Decq P
Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil.
Neurochirurgie. 2003 May;49(2-3 Pt 2):293-305.
Introduced by Stoffel in 1912 for the treatment of spastic equinus foot, selective fascicular neurotomy consists in a partial section of the motor collaterals of the muscles presenting excessive spasticity. This peripheral surgery for spasticity is based on two main concepts: 1) Spinal reflexes and muscles are heterogeneous and have a regional organization depending on their role during normal movements. This is the physiological base of focal spasticity and peripheral treatment. 2) There is a differential re-innervation after a partial section, leading to motor recovery without spindles reinnervation (therefore without spasticity). Before performing neurotomies, a careful clinical assessment is required: what kind of spasticity? For what kind of goal (functional or comfort)? The surgery effects can be mimicked by motor nerve blocks (anesthetic drugs) to give to the patient an idea of the expected result. There are many neurotomies, depending on the clinical status, either in the lower or the upper limb. The most frequent is tibial neurotomy for spastic equinus foot.
选择性束状神经切断术由施托费尔于1912年引入用于治疗痉挛性马蹄足，该手术是对表现出过度痉挛的肌肉的运动侧支进行部分切断。这种针对痉挛的外周手术基于两个主要概念：1）脊髓反射和肌肉是异质性的，并且根据它们在正常运动中的作用具有区域组织。这是局灶性痉挛和外周治疗的生理基础。2）部分切断后存在差异性再支配，导致运动恢复而无肌梭再支配（因此无痉挛）。在进行神经切断术之前，需要进行仔细的临床评估：是哪种痉挛？出于何种目的（功能还是舒适度）？运动神经阻滞（麻醉药物）可模拟手术效果，让患者了解预期结果。根据临床状况，在下肢或上肢有许多种神经切断术。最常见的是用于痉挛性马蹄足的胫神经切断术。
