Nicolini-Panisson Renata D'Agostini, Tedesco Ana Paula, Folle Maira Rech, Donadio Márcio Vinicius Fagundes
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Instituto de Neuro-Ortopedia, Caxias do Sul, RS, Brasil.
Rev Paul Pediatr. 2018 Jan 15;36(1):9. doi: 10.1590/1984-0462/;2018;36;1;00005. Print 2018 Jan-Mar.
To identify selection criteria for selective dorsal rhizotomy (SDR) in cerebral palsy, to analyze the instruments used for evaluation, and to describe the characteristics of physical therapy in postoperative protocols.
Integrative review performed in the following databases: SciELO, PEDro, Cochrane Library, and PubMed. The terms in both Portuguese and English for "cerebral palsy", "selective dorsal rhizotomy", and "physical therapy" were used in the search. Studies whose samples enrolled individuals with cerebral palsy who had attended physical therapy sessions for selective dorsal rhizotomy according to protocols and describing such protocols' characteristics were included. Literature reviews were excluded and there was no restriction as to period of publication.
Eighteen papers were selected, most of them being prospective cohort studies with eight-month to ten-year follow-ups. In most studies, the instruments of assessment encompassed the domains of functions, body structure, and activity. The percentage of posterior root sections was close to 50%. Primary indications for SDR included ambulatory spastic diplegia, presence of spasticity that interfered with mobility, good strength of lower limbs and trunk muscles, no musculoskeletal deformities, dystonia, ataxia or athetosis, and good cognitive function. Postoperative physical therapy is part of SDR treatment protocols and should be intensive and specific, being given special emphasis in the first year.
The studies underline the importance of appropriate patient selection to obatin success in the SDR. Postoperative physical therapy should be intensive and long-term, and must necessarily include strategies to modify the patient's former motor pattern.
确定脑瘫选择性背根切断术（SDR）的选择标准，分析所使用的评估工具，并描述术后方案中物理治疗的特点。
在以下数据库进行综合综述：SciELO、PEDro、Cochrane图书馆和PubMed。搜索中使用了葡萄牙语和英语的“脑瘫”“选择性背根切断术”和“物理治疗”等术语。纳入的研究样本为按照方案接受过选择性背根切断术物理治疗课程并描述此类方案特点的脑瘫患者。排除文献综述，对发表时间无限制。
共筛选出18篇论文，其中大部分是前瞻性队列研究，随访时间为8个月至10年。在大多数研究中，评估工具涵盖功能、身体结构和活动领域。后根切断的比例接近50%。SDR的主要适应证包括可步行的痉挛性双侧瘫、存在干扰活动的痉挛、下肢和躯干肌肉力量良好、无肌肉骨骼畸形、肌张力障碍、共济失调或手足徐动症，以及认知功能良好。术后物理治疗是SDR治疗方案的一部分，应强化且具有针对性，在第一年应特别重视。
这些研究强调了选择合适患者对SDR取得成功的重要性。术后物理治疗应强化且长期进行，并且必须包括改变患者既往运动模式的策略。
