改良式选择性脊神经后根切断术（初步报告）

作者结合对脊髓圆锥解剖研究，在圆锥水平成功的完成了改良式选择性脊神经后根切断术（ｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙＳＰＲ）。经治痉挛性脑瘫３１例，男２５例，女６例，平均年龄８岁（４～２１岁），术后追访时间均超过３个月。全部病例术后３个月复查时，肢体功能均有明显改进且无并发症，仅将追访达一年以上的１０例做总结报道。术前对肌痉挛状态评定仿Ｌａｚａｒｅｆｆ方案定为０～４级；被评定肌群，上肢包括屈肩、肘、腕，下肢髋屈曲、内收，膝屈曲和踝跖屈。１０例术前评级：２级５例，３级４例，４级１例。对后根切断率均结合术前肌力和肌张力制定“个体化”方案，９例后根切断率均限定在４０％～７０％，１例达６０％～８０％。术后每隔３个月定期复查。至术后一年疗效评定：优良率占９０％，步态改善率９０％，痉挛解除率１００％。通过临床实践证实此改良术式具下列优点：（１）最大限度的保持了脊柱稳定；（２）利于病人早期康复；（３）通过限局性暴露可切除Ｌ１～Ｓ１脊神经后根。     

选择性颈神经后根切断术

于１９９２年２月～１９９５年６月，作者对１２例上肢痉挛性脑瘫患者施行了选择性颈神经后根切断术．术中观察了Ｃ５～Ｔ１各脊神经后根的形态、位置，各后根按比例切除．术后短期随访，异常增高的上肢肌张力，明显缓解．该术式可较佳解除上肢痉挛．     

改良式选择性脊神经后根切断术十例报告

目的 探索选择性脊神经后根切断术（ＳＰＲ）改进的方法,以期减少手术创伤和对脊柱后柱的破坏,减少术后远期并发症发生的危险。方法 利用磁共振定位,切除一个半椎板,在圆锥部马尾发出处鉴别分离出Ｌ２￣Ｓ１神经后根,根据电刺激阈值选择性切断部分神经小束,以缓解小儿痉挛性脑瘫人的痉挛状态。手术的关键在于对脊神经后根的节段鉴别。 结果 术后随访４￣６个月,单纯痉挛型９例病人肌张力均下降、交叉腿解除,关节活动度增     

选择性脊神经后根切断术治疗成人脑外伤后肢体痉挛

目的：探讨选择性脊神经后根切断术（ＳＰＲ）治疗成人脑外伤后肢体痉挛的效果。方法：将支配痉挛上肢的Ｃ５＝Ｔ１和支配痉挛下肢的Ｌ２－Ｓ１脊神经后发束,义测阈值后将值较低的神经束切断,观察其治疗效果。结果：３０例随方忻,痉挛解除率９０％,功能改善率８０％。结论：选择性脊神经后根切断术能较有效地治疗成人脑外伤后肢体痉挛。     

双侧连续开窗式选择性脊神经后根切断术

目的：探寻一种对脊柱稳定性影响较小的选择性脊神经后根切断术治疗脑瘫肢体痉挛。方法：采用双侧连续开窗式行双侧Ｌ１～Ｓ１５个节段的椎板间开窗,将Ｌ２～Ｓ１神经根后根分开、分束,将阈值较低神经束切断。结果：痉挛解除率为９０％,功能改善率为７５％。结论：双侧连续开窗式ＳＰＲ可保留椎板、棘突及韧带,保持脊柱稳定,解除痉挛效果满意。     

选择性脊神经后根切断术术后反应及其并发症分析

目的：观察和了解选择性脊神经后根切断术（ＳＰＲ）的并发症。方法：通过对１８２例以下肢痉挛为主要症状的脑瘫患者行Ｌ２～Ｓ１选择性脊神经后根切断术（ＳＰＲ）后的随访，对术后不良反应和并发症做了研究。结果：术后７例出现较为严重的术后不良反应和并发症，占３．８％，其中包括支气管痉挛、骨盆倾斜和癫痫发作。另外还有高热、不明原因的血尿、脑脊液漏、腹胀痛和下肢乏力等。结论：必须严格掌握ＳＰＲ手术适应证，采取积极有效的预防措施，才能减少和避免严重的术后不良反应和并发症的发生。     

