Motion Analysis Laboratory, Shriners Hospitals for Children, Salt Lake City, UT 84103, USA.
Dev Med Child Neurol. 2011 Aug;53(8):717-23. doi: 10.1111/j.1469-8749.2011.04010.x. Epub 2011 Jun 17.
To compare function and gait in a group of children older than most children who received selective dorsal rhizotomy (SDR) with age- and function-matched peers who received either orthopedic surgery or no surgical intervention.
A retrospective study examined ambulatory children with diplegic cerebral palsy, aged between 10 years and 20 years and categorized in Gross Motor Function Classification System (GMFCS) levels I or II. Three groups were considered: (1) children who had selective dorsal rhizotomy (n=8; two females, six males; mean age 15y 4mo at SDR, 16y 8mo at follow-up); (2) children who had orthopedic surgery (n=9; three females, six males; mean age 14y 6mo at SDR, 15y 1mo at follow-up), and (3) children who had no surgical intervention (n=9; two females, seven males; mean age 15y 6mo at follow-up). Longitudinal measures of gait analysis (velocity, gait deviation index, and gait variable scores) and gross motor function (GMFCS level, Gross Motor Function Measure scores, and centiles) were examined.
No significant differences were found between changes in gait comparing rhizotomy with orthopedic surgery; however, the group who received orthopedic surgery demonstrated improved gait compared with the group without surgical intervention. Longitudinal comparisons of gross motor function demonstrated a decrease in the group who received SDR. Between-group analysis of outcomes also demonstrated worse outcomes of the SDR group compared with the orthopedic surgery group and with the no surgical intervention group.
Rhizotomy in older children was associated with functional declines compared with similar children who had no surgery and with those who underwent orthopedic surgery. This suggests that age greater than 10 years might be a contraindication for SDR if the goal is to improve motor skills.
比较一组接受选择性脊神经后根切断术（SDR）的大龄儿童与接受矫形手术或无手术干预的年龄和功能匹配的同龄儿童的功能和步态。
一项回顾性研究检查了患有双瘫脑瘫的可步行儿童，年龄在 10 岁至 20 岁之间，分类为粗大运动功能分级系统（GMFCS）水平 I 或 II。考虑了三个组：（1）接受选择性脊神经后根切断术的儿童（n=8；2 名女性，6 名男性；SDR 时的平均年龄为 15 岁 4 个月，随访时为 16 岁 8 个月）；（2）接受矫形手术的儿童（n=9；3 名女性，6 名男性；SDR 时的平均年龄为 14 岁 6 个月，随访时为 15 岁 1 个月），和（3）未接受手术干预的儿童（n=9；2 名女性，7 名男性；随访时的平均年龄为 15 岁 6 个月）。检查步态分析（速度、步态偏差指数和步态变量评分）和粗大运动功能（GMFCS 水平、粗大运动功能测量评分和百分位数）的纵向测量值。
比较脊神经切断术与矫形手术对步态变化的影响，未发现显著差异；然而，接受矫形手术的组的步态改善优于未接受手术干预的组。接受 SDR 的组的粗大运动功能的纵向比较显示出下降。结果的组间分析还表明，与矫形手术组和无手术干预组相比，SDR 组的结果更差。
与无手术和接受矫形手术的类似儿童相比，大龄儿童的脊神经切断术与功能下降相关。这表明如果目标是改善运动技能，年龄大于 10 岁可能是 SDR 的禁忌症。
