内镜下选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛

目的探讨内镜在选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛中的应用.方法回顾分析2002年3月至2003年4月显微手术治疗的53例脑瘫性下肢痉挛,全部采用选择性腰骶段脊神经后根部分切断术,并在术中应用软性神经内窥镜.结果全部患者平均随访 10个月. 100%患者术后立即感痉挛状态缓解,随访期间缓解率为94.3%.术后6周内步态功能改善率为56.6%,随访期间为90.6%.生活质量提高率在随访期间为94.3%.术后发生下肢感觉障碍20例(37.7 %),肌力下降 5例(9.4%),随访期间均见好转.术后无一过性尿失禁及尿潴留发生.随访期间无复发病例.结论选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛,术中应用内窥镜有利于提高疗效、减少创伤和降低并发症发生率.

Endoscopic selective posterior rhizotomy for relief of spasticity of lower limbs in cerebral palsy patients

Objective To study the application of endoscope in selective posterior rhizotomy (SPR) for relief of spasticity of lower limbs in cerebral palsy patients.Methods Fifty three cases of cerebral palsy patients with spasticity of lower limbs were treated by microsurgical SPR from March, 2002 to April,2003. The soft neuroendoscope was used in SPR.Results At follow up evaluation(average ten months of follow up), this study showed that 100 % of cases experienced disappearance or notable regression of the spasticity right after operation,and the percentage in follow up duration was 94.3%. The percentage of improved motor capacities within 6 weeks after operation was 56.6%, while 90.6% in follow up duration. A total of 94.3% cases had better quality of life by follow up studying. Postoperative complications included dysaesthesias of lower limbs in 20 cases(37.7%), muscle weakness in 5 cases(9.4%), without transient urinary incontinence and transient uroschesis. There was no case of recurrence of spasticity.Conclusion The application of endoscope in SPR for the treatment of spasticity of lower limbs in cerebral palsy patients can achieve better effects and less complications.