选择性脊神经后根切断术对脑瘫患儿膀胱功能的影响

目的：探讨功能性选择性脊神经后根切除术，（F－SPR）对脑瘫儿童膀胱功能的影响，方法：本组病例为行F－SPR的脑瘫儿童97例，术前1周和术后6个月行膀胱平均功能容量（AFBV）测定和尿液动力学检查。结果：痉挛型脑瘫术前下尿路症状（LUTS）发生率为34．24％，混合型发生率为58．33％；术后分别下降至20．54％和29．165。尿流动力学检查36例中术前26例（72．22％存在尿流动力学指标异常，其中18例（69．23％）无临床症状，AFBV和尿流动力学指标术后改善明显，I2－S1节段SPR较L5－S1节段SPR改善明显。结论：约50％脑瘫儿童合并有临床静止性膀胱功能障碍。F－SPR在有效缓解下肢痉挛的同时，可改善膀胱贮尿功能，减少上尿道并发症。

Bladder function before and after functional selective posterior rhizotomy in children with cerebral palsy

Objective To evaluate the influ en ce of functional selective posterior rhizotomy (F SPR)on bladder function i n children with cerebral palsy. Methods We rev iewed average functional bladder volume(AFBV) and urodynamics in 97 patients wit h cerebral palsy who had undergone F SPR for spasticity before and after operat ion. Results The incidence of low urinary trac t symptom was 34 24% in patients with spastic cerebral palsy before operation, and 58 33% in the mixed type, but they were 20 54% and 29 16% respectively af ter operation. Of 36 patients subjected to preoperative urodynamic studies, the total bladder capacity (TBC) and pressure specific volume(PSV) were abnormal for age in 26(72 22%). In addition, 18 of 26 children (69 23%)were completely asy mptomatic.In the group subjected to preoperative and postoperative urodynamic st udies, there was significant improvement in AFBV,TBC and PSV. More significant improvement was noted in all three indexes in the L 2 S 1SPR group tha n in the L 5 S 1 SPR group. Conclusions At least half of children with spastic cerebral palsy have clinically silent bladder dysfunction.F SPR improves spasticity and significantly improves bladde r storage function.