Jia Yongzheng, Xiao Yuzhou, Yang Wenbin
Department of Orthopaedics, the First People'sHospital of Mengcheng County, Mengcheng Anhui, 233500, P.R.China.
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Nov;27(11):1345-9.
To assess the medium- and long-term effectiveness of selective posterior rhizotomy (SPR) for spastic cerebral palsy.
A retrospective analysis was made on 27 patients with spastic cerebral palsy undergoing SPR between January 1997 and January 2008, whose data were complete with more than 5 years follow-up. There were 14 males and 13 females with an average age of 10.1 years (range, 4-19 years). All patients had simple spastic cerebral palsy, including 17 cases of bilateral spastic palsy and 10 cases of unilateral spastic palsy. The muscle strength, muscle tone, ambulatory function, the sharp foot and crossing-feet, knee jerk, ankle clonus, and Babinski's sign were evaluated before and after operation.
All the patients were followed up 5-16 years (mean, 9.6 years). No obvious limitation of lumbar flexion, extension and lateral flexion, spondylolisthesis, kyphosis, and other deformities occurred. At last follow-up, the muscle strength of hip extensors, hip flexors, and knee extensors were significantly increased when compared with preoperative ones (P < 0.05); but no significant difference was found in the muscle strength of hip abductors, hip adductors, knee flexors, plantar extensors, and plantar flexors (P > 0.05). Abnormal increased muscle tone of hip flexors, hip adductors, knee flexors, and plantar flexors was declined in different degrees in all patients, showing significant differences when compared with preoperative ones (P < 0.05); but no significant difference was found in hip extensors, hip abductors, knee extensors, and plantar extensors (P > 0.05). At last follow-up, the status of toe steps and crossing-feet disappeared without recurrence for a long time. Sthenic knee jerk was eliminated, but there were several patients also keeping the active knee jerk, showing significant difference when compared with preoperative ones (Z= -7.404, P=0.000). The results of Babinski's sign were negative in 31 sides and positive in 13 sides, showing significant difference when compared with preoperative ones (Z= -6.897, P=0.000). No sharp foot or crossing-feet was observed. And ambulation ability was significantly improved after operation (Z= -4.111, P=0.000).
SPR is very effective in decreasing the muscle tone and improving the motor function without recurrence in long-term.
评估选择性后根切断术（SPR）治疗痉挛型脑瘫的中长期疗效。
回顾性分析1997年1月至2008年1月期间接受SPR治疗的27例痉挛型脑瘫患者，其资料完整且随访时间超过5年。其中男性14例，女性13例，平均年龄10.1岁（范围4 - 19岁）。所有患者均为单纯痉挛型脑瘫，包括双侧痉挛性瘫痪17例，单侧痉挛性瘫痪10例。分别于术前、术后评估患者的肌力、肌张力、行走功能、尖足及交叉步态、膝跳反射、踝阵挛和巴宾斯基征。
所有患者随访5 - 16年（平均9.6年）。未出现明显的腰椎前屈、后伸及侧屈受限、椎体滑脱、脊柱后凸等畸形。末次随访时，与术前相比，髋伸肌、髋屈肌及膝伸肌肌力显著增加（P < 0.05）；而髋外展肌、髋内收肌、膝屈肌、跖伸肌及跖屈肌肌力差异无统计学意义（P > 0.05）。所有患者髋屈肌、髋内收肌、膝屈肌及跖屈肌异常增高的肌张力均有不同程度下降，与术前相比差异有统计学意义（P < 0.05）；髋伸肌、髋外展肌、膝伸肌及跖伸肌差异无统计学意义（P > 0.05）。末次随访时，尖足及交叉步态消失且长期无复发。亢进的膝跳反射消失，但仍有部分患者保留活跃膝跳反射，与术前相比差异有统计学意义（Z = -7.404，P = 0.000）。巴宾斯基征结果31侧为阴性，13侧为阳性，与术前相比差异有统计学意义（Z = -6.897，P = 0.000）。未观察到尖足或交叉步态。术后行走能力显著改善（Z = -4.111，P = 0.000）。
SPR在降低肌张力和改善运动功能方面非常有效，且长期无复发。
