Buffenoir K, Rigoard P, Ferrand-Sorbets S, Lapierre F
Service de neurotraumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Neurochirurgie. 2009 Mar;55 Suppl 1:S150-60. doi: 10.1016/j.neuchi.2008.04.003. Epub 2009 Feb 14.
BACKGROUND/OBJECTIVE: Peripheral selective neurotomy is commonly used to treat the equinus spastic foot (tibial nerve), but is less frequently used in treating upper limb spasticity, because of the complexity of the articular deformities and the complex innervations of the different muscles. We present our experience and the long-term results of this surgery based on a retrospective series of 22 patients with a disabling spasticity of the upper limb.
Between 2003 and 2006, neurotomies were performed in 22 patients with disabling spasticity of the upper limb despite optimal medical treatment. Patients were evaluated before and after the surgical procedure. Twelve clinical parameters were studied for describing deformity (resting position and amplitude of each joint), spasticity (Ashworth and Tardieu scores), and the functional impacts of the spasticity.
At long-term follow-up, all parameters were improved from the surgery, both in terms of spastic symptoms (highly significantly decreased in Ashworth and Tardieu scores) and the deformity of the upper limb (e.g., 60 degrees increase in the extension of the elbow). Pain, active amplitude, and functional impact scores were also statistically significantly improved after surgery. The mean satisfaction index was 7/10 (+/-1.6).
Selective neurotomy is an effective treatment for patients with a disabling and excessive spasticity in the upper limb. It provides a long-term, objective improvement based on analytical and functional parameters. We emphasize the importance of accurate clinical evaluation and surgical planning. Finally, excessive time to treatment seems to be an important factor for recurrence or incomplete efficiency of the procedure.
背景/目的：外周选择性神经切断术常用于治疗马蹄内翻足痉挛（胫神经），但较少用于治疗上肢痉挛，因为关节畸形复杂且不同肌肉的神经支配复杂。我们基于对22例上肢致残性痉挛患者的回顾性系列研究，介绍了该手术的经验和长期结果。
2003年至2006年期间，对22例尽管接受了最佳药物治疗但仍有上肢致残性痉挛的患者进行了神经切断术。在手术前后对患者进行评估。研究了12项临床参数，以描述畸形（每个关节的静止位置和幅度）、痉挛（Ashworth和Tardieu评分）以及痉挛的功能影响。
在长期随访中，手术使所有参数均得到改善，无论是痉挛症状（Ashworth和Tardieu评分显著降低）还是上肢畸形（例如，肘部伸展增加60度）。术后疼痛、主动活动幅度和功能影响评分也有统计学显著改善。平均满意度指数为7/10（±1.6）。
选择性神经切断术是治疗上肢致残性和过度痉挛患者的有效方法。它基于分析和功能参数提供长期、客观的改善。我们强调准确临床评估和手术规划的重要性。最后，治疗时间过长似乎是该手术复发或效果不完全的重要因素。
