Trost Joyce P, Schwartz Michael H, Krach Linda E, Dunn Mary E, Novacheck Tom F
Centre for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA.
Dev Med Child Neurol. 2008 Oct;50(10):765-71. doi: 10.1111/j.1469-8749.2008.03031.x.
This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo-18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels (p<0.001). The rate of complications was low, with peri- and postoperative complications resolved by time of discharge.
本研究对经过严格筛选流程、统一手术程序及标准化术后康复流程的参与者，进行了选择性背根切断术（SDR）安全性和有效性的回顾性评估。评估的结果指标包括：用于评估痉挛程度的Ashworth量表、用于评估整体步态病理状况的吉列步态指数（GGI）、用于评估步态效率的氧气消耗，以及用于评估功能活动能力的吉列功能评估问卷（功能性步行能力量表；[FAQ]）。对136名儿童（81名男性，55名女性；平均年龄7岁3个月[标准差2岁1个月]，范围3岁5个月至18岁9个月）进行了术后平均18.3个月（标准差4.4个月）的结果评估。所有参与者均被诊断为脑瘫（CP）：10例四肢瘫、19例三肢瘫和107例双瘫。术前粗大运动功能分类系统水平为：I级n = 6；II级n = 64；III级n = 59，IV级n = 7。总体而言，所有结果指标均有所改善。痉挛程度改善，Ashworth评分获得了66%至92%的可能改善幅度；GGI显示良好结果的可能性是不良结果的7.5倍；超过半数参与者的能量效率得到改善，且FAQ显示有0.9级的统计学显著改善（p<0.001）。并发症发生率较低，围手术期和术后并发症在出院时均已解决。
