Langerak Nelleke G, Lamberts Robert P, Fieggen A Graham, Peter Jonathan C, Peacock Warwick J, Vaughan Christopher L
Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa.
Arch Phys Med Rehabil. 2009 Jun;90(6):994-1003. doi: 10.1016/j.apmr.2008.11.019.
To determine functional status of patients with cerebral palsy 20 years after they received selective dorsal rhizotomy (SDR).
A prospective 20-year follow-up study.
Red Cross Children's Hospital (SDR operation and 1-year follow-up assessment) and at institutional or private locations nearby patients' homes (20-year follow-up assessment).
Referred sample of 14 patients with spastic diplegia (6 women, 8 men; mean age, 27y; range, 22-33y) who were preoperatively ambulant and fulfilled strict selection criteria for SDR operation in 1985.
Patients were assessed before and 1 and 20 years after SDR.
Standardized assessments of function according to 2 dimensions of the International Classification of Functioning, Disability and Health (ICF) model: (1) body structure and function (muscle tone, joint stiffness, voluntary movement) and (2) activity (rolling, sitting, kneeling, crawling, standing, walking, transitions) were obtained. In addition, based on assessments and questionnaires, Gross Motor Function Classification System (GMFCS) levels were determined before and at 1 year after SDR retrospectively and currently at 20 years after SDR.
One year after SDR, functional outcomes based on the 2 dimensions of the ICF model improved significantly, and these improvements were maintained at 20 years after surgery. Patients showed a shift in their GMFCS levels 1 and 20 years after SDR.
In line with our 20-year follow-up study with gait parameters as outcome measures, patients with spastic diplegia still show improvements in their functional status 20 years after SDR. We acknowledge the presence of possible confounding factors and a small sample size, but we argue that the improvements found in this study were caused mainly by SDR. Finally, changes in GMFCS levels suggest a possible role for this tool to detect changes after an intervention.
确定接受选择性背根切断术（SDR）20年后脑瘫患者的功能状态。
一项前瞻性20年随访研究。
红十字儿童医院（SDR手术及1年随访评估）以及患者家附近的机构或私人场所（20年随访评估）。
1985年转诊的14例痉挛性双侧瘫患者样本（6名女性，8名男性；平均年龄27岁；范围22 - 33岁），术前可独立行走且符合SDR手术的严格入选标准。
在SDR术前、术后1年和20年对患者进行评估。
根据国际功能、残疾和健康分类（ICF）模型的两个维度进行功能标准化评估：（1）身体结构和功能（肌张力、关节僵硬、自主运动）以及（2）活动（翻身、坐、跪、爬、站、走、转换姿势）。此外，根据评估和问卷，回顾性确定SDR术前及术后1年以及当前SDR术后20年的粗大运动功能分类系统（GMFCS）水平。
SDR术后1年，基于ICF模型两个维度的功能结局显著改善，且这些改善在术后20年得以维持。患者在SDR术后1年和20年时GMFCS水平发生了变化。
与我们以步态参数作为结局指标的20年随访研究一致，痉挛性双侧瘫患者在SDR术后20年其功能状态仍有改善。我们承认存在可能的混杂因素且样本量较小，但我们认为本研究中发现的改善主要是由SDR引起的。最后，GMFCS水平变化表明该工具在检测干预后变化方面可能发挥作用。
