颅脑外伤后肢体痉挛状态的显微外科治疗

目的 探讨显微外科治疗颅脑外伤后肢体痉挛状态的疗效.方法 回顾分析2006年7月至2008年7月实施的21例显微外科治疗颅脑外伤后肢体痉挛状态,根据不同病例采用相应的选择性周围神经部分切断术,包括:胫神经、肌皮神经、正中神经、尺神经和腰骶段脊神经后根,共计50个肢体.结果 术后随访2～24个月,全部患者术后立即感相应肢体痉挛状态缓解,随访期间缓解率为98%(49/50).随访期间运动功能改善率为86%(18/21),生活质量提高率为95%(20/21).术后发生肢体麻木、疼痛等感觉异常26个(52%),肌力下降18个(36%),随访期间均见好转.术后痉挛状态复发1个(2%).结论 选择性周围神经部分切断术是治疗颅脑外伤后肢体痉挛状态安全有效的方法.选择适应证及手术时机和术后坚持康复训练是保证疗效的关键.

Microneurosurgical treatment for relief of spasticity of limbs in brain injury patients

Objective To study the effectiveness of microneurosurgical treatment for relief of spasticity of limbs in brain injury patients. Methods 21 patients (50 limbs) of spasticity duo to brain injury were treated by microsurgical selective peripheral neurotomy from July 2006 to July 2008. The peripheral nerves included: tibial, musculocutaneous, median, ulner, and lumbosacral posterior spinal nerves. Results At follow up evaluation( mean duration: 12. 6 months), this study showed that 100% cases experienced disappearance or notable regression of the spasticity right after operation, and the relief percentage in follow - up duration was 98%. The improved motor capacities was found in 86% cases in follow - up duration. Better quality of life was found in 95% cases by follow - up studying. Postoperative complications included dysaesthesias and pain of limbs in 26 limbs (52%), muscle weakness in 18 (36%). All the complications were relieved during follow- up period. There was 1 limb (2%) of recurrence of spasticity. Conclusions Selective peripheral neurotomy is an effective and safe microsurgical method for the treatment of spasticity of limbs in brain injury patients. The proper choice of cases and operation time and long time regular postoperative rehabilitation are keys to gain good effects.