选择性脊神经后根切断术治疗痉挛型脑瘫的远期疗效观察与分析

发布时间：2019-04-03 21:57

【摘要】：目的:观察分析SPR手术治疗痉挛型脑瘫的远期临床疗效。资料与方法:选择1998～2000年期间在济南市市中区人民医院行SPR手术的病人34例作回顾性分析。本组病例男28例,女6例,平均年龄8.6岁。(1)瘫痪情况:34例病人均被诊断为痉挛型脑瘫,双侧瘫24例,四肢瘫8例,单瘫2例。(2)并发症情况:12例有语言障碍,6例智力低下,在其他医院行内收肌切断术2例,合并扭转性肌张力障碍1例。(3)行走功能:术前不能独立行走5例,双手扶持行走14例,能独立行走但步态异常15例。(4)步态情况:不同程度尖足现象27例,交叉腿、剪刀步态26例,膝关节屈曲12例。(5)肌力:术前检查下肢肌力3级者162侧,4级者440侧,5级者78侧。(6)肌张力:Ⅱ级112侧,Ⅲ级352侧,Ⅳ级64侧。(7)查体情况:髌阵挛阳性47侧,踝阵挛阳性53侧,巴彬斯基征阳性63侧。髋关节半脱位1侧。(8)术前常规X线片检查,发现隐性脊柱裂11例。采用选择性腰骶神经后根切断术进行治疗。经过15年+后(16～18年),进行随访,比较手术前后患者肌力、肌张力及肢体功能和步态的变化,并以此为临床有效和无效的评估标准。结果:34例患者均行SPR手术治疗,并全部进入结果分析。(1)患肢肌力:32例与术前相当或好于术前,2例较术前差。(2)肌张力改善:绝大部分患者肌张力降至正常,平均降低Ⅱ～Ⅲ级。(3)行走功能:腰骶神经后根切断术后25例(行走能力4～5级)可独立行走,2例不能行走,其余患者的行走能力都得到不同程度的改善。(4)步态改善:尖足现象及交叉腿、剪刀步态均得到不同程度改善。(5)查体情况:绝大部分患者术后髌阵挛、踝阵挛消失,膝反射及踝反射基本正常。脊柱前凸6例(17.6%),脊柱侧弯5例(14.7%)。(6)临床效果:临床有效32例,临床无效2例。总有效率94%。结论:实行手术个体化,严格掌握手术适应症,准确选择神经后根的切断比例,加强手术后功能锻炼,减少骨损伤,绝大部分患者可取得满意疗效,不同程度地提高和改善下肢运动功能。迄今为止,SPR仍是治疗痉挛型脑瘫的重要方法。
[Abstract]:Objective: to observe and analyze the long-term clinical effect of SPR operation on spastic cerebral palsy. Materials and methods: from 1998 to 2000, 34 patients who underwent SPR operation in the people's Hospital of the Central District of Jinan were selected and analyzed retrospectively. There were 28 males and 6 females with an average age of 8.6 years. (1) paralysis: 34 cases were diagnosed as spastic cerebral palsy, bilateral paralysis in 24 cases and quadriplegia in 8 cases. (2) complications: 12 cases with language disorder, 6 cases with mental retardation, 2 cases underwent adductor amputation in other hospitals, 1 case complicated with torsion dystonia. (3) walking function: 5 cases were unable to walk independently before operation, 5 cases were unable to walk independently before operation, 2 cases were treated with adductor amputation, 1 case was complicated with torsion muscular dystonia. (4) gait: 27 cases of pointed foot phenomenon, 26 cases of cross leg gait, 26 cases of scissors gait. (5) muscle strength of knee joint flexion in 12 cases. (5) muscle strength: 162 sides of lower limb muscle strength grade 3, 440 sides of grade 4, 78 sides of grade 5. (6) muscle tension: 112 sides of grade 鈪，

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