选择性脊神经后根切断术对大脑功能的影响

目的：探讨选择性脊神经后根切断术（SPR）治疗脑瘫下肢痉挛时对脑瘫患者大脑功能的影响及其机制。方法：对1990年5月-1998年4月间采用腰骶段选择性脊神经后根切断术治疗的痉挛型脑瘫患者进行随访，并对得到2年以上随访的825例病例进行上肢痉挛、癫痫、斜视、流涎及语言发音障碍等情况调查分析。结果：伴有上肢痉挛者328例，其中67例（20.4%）上肢痉挛减轻；伴有癫痫者35例，其中31例（88.6%）术后癫痫发作频率减少或癫痫控制药物服用量减少；伴有斜视者386例，其中132例（34.2%）减轻；伴有流涎者73例，其中49例（67.1%）流涎减少，21例（28.8%）流涎消失；伴有语言发音障碍者456例，其中72例（15.8%）发音功能改善。结论：腰骶段选择性脊神经后根切断减少外周神经传入冲动，从而降低了中枢的兴奋性，影响大脑高级中枢的调控作用；此外周-皮层-外周大环路反射可能是SPR解痉的另一机制。

The effects of selective posterior rhizotomy (SPR) on cerebral functions in patients with spastic cerebral palsy

Objective To investigate the effects of lumbar-sacral SPR on the cerebral functions in patients with spastic cerebral palsy. Methods Follow-up observations were carried out among the patients with cerebral palsy who had undegone SPR between 1990 and 1998. The records of spasticity of upper limbs, epilepsy, strabismus, sialorrhea and dysarthria of 825 patients after SPR for at least two years were reviewed. Results Of the 328 patients with spasticity of upper limbs, 67 (20.4%) had partial amelioration of spasticity of upper limbs. Among the 35 cases of epilepsy, 31 (88.6%) had the frequency of attack and/or the controlling dose of drug reduced. Of the 386 cases of strabismus, 132 (34.2%) got improved. Among the 73 cases of sialorrhea, 49 (67.1%) got improved and 21 (28.8%) were completely cured. Out of the 456 cases of dysarthria, 72 (15.8%) got improved. Conclusion SPR reduces the afferent impulses from periphery, which may decrease the central excitability and affect the cerebral functions. It is possibe that a periphery-cortex-periphery mechanism exists for the antispastic effects of SPR, in addition to the spinal one.