Xu Shi-Gang, Xu Lin, Cao Xu, Jiao Yong
Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
Zhongguo Gu Shang. 2010 Apr;23(4):291-3.
To retrospectively review the results of cervical perivascular sympathectomy (CPVS) in treating athetoid cerebral palsy and discuss the possible mechanism of the surgery.
From 1998 to 2006,560 patients with athetoid cerebral palsy were treated with cervical perivascular sympathectomy and all had periodical follow-up at 1 week, 6 months and 1 year postoperatively. Among the 560 patients,there were 391 boys and 169 girls. The age at operation was from 3 to 25 years old with an average of 10.7 years.
At 1 year follow-up postoperatively, among the 560 cases, athetoid movement of the neck and head improved in 308 patients (55%), the movement of the hand and fingers improved in 403 patients (72%), standing and gait improved in 229 patients (41%), muscle tone reduced in 185 patients (33%), salvation reduction appeared in 252 patients (45%), eyeball movement improved in 174 patients (31%), speaking improved in 251 patients (45%); 310 patients (55%) agreed that the operation had curative effect for the patients. Short-term follow up results was better than long-term follow up results.
Primary results showed that CPVS had a curative effect on athetoid cerebral palsy, especially in improving athetoid movement of the neck and head, hand and fingers, standing and gait, speaking ability, eye-ball movement and so on. The possible mechanism of the CPVS in the treatment of athetoid cerebral palsy might be reducing the excitability of sympathetic nerve, improving microcirculation of the brain and eventually activating potential neurons. Long-term follow up is necessary.
回顾性分析颈交感神经血管网剥脱术(CPVS)治疗手足徐动型脑性瘫痪的效果,并探讨其可能的手术机制。
1998年至2006年,对560例手足徐动型脑性瘫痪患者行颈交感神经血管网剥脱术,所有患者术后均于1周、6个月及1年进行定期随访。560例患者中,男391例,女169例。手术年龄3至25岁,平均10.7岁。
术后1年随访,560例患者中,颈部和头部的手足徐动样运动改善者308例(55%),手部和手指运动改善者403例(72%),站立和步态改善者229例(41%),肌张力降低者185例(33%),流涎减少者252例(45%),眼球运动改善者174例(31%),言语改善者251例(45%);310例(55%)患者认为手术对患者有疗效。短期随访结果优于长期随访结果。
初步结果表明,CPVS对手足徐动型脑性瘫痪有治疗作用,尤其在改善颈部和头部、手部和手指的手足徐动样运动、站立和步态、言语能力、眼球运动等方面。CPVS治疗手足徐动型脑性瘫痪的可能机制可能是降低交感神经兴奋性,改善脑微循环,最终激活潜在神经元。有必要进行长期随访。