选择性脊神经后根切断术治疗脑瘫马蹄足

目的评价L4～S1选择性脊神经后根切断术治疗脑瘫马蹄足的疗效.方法对15例以踝部痉挛为主的脑瘫病人进行L4～S1椎板切除术.显露L4、L5和S1脊神经后根,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所示肌肉收缩情况,将运动阈值明显减低的小束切断.跖屈肌群肌张力按照Ashworth法进行评估,随访6个月并观察疗效.结果所有病人踝部痉挛明显缓解,行走功能改善,无明显并发症.结论L4～S1选择性脊神经后根切断术治疗脑瘫踝痉挛有效,但应严格掌握手术适应证.

Neurosurgical treatment for spastic equinus secondary to cerebral palsy

Objective To evaluate the effect of L4-S1 selective posterior rhizotomy for spastic equinus secondary to cerebral palsy. Methods Fifteen patients with spastic equinus secondary to cerebral palsy were selected for this study. The dorsal roots of L4-S1 were exposed through a L4-S1 laminectomy. Three to five rootlets from each root were electrically stimulated with a concentric needle electrode. The muscle responses were observed visually and registered by electromyography. Those rootlets with a much lower threshold were divided. The spastic degree of plantar flexor was assessed according to Ashworth scale 1 week before and 6 months after the operation. Results Reduction of spasticity was observed in plantar flexors. All the patients presented functional improvement of motor abilities without any complications. Conclusion Selective posterior rhizotomy (SPR) from L4-S1 dorsal roots is an effective procedure for spastic equinus secondary to cerebral palsy, howerer, the indications should be controlled strictly.