Vaughan CL, Subramanian N, Busse ME
Department of Biomedical Engineering, University of Cape Town, Observatory, Western Cape 7925, South Africa
Gait Posture. 1998 Aug 1;8(1):43-59. doi: 10.1016/s0966-6362(98)00018-6.
Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective dorsal rhizotomy has gained widespread exposure, and indeed acceptance, over the past two decades, despite there being some controversy as to its efficacy. In this paper we review: cerebral palsy, including classification and treatment; selective dorsal rhizotomy, including historical background, patient selection, operative procedure, clinical outcome and complications; and gait analysis studies, including temporal-distance parameters, joint kinematics, normalisation for growth, and long-term follow-up. Both the short-term (1 year) and long-term (10 years) evidence has demonstrated that selective dorsal rhizotomy not only reduces spasticity but it also provides lasting functional benefits as measured by improved range of motion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider. Copyright 1998 Elsevier Science B.V.
脑瘫是儿童期最常见的运动障碍，痉挛是最常见的表现形式。减轻痉挛从而改善随之而来的步态异常的治疗策略包括物理治疗、矫形器、抗痉挛药物、矫形外科手术和神经外科手术。其中，在过去二十年里，被称为选择性背根切断术的神经外科手术已得到广泛关注，甚至被广泛接受，尽管其疗效仍存在一些争议。在本文中，我们回顾：脑瘫，包括分类和治疗；选择性背根切断术，包括历史背景、患者选择、手术过程、临床结果和并发症；以及步态分析研究，包括时间-距离参数、关节运动学、生长归一化和长期随访。短期（1年）和长期（10年）的证据均表明，选择性背根切断术不仅能减轻痉挛，还能通过改善步态时的活动范围带来持久的功能益处。背根切断术并非痉挛性双侧瘫患儿的万灵药，但它是临床医生应考虑的重要治疗选择。版权所有1998爱思唯尔科学出版社B.V.
