儿童痉挛型脑性瘫痪的神经外科治疗

目的 探讨神经外科治疗痉挛型脑性瘫痪的方法和效果.方法 对351例2~14岁(平均4.8岁)痉挛型脑瘫患者施行选择性脊神经后根切断术(SPR)135例,其中颈胸段26例,腰骶段109例;选择性周围神经缩窄术(SPN)216例,其中单神经干92例,多神经干124例.结果 随访期间6-31个月,平均17.8个月.颈胸段和腰骶段SPR痉挛改善率:上下肢分别为82.7%和91.4%,肢体运动功能改善率:上下肢分别为83.7%和72.5%.SPN痉挛改善率:上下肢分别为67.4%和92.7%,运动功能改善率:上下肢分别为54.9%和84.3%.结论 神经外科治疗痉挛型脑瘫为有效的康复训练创造了机会和条件.术前正确的评估,选择恰当的手术方式,掌握手术技巧,方能提高手术效果减少并发症.

Neurosurgical management of spastic cerebral palsy in children

Objective To explore the methods and effectiveness of neurosurgical management of spastic cerebral palsy. Method Among 351 patients of spastic cerebral palsy(aged from 2 to 14 years, 4.8 in average), the treatment includes 26 cervicothoracic selective posterior rhizotomy (SPR), 109 lumbosacral SPR; 216 selective peripheral neurotomy (SPN) include 92 single neural trunk neurotomies and 124 multiple neural trunk neurotomies. Results Following-up period was from 6 to 31 months (means 17.8 months). The spasm was improved by 82.7% and 91.4% in cervicothoracic SPR and lumbosacral SPR. The movement was improved by 83.7% and 72.5% in upper and lower limbs respectively. In peripheral neurotomy, the spasm was improved by 67.4% and 92.7% in upper and lower limbs. The movement was improved by 54.9% in upper limbs and 84.3% in lower limbs. Conclusions Neurosurgical management is an effective and safe method for treatment of spastic cerebral palsy, offers a chance for effectual rehabilitation. The preoperational evaluation, the suitable operation decision and the understanding of microsurgical techniques are the key to gain good effects and prevent complication.