Hong Joo-Chul, Kim Min-Soo, Chang Chul-Hoon, Kim Sang-Woo, Kim Oh-Lyong, Kim Seong-Ho
Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea.
J Korean Neurosurg Soc. 2008 Apr;43(4):182-5. doi: 10.3340/jkns.2008.43.4.182. Epub 2008 Apr 20.
The purpose of the present study is to assess the long-term results of microsurgical dorsal root entry zonotomy (MDT) for the treatment of medically intractable upper-extremity spasticity.
The records of nine adult patients who underwent MDT by one operating neurosurgeon from March 1999 to June 2004 were retrospectively reviewed by another investigator who had no role in the management of these patients. In all patients, MDT was performed on all roots of the upper limb (from C5 to T1) for spasticity of the upper extremity. The degree of spasticity was measured by the Modified Ashworth Scale (grade 0-4). Severity of the pain level was determined using the Numeric Rating Scale (NRS, score 0-10). Also, patient satisfaction of the post-operative outcome was assessed.
Comparing the preoperative and postoperative spasticity using the Modified Ashworth Scale, we observed improvement in all patients, particularly in five of the nine patients (55.6%) who improved by three grades over an average of 66.4 months (range, 40-96). Regarding patient satisfaction, seven patients (77.8%) had affirmative results. None of the patients experienced severe, life-threatening, postoperative complications. We observed a decrease in the intensity of painful spasms to less than three scores as measured by NRS in all four patients with associated pain.
This study shows that MDT provides significant, long-term reduction of harmful spasticity and associated pain in the upper limbs.
本研究旨在评估显微外科背根入髓区切开术（MDT）治疗药物难治性上肢痉挛的长期效果。
由另一位未参与这些患者治疗管理的研究者，对1999年3月至2004年6月期间由一位神经外科医生为9例成年患者实施MDT的记录进行回顾性分析。所有患者均因上肢痉挛对上肢所有神经根（从C5至T1）进行MDT。痉挛程度采用改良Ashworth量表（0 - 4级）进行测量。疼痛程度的严重程度使用数字评定量表（NRS，评分0 - 10）确定。此外，还评估了患者对术后结果的满意度。
使用改良Ashworth量表比较术前和术后痉挛情况，我们观察到所有患者均有改善，特别是9例患者中的5例（55.6%）平均在66.4个月（范围40 - 96个月）内改善了三个等级。关于患者满意度，7例患者（77.8%）给出肯定结果。所有患者均未出现严重的、危及生命的术后并发症。在所有4例伴有疼痛的患者中，我们观察到通过NRS测量的疼痛性痉挛强度降至低于三分。
本研究表明，MDT能显著、长期减轻上肢有害痉挛及相关疼痛。
