功能性脊神经后根手术治疗脑性瘫痪的改进

目的 研究功能性脊神经后根手术治疗脑性瘫痪的一些改进方法。方法 对16例主要表现为双下肢运动障碍的脑瘫患者进行手术。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,选择刺激阈值小者予以切断。根据患者症状和年龄特点对每个后根的切断比例进行调整。手术后按照统一的方案进行功能康复训练。结果 术后随访3～6个月,16例患者肌张力增高均得到缓解,踝阵挛和病理反射消失或减轻。13例行走功能明显改善,其中4例步态已基本正常。3例行走功能改善不明显但关节活动范围明显增大。结论 跳跃式椎板切除可能是一种理想的手术显露方法;后根纤维的切断比例应遵循个体化原则;术后强化康复训练对改善肢体功能至关重要。

Improvement of Functional Posterior Rhizotomy in Children with Cerebral Palsy

Objective To improve the functional posterior rhizotomy in the children with cerebral palsy. Methods Sixteen children with cerebral palsy, who had functional impairment of both the legs, underwent the functional posterior rhizotomy. The spinal nerves of L2,L3, L5 and S1 were exposed through the jumping laminectorny for Lj and L5, and their posterior roots were stimulated electrically. The fibers with lower threshold were chosen for transection and the percentage of cutting the fibers was adjusted according to the manifestations and age of each patient. After the operation, the patients undertook the exercises of reahabitation according to a fixed schedule. Results During the follow up of 3 to 6 months, all the sixteen patients showed decreasing of the muscular spasticity, disappearance or relief of the ankle tremor and Babinski sign. Walking was significantly improved in 13 patients, of whom, 4 had almost normal gait. Improved walk was not so significant in 3 patients, in whom the movement field of the joints increased. Conclusions The jumping laminectorny could be a good method to expose the nerves during the posterior rhizotomy. The cutting percentage of the posterior root fibers should be individualized according to the clinical manifestations and the ages of the patients. Enhanced excises of reahabitation are very important to improving the function of the extremities after the operation in the children with cerebral palsy.