Deltombe T, Gustin T, Laloux P, De Cloedt P, De Wispelaere J F, Hanson P
Deltombe, Consultation de la Spasticité, Service de Médecine Physique et Réadaptation, Cliniques Universitaires de Mont-Godinne, 5530 Yvoir, Belgique.
Acta Orthop Belg. 2001 Feb;67(1):1-5.
Spasticity is usually treated by rehabilitation, orthosis, chemical denervations, orthopaedic surgery and neurosurgery. Selective fascicular neurotomy is a neurosurgical procedure consisting in partial section of selected motor nerves innervating spastic muscles. Neurotomy is indicated in cases of localised disabling spasticity without musculotendinous shortening, resistant to chemical denervation and for which a motor nerve block with anaesthetic has given a good functional result. Neurotomy includes division of the afferent Ia and Ib fibers, unable to recover, leading to permanent disappearance of the spasticity. Neurotomy also includes section of the motor efferent fibers with transient paresis as a result. In adults, neurotomy provides functional improvement in 81 to 97% of cases. In case of posterior tibial neurotomy, improved walking stability and a decrease in foot equinus and knee recurvatum is observed. In children, the risk of deformity recurrence seems higher because of motor axonal reinnervation: indications must therefore be carefully considered and rehabilitation provided after surgery.
痉挛通常通过康复治疗、矫形器、化学去神经支配、矫形外科手术和神经外科手术来治疗。选择性束状神经切断术是一种神经外科手术，包括对支配痉挛肌肉的选定运动神经进行部分切断。神经切断术适用于局部致残性痉挛且无肌腱缩短、对化学去神经支配有抵抗且麻醉性运动神经阻滞已取得良好功能结果的病例。神经切断术包括切断无法恢复的传入Ia和Ib纤维，导致痉挛永久消失。神经切断术还包括切断运动传出纤维，结果导致短暂性轻瘫。在成人中，神经切断术在81%至97%的病例中可改善功能。在胫后神经切断术的情况下，可观察到步行稳定性改善以及马蹄足和膝反屈减少。在儿童中，由于运动轴突再支配，畸形复发的风险似乎更高：因此，必须仔细考虑适应症，并在术后提供康复治疗。
