功能性脊神经后根手术治疗脑瘫患者下肢痉挛性瘫痪

目的：研究功能性脊神经后根手术治疗下肢痉挛性瘫痪的改进方法。方法:：对19例脑瘫患进行手术,其主要症状为下肢关节僵硬和行走困难。通过对腰3和腰5做跳跃式椎板切除,显露腰2,3和腰5,骶1脊神经。对后根纤维进行电刺激,选择刺激阈值小予以切断。每个后根的切断比例根据患症状和年龄特点进行调整,手术后按照统一的方案进行功能康复训练。结果;19例患术后肢体痉挛都得到缓解（100％）,表现在肌张力下降,踝阵挛和病理反消失或减轻。随访3－12mo,16例行走功能显改善（84．2％）,其中8例步态基本正常。3例行走功能不明显,但关节活动范围增大。结论：功能性脊神经后根手术是治疗下肢痉挛性瘫痪的有效方法;采用跳跃式椎板切除和个体化的后根纤维切断比例有助于减少并发症;术后强化康复训练对改善肢体功能至关重要。

Functional posterior ryzotomy for spastic paralysis of lower extremities due to cerebral palsy

AIM To explore some modifications of functional posterior ryzotomy (FPR) to treat spastic paralysis of lower extremities. METHODS Nineteen patients of cerebral palsy were operated on, whose main symptoms presented as rigidity of joints in lower limbs and difficulty of walking. Through a jump laminectomy of L 3 and L 5, the nerves of L 2, L 3, L 5 and S1 were exposed, and their fibers of the posterior rootswere stimulated electrically. The lower threshold fibers were chosen to cut. And the percentages of fibers cutting were adjusted according to the manifestations and ages of the patient. After operation, the patient undertook the intensive excises of reahabitation, which were arranged on a fix schedule. RESULTS Spasticity in lower extremities got lessened in all patients (100%), which showed decreasing of muscle tone, disappearance or decrease of ankle tremor and Babinski sign. In the follow up of 3 to 12 months, sixteen patients got an obvious improvement of walk (84.2%), eight of which had basically normal gait; the other three did not get improved walk, but their ranges of the joint movement got increased. CONCLUSION FPR is an effective treatment for spastic paralysis of lower extremities. A jump laminectomy and posterior ryzotomy of individuation could be helpful to decease the surgical complications, and enhanced exercises of reahabitation postoperatively are very important to improve the function of extremities.