Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.
Department of Orthopedic Surgery, University of Minnesota - Twin Cities, Minneapolis, MN, USA.
Dev Med Child Neurol. 2021 Mar;63(3):336-342. doi: 10.1111/dmcn.14716. Epub 2020 Oct 25.
To compare short-term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy.
This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre-SDR (baseline) and 8 to 36 months post-SDR (follow-up). Transient complications during inpatient stay were quantified.
In total, 21 and 59 children underwent conus and cauda SDR respectively. Ashworth Scale scores were nearly normalized at follow-up. Most physical examination and functional measures exhibited similar baseline to follow-up responses for both groups. From baseline to follow-up, sagittal plane knee kinematics for both groups significantly improved (p<0.01) by 11° at initial contact, 9° to 10° in stance phase, and 4° in swing phase. Sagittal plane ankle kinematics improved more for the cauda group than the conus group in both stance phase (10° vs 2°, p<0.01) and swing phase (13° vs 3°, p<0.01). Post-surgical complications were similar between groups.
Conus and cauda SDR techniques resulted in similar short-term outcomes except in ankle kinematics at follow-up. The cauda group exhibited a large improvement towards dorsiflexion, while there was residual equinus in the conus group despite Ashworth Scale scores normalizing equally in both groups.
Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short-term gait and functional outcomes. Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures. Post-surgical complications were mostly similar between SDR techniques.
比较圆锥部（圆锥）和马尾部（马尾）选择性脊神经后根切断术（SDR）治疗痉挛性脑瘫儿童的短期疗效。
这是一项对 2013 年至 2017 年在单一中心进行的 SDR 的回顾性研究。在 SDR 前不超过 18 个月（基线）和 SDR 后 8 至 36 个月（随访）评估步态和功能结果。量化住院期间的短暂并发症。
共 21 例和 59 例儿童分别行圆锥部和马尾部 SDR。在随访时，Ashworth 量表评分几乎正常化。两组的大多数体格检查和功能测量在基线到随访时都有相似的反应。从基线到随访，两组的矢状面膝关节运动学在初始接触时显著改善（p<0.01），11°在站立相，9°至 10°在站立相，4°在摆动相。与圆锥部组相比，马尾部组在站立相（10°比 2°，p<0.01）和摆动相（13°比 3°，p<0.01）的踝关节运动学改善更多。两组术后并发症相似。
圆锥部和马尾部 SDR 技术的短期疗效相似，除了随访时踝关节运动学的结果不同。在圆锥部组，背屈有明显改善，而在马尾部组，尽管两组的 Ashworth 量表评分都正常化，但仍有马蹄内翻残留。
圆锥部和马尾部选择性脊神经后根切断术（SDR）的短期疗效大多相似。尽管痉挛程度的测量值正常化，但圆锥部 SDR 仍导致残留马蹄内翻畸形。两种 SDR 技术的术后并发症大多相似。