选择性脊神经后根切断术早期并发症分析

自１９９２年以来对５０例下肢痉挛患者施行Ｌ２－Ｓ１选择性脊神经后根切断术（ＳＰＲ）。术后早期出现严重并发症２例，占４％，包括喉头水肿和神经元性膀胱。其他并发症有双下肢乏力２０例、皮肤感觉异常１５例、伤口愈合不良１例、皮下积液２例、不明原因腹痛４例、短暂性尿潴留２例等。ＳＰＲ是创伤性较大的手术，应严格适应症的选择，抓好术前、术中和术后各环节，才能减少或避免术后严重并发症的发生。     

脊神经后根小范围选择性切断术治疗痉挛性脑瘫

目的 报道选择性脊神经后根切断术（ＳＰＲ）加内收肌切断术治疗痉挛性脑瘫珠临床效果。方法 对１８例以下肢痉挛为主要症状的脑瘫施行ＳＰＲ术及内收肌切断术。结果 通过术后２年以上随访,症状较轻的８例中,有６例能单腿站立,症状较重的１０例中,有６例能在室内脱手行走。术后无并发症发生。结论 内收肌切断术加ＳＰＲ手术治疗痉挛性脑瘫,不但缩小了ＳＰＲ在脊柱上的手术范围,而且减少了手术后并发症的发生,是一种安全、     

选择性颈神经后根切断治疗手与上肢痉挛

采用选择性颈神经后根切断术治疗手与上肢痉挛，收到满意疗效。病例均为上运动神经元损害所致严重痉挛与功能障碍，其中脑性瘫痪２０例，脑血管意外偏瘫２例，脑外伤后遗症２例，颈髓损伤高位瘫１例，共２５例。手术采用全麻，行颈４至胸１半椎板或全椎板切除，切开硬膜直视颈神经后根，电刺激选择后切断阈值低的后根小束。术后经６个月以上随访，痉挛解除有效率为９２％，手与上肢功能改善率为７２％。     

SPR手术治疗脑瘫下肢痉挛53例

ＳＰＲ手术治疗脑瘫下肢痉挛５３例奏枚才，赵宝泉，孟祥海，尹玉军近２年来，我们采用高选择性脊神经后根切断术（ＳＰＲ）治疗脑瘫引起的下肢痉挛５３例，均随访，疗效满意。１临床资料１．１一般资料男３２例，女２１例；年龄５～３１岁，平均１４．３岁。４例术前曾做...     

SPR手术中椎板后移回植技术的应用

目的探讨在选择性脊神经后根切断术（ＳＰＲ）治疗痉挛性脑瘫中维护脊椎后柱结构稳定的新方法。方法在ＳＰＲ手术中采用椎板后移回植术治疗痉挛性脑瘫４６例。结果３４例随访６个月～２年４个月,优良率９７１％。结论椎板后移回植是维护脊椎后柱稳定的有效方法。     

Femoro-distal ePTFE bypass grafting using femoro-crural patch prosthesis (FCPP). Results of a prospective clinical study

Femorodistal bypass using exclusively PTFE is known to have a poor prognosis, mostly because of the development of myointimal hyperplasia (MIH). Several vein patch techniques are established but the role of hemodynamics within the anastomotic site has only been explained insufficiently and is hardly considered clinically. In a prospective study, between 6/1992 and 7/1998 129 patients (89 m/40 f, mean age 65.2 +/- 10.0 years) with critical limb ischemia and no usable saphenous vein were included to undergo femorodistal ePTFE bypass grafting with a new, hemodynamically optimized distal end-to-side anastomosis. Patients were followed at 6-month intervals with clinical investigation and color-coded Doppler sonography. Primary and secondary graft patency (PPR, SPR), limb salvage, and patient survival were calculated according to Kaplan-Meier. With a median follow-up of 45 (range 6 to 72) months, PPR and SPR at 1, 3 and 5 years were 63.0, 35.7 and 27.6% and 74.5, 44.8%, and 37.6%, respectively. Limb salvage at 1, 3 and 5 years was 86.4%, 78.7% und 73.2%. There was no perioperative mortality. Graft infection occurred in 7 patients (5.2%). ePTFE bypass grafting represents a valuable option for infragenicular and crural reconstruction in the absence of autologous vein. The new anastomotic design was feasible and represents another adjunct to possibly improve patency of femorodistal bypass allografts.     

