）最大限度的保持了脊柱稳定；（２）利于病人早期康复；（３）通过限局性暴露可切除Ｌ１～Ｓ１脊神经后根。
Basedontheanatomicalstudiesofconusmedularis,theauthorsdesignedamodifiedpro-cedureofselectiveposteriorrhizotomy(SPR)atthelevelofconusmedularis.Thirty-onecaseswithspasticparalysisofthelimbsresultedfromcerebralpalsyweretreated.Therewere25malesand6fe-males.Theagerangedfrom4to21yearswithanaverageof8years.Alwerefolowed-upformorethan3monthsandshowedimprovementinlimb'sfunctionwithoutanycomplication.Tencasesfol-lowed-upformorethan1yearwerereportedindetails.Spasticitywasscoredfrom0to4gradeaccord-ingtoLazareff.Themusculargroupsassessedwerethoseinvolvedintheflexionoftheshoulder,elbowandwristintheupperlimbs,andthoseinvolvedinflexionandadductionofthehip,flexionoftheknee,andplantarflexionofthefoot.AccordingtotheLazaref'smethods,therewere5casesofgrade2,4casesofgrade3,and4casesofgrade1.Thepercentageofrootstobesectioneddependuponthetonusandpoweroftheindividualmusclespreoperatively.Afterthesurgery,excelentandgoodresultswereseenin90%ofthecasesandtheefectiveratewas100%.Thisnewtechniquesmayhavethefolowingadvantages:(1)maintenanceofthemaximalstabilityofthespinalcolum;(2)shorteningoftherecov-eryperiodfolowingsurgery;(3)thepossibilityofsectioningtheL1～S1nerverootsthroughalimitedexposure.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1996年第10期613-615,共3页
Chinese Journal of Orthopaedics
关键词
痉挛性
脑瘫
脊神经后根切断
SpasticcelebralpalsyConusmedularisSelectiveposteriorrhizotomy
