改良选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛状态.pdfVIP

· 886· 2007年12月第23卷第l2期 Chin J Neurosurg．December 2007．Vol 23．No．12 ． 功能神经外科 ． 改良选择性腰骶段脊神经后根部分 切断术治疗脑瘫性下肢痉挛状态 张黎 张继武 于炎冰 徐晓利 许骏 李放 刘江 【摘要】 目的 探讨改良选择性腰骶段脊神经后根部分切断术治疗痉挛型脑瘫下肢痉挛状态 的疗效。方法 回顾分析显微手术治疗的1455例痉挛型脑瘫患者下肢痉挛状态，全部采用改良选择 性腰骶部脊神经后根部分切断术。结果 平均随访21、8个月。随访期间痉挛状态缓解率为94．8％， 步态功能改善率为85．6％，生活质量提高率为89、7％。6、2％患者存在随访期间未完全缓解的下肢 感觉障碍或异常，肌无力者占15、5％，术后发生一过性尿失禁7例(0．5％)，一过性尿潴留17例 (1、2％)。随访期间无永久性二便障碍发生。术后下肢痉挛状态不同程度复发72例(4．9％)。 结论 改良选择性腰骶部脊神经后根部分切断术是治疗痉挛型脑瘫下肢痉挛状态安全有效的手术方 法。合理选择病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效、减 少并发症及复发的关键。 【关键词】 脑性瘫痪；痉挛；显微外科手术 Modified selective posterior rhizotomy of lumbosacral regi011 for relief of spastidty of lower limbs of cerebral palsy ZHANG Li ，ZHANG ji—WlZ，YU Yah—bing，XU Xiao—li，XU Ju ，LI Fang， U Jiang． Department ofNeurosurgery，China—Japan Frien~hip Hospital，Beqing 100029，China Corresponding authOF：YU Ya —bing，Email：zllnd@yahoo．com 【Abstract】 objective To study the effectiveness of modified selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy、Methods 1455 cases of cerebral palsy patients with spasticity of lower limbs were treated by modified selective posterior rhizotomy of lumbosacral region．Results At follow up evaluation(mean duration：21．8 months)，this study showed that 94．8％ cases experienced disappearance or notable regression of spasticity in follow—up duration．The improved motor capacities were found in 85．6％ cases．89．7％ cases had better quality of life by follow—up studying．Postoperative complication included dysaesthesias of lower limbs(6．2％)，muscle weakness(15． 5％)，transient urinary incontinence(0．5％)，transient uroschesis(1．2％)，and recurrence of spasticity (4．9％)．Conclusions Modified selective posterior rhizotomy of lumbosacral region is an effective and safe microsurgical method for treatment of spasticity of lower limbs in cerebral p