应用三项“选择”的原则行SPR治疗痉挛性脑瘫（附46例报告）

目的:了解高选择性脊神经后根切断术(简称SPR)治疗小儿痉挛性脑瘫的机理以及三项“选择”病例的重要性并明确手术与康复训练的关系。方法:在严格掌握三项“选择”即:病例的选择、脊神经后根节段的选择以及术中电刺激脊神经后根小束切断比例的选择下,对46例痉挛性脑瘫患儿进行SPR手术。结果:下肢痉挛的解除率达98％,经过合理的PT训练,随访半年以上功能及步态改善率达80％,原有流涎6例,斜视5例,上肢肌张力高3例,术后均有不同程度改善,术后5例合并尿潴留,经过按摩及电针治疗2周恢复,未出现其它并发症。结论:应用SPR手术治疗痉挛性脑瘫重在“三项选择上”是疗效的保证,由于SPR是针对痉挛机制的治疗,其科学性与可靠性以及疗效方面明显优于矫形手术和其它传统方法。但应当强调掌握三分手术,七分训练的这一原则。     

Long-term functional outcome after selective posterior rhizotomy

OBJECT: Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring. METHODS: The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements. CONCLUSIONS: The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.     

Femorodistal PTFE bypass grafting for severe limb ischaemia: results of a prospective clinical study using a new distal anastomotic technique.

OBJECTIVES: To analyse graft patency and limb salvage following femorodistal bypass with ePTFE using a new distal anastomotic technique. Design prospective non-randomised study. MATERIAL AND METHODS: One hundred and twenty-nine patients (M:F; 2.23:1; mean age 65.2+/-10.0 years) underwent 135 operations for severe limb ischaemia. The new anastomosis, constructed entirely from ePTFE, was attached to the popliteal (21), anterior (46) and posterior (52) tibial, and peroneal (16) arteries. Cumulative primary (PPR) and secondary patency rates (SPR), limb salvage and survival were analysed using the Kaplan-Meier method. RESULTS: Median follow-up was 45 (range 6 to 72) months. There was no perioperative mortality. PPR and SPR at 1, 2, 3, 4, and 5 years were 63.0%, 44.9%, 35.7%, 33.1% and 27.6% and 74.5%, 55.2%, 44.8%, 43.0%, and 37.6%, respectively. Cumulative limb salvage was 86.4%, 78.7%, and 73.2% at 1, 3, and 5 years, respectively. CONCLUSIONS: This new anastomotic design was feasible and resulted in acceptable long-term results.     

Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties

Purpose

In Norway, 19 % of revisions of non-resurfaced total knee arthroplasties done for knee pain between 1994 and 2011 were Secondary Patella Resurfacing (SPR). It is, however, unclear whether SPR actually resolves the pain. The aim was to investigate prostheses survival and clinical outcomes following SPR.

Method

A total of 308 knees (301 patients) with SPR were used to assess implant survival, and a sub-cohort (n?=?114 out of 301 patients) with Patient Reported Outcome Measures (PROMs) data were used to assess the clinical outcomes. The EuroQol (EQ-5D), the Knee Injury and Osteoarthritis Outcome Score, and Visual Analogue Scales on satisfaction and pain were used to collect PROM data. Outcomes were analysed by Kaplan-Meier, Cox regression, and multiple linear regression.

Results

The five- and ten-year Kaplan-Meier survival percentages were 91 % and 87 %, respectively. Overall, 35 knees were re-revised at a median follow-up of eight years and pain alone (10 knees) was the main cause of re-revision. Younger patients (<60 years) had nearly nine times higher risk of re-revision compared to older patients (>70 years) (RR?=?8.6; p?<?0.001). Mean EQ-5D index score had improved from 0.41 (SD 0.21) preoperative to 0.56 (SD 0.25) postoperative following SPR. A total of 63 % of patients with PROM data were satisfied with the outcomes of SPR.

Conclusion

The long-term prostheses survival following SPR was satisfactory, although not as good as for primary knee replacement. Patients’ health related quality of life improved significantly following SPR. Still, more than a third of patients with PROMs data were dissatisfied with the outcomes of the SPR procedure.

