选择性周围神经部分切断术治疗脑瘫性肢体痉挛

目的观察选择性周围神经部分切断术治疗痉挛性脑瘫的效果。方法采用显微神经外科手术治疗的68例痉挛型脑瘫病例,根据患者肢体痉挛的不同情况采用相应的选择性周围神经部分切断术,包括胫神经、坐骨神经和正中神经,其中选择性胫神经切断术36侧,选择性正中神经切断术28侧,选择性坐骨神经切断术28侧,共计92侧。结果全部患者经3-15个月的随访,术后即刻肢体痉挛状态缓解率为97.8%(90/92),随访期间为94.6%(87/92),随访期间运动功能改善率为76.5%(52/68),术后肢体痉挛状态不同程度复发5侧(5.4%)。结论选择性周围神经部分切断术对降低痉挛性脑瘫患者肌张力、纠正痉挛性畸形近期疗效满意,手术创伤小,治疗效果能够被医患双方同时认可。

Treatment of spastic cerebral palsy by selective peripheral partial neurotomy

Objective To evaluate the effects of selective peripheral partial neurotomy in the treatment of spastic cerebral palsy. Methods Selective peripheral partial neurotomy in 92 sides of spastic limbs of 68 patients with cerebral palsy were performed. The peripheral nerves included tibial nerve (36 sides) , sciatic nerve (28 sides) and median nerve (28 sides). Results All cases were followed-up from 3 to 15 months, The spasticity of limbs at 90 sides were relieved(97. 8% )after operation, and were relieved (94. 8%) during follow-up period (87/92). The improvement of motor capacity were observed in 52 patients(76. 5% ). The recurrence rate of spasticity was 5.4%. Conclusion Selective peripheral partial neurotomy is effective in decreasing muscle tension, relieving spasticity in spastic cerebral patients, with minimal trauma. It could be accepted by both neurosurgeons and patients.