辅加单侧脊神经S2后根选择性切断治疗脑瘫踝痉挛的疗效观察

目的评价脊神经S2后根选择性切断术治疗脑瘫踝痉挛疗效。方法25例痉挛性脑瘫患者均为双下肢受累,对踝痉挛较重的一侧下肢采用L2~S2SPR术,对另一侧踝痉挛相对较轻者采用L2~S1SPR术。术中将各后根分为3~5个小束,采用同心圆电极进行刺激,通过肉眼观察及肌电图记录显示肌肉收缩情况,将肌肉收缩范围明显异常的小束切断。踝痉挛情况按照Ashworth法进行评估,随访16.3±4.9个月,观察疗效并比较两侧肢体踝痉挛改善情况。结果S2后根的切断率为32%。病人术后踝痉挛均明显缓解,行走功能改善,无括约肌功能障碍。手术范围包括S2后根时,该侧踝痉挛改善更佳。结论对踝痉挛严重的脑瘫患者,采用选择性脊神经后根切断术治疗时,手术范围应包括S2后根。

Inclusion of the S2 dorsal rootlets in selective posterior rhizotomy for ankle spasticity in children with cerebral palsy

Objective To assess the effects of sectioning the S_2 dorsal rootlets during selective posterior rhizotomy(SPR) for spastic ankle secondary to cerebral palsy.Methods All 25 patients presented spasticity in both lower limbs.Selective posterior rhizotomy from L_2-S_2 was performed on the side with more serious spastic ankle (A group).SPR from L_2-S_1 was performed on the other side with less serious spastic ankle.3 to 5 rootlets from each posterior root were electrically stimulated with a concentric needle electrode.The muscle responses were observed visually and registered by electromyography.Those rootlets with an abnormal muscular response were divided.The degree of spastic ankles was assessed according to Ashworth scale 1 week before and 16.3 months on average after the operation.Results Approximately 32% of rootlets of S_2 posterior roots were sectioned.Reduction of ankle spasticity was observed in both sides,they also presented functional improvement of motor abilities without sphincter dysfunction.Spastic ankles received SPR including of S_2 dorsal rootlets presented better improvements.Conclusion For serious spastic ankle secondary to cerebral palsy,S_2 posterior rootlets should be included during SPR.