     

腰椎管成形在儿童选择性脊神经后根切断术中的应用及临床转归

[目的]探讨棘突椎板韧带复合体回植腰椎管成形在儿童选择性脊神经后根切断(SPR)术中的应用价值及术后转归。[方法]回顾性分析2007年7月～2009年12月本院腰椎SPR手术的脑瘫患儿36例68椎。手术时平均年龄6.5岁。椎管成形方法为棘突椎板棘上韧带复合体整块取出后纵劈开大,原位覆盖回植,丝线固定并重建棘上韧带连续性。术后随访患者症状和影像学评估腰椎稳定性、回植椎板骨融合及转归。[结果]随访平均32个月。术后患者均无腰痛。双下肢肌张力级别由术前平均2.2±0.6降至术后平均0.5±0.2,差异有统计学意义(P<0.05)。腰椎X线片19例未见明显异常;16例可见腰椎术后改变;12例腰椎屈伸位相术前和随访时比较未见明显变化。腰椎CT,椎管形态均基本完整,回植椎板融合率(85.3%),吸收率(61.8%)二者之间呈统计学负相关关系。2例腰椎MRI可见回植椎板部分缺失,硬膜囊无受压,棘上韧带连续。[结论]棘突椎板韧带复合体回植腰椎管成形应用于儿童SPR术可较好重建腰椎稳定性,随访2年以上有回植椎板吸收现象,但对腰椎发育无明显影响,残存椎板与周围软组织共同对椎管内神经起保护作用。     

预防选择性脊神经后根切断术并发症探讨

报告采用高选择性脊神经后根切断术(SPR)治疗痉挛型脑瘫46例,获随访34例,优良率97.1％。对手术的机理、并发症预防和几项改进作了详细探讨。     

运动疗法在脑瘫儿童选择性脊神经后根切断术后康复中的应用

目的：分析运动疗法在脑瘫儿童选择性脊神经后根切断术后康复中的临床疗效,为脑瘫儿童的康复提供可靠方法。方法：2003年9月至2007年4月脑瘫患儿226例,男125例,女101例;年龄3～10岁,平均6．8岁;随机分为对照组113例和治疗组113例。治疗组：男66例,女47例;年龄3-8岁,平均（6．5±1．2）岁;采用选择性脊神经后根切断术同时辅以运动疗法。,对照组：男59例,女54例;年龄3～10岁,平均（6．9±1．5）岁;采用选择性脊神经后根切断术。两组治疗前后采用小儿脑瘫粗大运动功能测试量表（CMFM）、肌张力评分、被动关节活动度进行评估。结果：226例均获随访,时间6～18个月,平均8个月。治疗后组间进行比较：治疗组GMFM得分平均（134．29±46．43）分,高于对照组（P〈0．05）;肌张力评分平均（1．27±0．42）分,优于对照组（P〈0．05）;关节活动度中踝背屈角度平均（14．2±3．1）°,大于对照组（P〈0．05）。结论：运动疗法在脑瘫儿童SPR术后康复中具有明显效果,有助于减轻痉挛状态、降低肌张力、改善脑瘫儿童的运动功能。     

脑瘫SPR术后遗留髋内收畸形的个体化手术治疗

目的评价痉挛型脑瘫患者腰骶段选择性脊神经后根切断术（SPR）后遗留髋内收畸形的手术方案选择及临床疗效。方法回顾性分析2008年8月至2012年8月北京中医药大学东直门医院收治的126例脑瘫SPR术后遗留髋内收畸形患者的临床资料,根据肌肉挛缩的范围和畸形程度采取不同的手术方式,包括长收肌、短收肌、股薄肌、髂腰肌、闭孔神经前支切断术等。观察患者术后髋外展角度及畸形矫正情况。结果 126例患者随访14~38个月（平均22个月）。术后髋内收畸形均较术前有明显改善,其中术后髋外展角度≥30°118例、20°~30°8例,缓解率100%（126/126）,满意率93.6%（118/126）。未出现下肢感觉障碍、髋外展或外旋畸形。结论对于脑瘫SPR术后遗留的髋内收畸形,根据个体情况不同,采用肌肉切断松解、闭孔神经前支切断术等个体化治疗方案,可取到满意的临床疗效。