Putty T K, Shapiro S A
Section of Neurosurgery, Indiana University, Indianapolis.
J Neurosurg. 1991 Sep;75(3):397-401. doi: 10.3171/jns.1991.75.3.0397.
The authors report their experience using dorsal longitudinal myelotomy in treating spasticity in 20 patients with complete spinal cord injuries. These patients suffered from severe painful flexor/extensor spasms that prevented them from wheelchair ambulation and/or their decubitus ulcers healing. All were receiving large doses of various oral drugs, including baclofen, which had failed to control their spasticity, and all underwent a modification of a posterior T-myelotomy as first described by Bischof. All 20 patients enjoyed immediate complete relief of their painful spasms, although two (10%) eventually experienced return of their spasms and are thus classified as long-term failures. Seventeen patients succeeded in markedly reducing, or being completely weaned from, their antispasmodic medications. In 11 of 14 patients, nonhealing decubitus ulcers subsequently healed with treatment. Bladder function was unchanged from the preoperative status in all patients. Chronic intrathecal baclofen infusion has recently been reported as an effective treatment of the spasticity of paraplegia. The results of this study, along with previous reports advocating dorsal longitudinal myelotomy, suggest that this approach is an efficacious alternative to chronic baclofen infusion in reducing spasticity for complete paraplegics. Considering the cost of the infusion pump, along with the fact that chronic intrathecal baclofen therapy necessitates long-term medical supervision, it appears that myelotomy is superior for this select group of patients who have no hope of regaining voluntary motor function.
作者报告了他们使用背侧纵行脊髓切开术治疗20例完全性脊髓损伤患者痉挛状态的经验。这些患者患有严重的屈肌/伸肌痛性痉挛，导致他们无法进行轮椅活动和/或褥疮愈合。所有患者均接受了大剂量的各种口服药物治疗，包括巴氯芬，但这些药物均未能控制其痉挛状态，所有患者均接受了Bischof首次描述的后路T形脊髓切开术的改良术式。所有20例患者的痛性痉挛均立即得到完全缓解，尽管有2例（10%）最终痉挛复发，因此被归类为长期治疗失败。17例患者成功地显著减少或完全停用了抗痉挛药物。14例患者中有11例，其不愈合的褥疮经治疗后随后愈合。所有患者的膀胱功能与术前状态相比均无变化。最近有报道称，慢性鞘内注射巴氯芬是治疗截瘫患者痉挛状态的一种有效方法。本研究结果以及先前提倡背侧纵行脊髓切开术的报告表明，对于完全性截瘫患者，在减轻痉挛方面，这种方法是慢性巴氯芬注射的一种有效替代方法。考虑到输液泵的成本，以及慢性鞘内注射巴氯芬治疗需要长期医疗监督这一事实，对于这组没有恢复自主运动功能希望的特定患者来说，脊髓切开术似乎更具优势。
