Steinbok P
Department of Surgery, University of British Columbia and British Columbia's Children's Hospital Vancouver, Canada.
Childs Nerv Syst. 2001 Jan;17(1-2):1-18. doi: 10.1007/pl00013722.
The purpose of this article was to review the published outcomes after selective dorsal rhizotomy (SDR) for treatment of spastic cerebral palsy.
A literature search identified all articles related to outcomes after SDR. The outcomes were reviewed according to a paradigm developed by the National Center for Medical Rehabilitation Research (NCMRR). The quality of the evidence for each outcome was assessed using Sackett's criteria and the classification system developed by the Brain Trauma Foundation and the American Association of Neurological Surgeons.
There is very strong evidence for benefits of SDR in the impairment domain of the NCMRR classification. SDR has been shown conclusively to decrease lower limb spasticity and increase lower limb range of motion. There is strong, but not as conclusive evidence that SDR has a positive impact in the functional limitation dimension, with improvements in motor function, and in particular the Gross Motor Function Assessment (GMFM). There is a moderate degree of certainty that SDR results in improvements in the disability dimension, as evidenced particularly by improvements in the Functional Independence Measure for Children (WeeFIM) and Pediatric Evaluation of Disability Inventory (PEDI). There is a moderate degree of certainty that SDR results in positive suprasegmental effects, especially related to upper limb function and cognition. There is weak evidence that SDR may reduce the need for orthopedic procedures in patients with spastic cerebral palsy, and the impact on hip subluxation relative to the natural history of this problem is unclear.
This information could help to define the role of SDR in the management of the child with spastic cerebral palsy, in the light of alternative therapies, such as intrathecal baclofen and botulinum toxin, which have been introduced more recently. It also reveals the need for further studies, particularly dealing with quality of life and economic impact.
本文旨在回顾选择性背根切断术（SDR）治疗痉挛性脑瘫后的已发表结果。
文献检索确定了所有与SDR术后结果相关的文章。根据国家医学康复研究中心（NCMRR）制定的范式对结果进行了回顾。使用Sackett标准以及脑创伤基金会和美国神经外科医师协会制定的分类系统评估了每个结果的证据质量。
有非常强有力的证据表明SDR在NCMRR分类的损伤领域具有益处。已确凿证明SDR可降低下肢痉挛并增加下肢活动范围。有强有力但并非结论性的证据表明SDR在功能受限维度有积极影响，可改善运动功能，尤其是粗大运动功能评估（GMFM）。有中等程度的确定性表明SDR可改善残疾维度，特别是儿童功能独立性测量（WeeFIM）和儿童残疾评定量表（PEDI）的改善证明了这一点。有中等程度的确定性表明SDR会产生积极的节段上效应，特别是与上肢功能和认知有关。有微弱证据表明SDR可能减少痉挛性脑瘫患者进行骨科手术的需求，并且相对于该问题的自然病程，其对髋关节半脱位的影响尚不清楚。
鉴于最近引入的替代疗法，如鞘内注射巴氯芬和肉毒毒素，这些信息有助于明确SDR在痉挛性脑瘫患儿管理中的作用。它还揭示了进一步研究的必要性，特别是关于生活质量和经济影响方面的研究。
