摘要
目的 :以随访方式对选择性脊神经后根切断术 (SPR )解除脑瘫痉挛 ,改善功能进行疗效观察。方法 :自1990年 5月始采用SPR治疗的 82 5例得到 2年以上随访的脑瘫患者。病理类型 :痉挛型 6 6 1例 ,僵直型 5 2例 ,混合型112例。病因 :绝大多数病例为早产 ,产后窒息 ,难产 ,持续黄疸等。痉挛程度 :Ⅲ级～Ⅴ级。下肢实用能力等情况 :独立行走 12 9例 ,简单介助行走 14 3例 ,介助站立并有行走动作 2 75例 ,双下肢交替爬行 12 2例 ,上肢助力式爬行或不能爬行15 6例。治疗方法及其技术改进 :根据术前判断下肢痉挛的范围并参考痉挛和下肢主要畸形施行功能性SPR ;混合性脑瘫SPR同时选择部分神经节段行SAR ;上肢痉挛较重 ,特别是痉挛影响手的日常生活的基本动作的脑瘫行CSPR ;保留L4椎板和LR SPR技术 ;部分病例应用射频技术 ;术前术后的康复措施应用 ;SPR后功能训练 3～ 6个月后 ,针对固定的畸形的矫形手术。治疗结果 :术后肌张力情况 ,Ⅰ级 6 72例 ,Ⅱ级 10 2例 ,Ⅲ级 12例 ,Ⅳ级 5例 ,Ⅴ级 10例。癫痫发作频率减少或癫痫控制药物服用量减少 31例 ,流口水减轻或消失 70例。眼外斜视减轻 132例。发音改善 72例。腰骶段SPR上肢痉挛程度减轻 6 7例。行走功能改变 :在介助行走 418例病例中 2 6 3例变为可独立行走 。
Objective: To summarize the long time effect of Selective Posterior Rhizotomy (SPR) in treatment of spastic cerebral palsy and the functional ameliorate of extremities by a 10 year follow up.Methods:825 patients with the average age 9.5(2.5～27) years were closely observed at least 2 years.There are 589 males and 234 females.According to pathological classification,there were 661 cases of spastic type;52 cases of rigidity type and 112 cases of mixed type.The muscle tonus were ranged from grade Ⅲ～Ⅴ.Function of extremities:walking independently 129 cases,walking assistant 143 cases,standing assistant 275 cases,crawling 122 cases,crawling disable 156 cases.Therapeutic methods and advancement:Functional SPR (segment selection according to the spasm and main deformities of lower limbs by preoperative physical exam),In addition to SPR,SAR was applied in some cases of mixed type,Radiofrequency was used in some cases,Application of rehabilitate methods both pre and postoperatively,Orthopaedic procedure was used in fixed deformities.Result:The muscle tonus were decreased obviously.Functional amelioration:263 patients can walk independently among the 418 cases of walking assistant,91 patients can walk independently among the 278 cases only could crawl preoperatively,and 52 patients can walk with assistant.Conclusion:SPR could relief spasm and ameliorate function of the patients with cerebral palsy,the effect of the operation could be maintained for a long time.
出处
《中国矫形外科杂志》
CAS
CSCD
2001年第1期42-44,共3页
Orthopedic Journal of China
关键词
脑瘫
脊神经
切断术
随访
功能
Cerebral Palsy
Nerve Root
Rhizotomy
Follow up
FunctP
