Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Dev Med Child Neurol. 2011 Aug;53(8):724-9. doi: 10.1111/j.1469-8749.2011.03969.x. Epub 2011 May 18.
The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).
Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR.
Baseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common.
The spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.
本研究旨在评估选择性脊神经后根切断术（SDR）治疗脑瘫（CP）患儿的长期疗效。
19 例双侧痉挛型 CP 患儿（4 例女性，15 例男性；平均年龄 4 岁 7 个月，标准差 1 岁 7 个月）前瞻性评估，基线及 SDR 后 18 个月、3 年和 10 年。评估包括痉挛的改良 Ashworth 量表、粗大运动功能测量 88 项（GMFM-88）和 Wilson 步态量表评估步行能力、神经学检查和被动关节活动度评估。对 SDR 后接受的矫形手术进行了 10 年回顾性图表审查。
基线时髋关节、膝关节和踝关节的肌肉张力显示出高度痉挛，SDR 后恢复正常。10 年后，膝关节和踝关节的痉挛略有复发。关节活动度从 SDR 后 3 年的最大值下降到 10 年的随访。SDR 后 3 年的中位步行状态最佳，然后下降。GMFM-88 评分从基线中位数 51 分增加到初始随访时的 66（p=0.002）和 76（p<0.001）。10 年后，粗大运动功能下降，GMFM-88 评分降至 62（p=0.022）。在 10 年内，19 例患者中有 16 例平均进行了 3 次矫形手术（标准差 2.8），软组织手术最常见。
SDR 的降低痉挛作用虽然明显，但似乎并不能改善长期功能或预防挛缩。这表明 CP 中的挛缩发展不仅仅是由痉挛引起的。
