选择性颈段脊神经后根部分切断术治疗脑瘫性上肢痉挛状态(附17例报告)

目的探讨选择性颈段脊神经后根部分切断术治疗脑瘫性上肢痉挛状态的疗效。方法回顾性分析17例脑瘫性上肢痉挛病人的临床资料．均采用选择性颈段脊神经后根部分切断术。平均随访38、7个月。结果94．1％的病人术后即刻痉挛状态缓解．随访期间缓解率为88．2％：术后6周内运动功能改善率为52．9％．随访期间为76．5％：生活质量提高率在随访期间为82．4％。术后发生上肢感觉障碍20侧（58．8％），肌力下降13侧（38．2％），随访期间均见好转。随访期间复发2例（11．8％）。结论选择性颈段脊神经后根部分切断术是治疗脑瘫性上肢肌群广泛痉挛有效的手术方法。选择合适病例．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等．是保证疗效的关键。

Cervical selective posterior rhizotomy for spasticity of upper limbs in cerebral palsy patients: report of 17 cases

Objective To explore efficacy of cervical selective posterior rhizotomy(SPR) for relieving spasticity of upper limbs in cerebral palsy patients.Methods Seventeen cases of cerebral palsy patients with spasticity of upper limbs treated by microsurgical cervical SPR were retrospectively analyzed.The mean follow-up duration was 38.7 months.Results 94.1% of the patients experienced disappearance or notable regression of the spasticity immediately after operation,and the remission rate in the follow-up period was 88.2%.The improvement of motor capacity within 6 weeks after operation was found in 52.9% of patients,while 76.5% during the whole follow-up period.Improvement of quality-of-life was seen in 82.4% of patients in the follow-up period.Postoperative complications included dysaesthesias of the upper limbs in 20 limbs(58.8 %) and decrease in muscle strength in 13 limbs(38.2%),but all of them recovered to a certain extent.There were 2 cases(11.8%) of recurrence of spasticity during the follow-up period.Conclusion Cervical SPR is an effective microsurgical method for treating spasticity of the upper limbs in cerebral palsy patients.The proper choice of cases,better understanding of regional anatomy,microsurgical techniques and postoperative rehabilitation are keys to gain good effects.