Sindou M, Keravel Y
Department of Neurosurgery, Hospital Neurologique, Lyon, France.
Scand J Rehabil Med Suppl. 1988;17:139-43.
When spasticity becomes severe and harmful, in spite of physical and medical therapy, neurosurgery can give functional improvement. This paper deals with the long term results of Selective Peripheral Neurotomies of the Tibial Nerve and Selective Posterior Rhizotomies in the Dorsal Root Entry Zone, in 123 patients with spastic disorders localized to the limbs. The micro-techniques and intra-operative electro-stimulation for identification of the nervous structures responsible for the spastic components, can give a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1 to 13 year follow-up (5 on average), in 89% of 47 Selective Peripheral Neurotomies of the tibial nerve for spastic foot, in 92% of 53 Selective Posterior Rhizotomies for paraplegia and in 87% of 23 Selective Posterior Rhizotomies for hemiplegia. In the most severe situations ("comfort" indications), correction of the abnormal postures and relief of pain facilitated nursing and physiotherapy. Sometimes there was reappearance of some useful voluntary movements. In the less affected patients ("functional" indications), the suppression of the harmful spastic components made the persistant capacities more effective.
当痉挛变得严重且有害时，尽管进行了物理和药物治疗，神经外科手术仍可改善功能。本文探讨了123例肢体痉挛性疾病患者行胫神经选择性周围神经切断术和背根入髓区选择性后根切断术的长期效果。用于识别导致痉挛成分的神经结构的显微技术和术中电刺激，可在不抑制有用肌张力和不损害残余运动及感觉功能的情况下，大幅降低有害痉挛。对47例因足部痉挛行胫神经选择性周围神经切断术患者中的89%、53例因截瘫行选择性后根切断术患者中的92%以及23例因偏瘫行选择性后根切断术患者中的87%进行了1至13年的随访（平均5年），结果显示手术有效。在最严重的情况下（“舒适”指征），纠正异常姿势和缓解疼痛有助于护理和物理治疗。有时会重新出现一些有用的自主运动。在病情较轻的患者中（“功能”指征），抑制有害的痉挛成分可使持久能力更有效。
