Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India.
Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India.
World Neurosurg. 2021 May;149:e170-e177. doi: 10.1016/j.wneu.2021.02.055. Epub 2021 Feb 19.
Using an intrathecal baclofen (ITB) pump for severe refractory spastic cerebral palsy is not a viable option in resource-constraint settings. Therefore authors assessed the role of microsurgical dorsal root entry zone-otomy (MDT) as an alternative for patients in whom the circumstances did not allow ITB pump placement.
A prospective clinical study was conducted from August 2016 to July 2020. All patients of spastic cerebral palsy (with III-IV Ashworth grade) who underwent MDT were included. Preoperative and postoperative Ashworth grade and Gross Motor Function Classification System level were assessed along with any change in power, sensation, and bladder functions postoperatively. At last follow-up, the patients' main care providers were asked to rate the effect of surgery (on scale of 0-5) on ease of providing care related to 6 activities of daily living.
Seven patients (5 males, 2 females) of spastic cerebral palsy with an age range of 6-21 years underwent MDT over the study period. Six patients had spastic diplegia, and 1 had spastic hemiplegia. Preoperative Ashworth grade in all patients was 3-4 in various involved muscle groups. Four patients with spastic diplegia underwent MDT at L3-S1 level bilaterally, 2 patients with spastic diplegia and spastic bladder underwent MDT at L3-S4 level bilaterally, and 1 patient with right-sided spastic hemiplegia underwent MDT at C5-T1 level and L3-S1 level on the right side. Postoperative Ashworth grade in all patients improved to 0-1. The improvement in mean Ashworth grade was from 3.14 ± 0.378 preoperatively to 0.29 ± 0.488 (P value = 0.000). Most care providers reported improvement in their ability to do physiotherapy, position, clothe, ambulate, and maintain patient's personal hygiene. Care providers of 6 patients reported that they were likely to recommend MDT to another similar patient.
MDT is a cost-effective tool in deceasing limb spasticity in spastic cerebral palsy, especially for those who cannot afford ITB placement.
在资源有限的情况下，使用鞘内巴氯芬（ITB）泵治疗严重难治性痉挛性脑瘫并非可行选择。因此，作者评估了显微外科背根入区切开术（MDT）作为一种替代方法的作用，适用于因各种原因无法放置 ITB 泵的患者。
这是一项从 2016 年 8 月至 2020 年 7 月进行的前瞻性临床研究。所有接受 MDT 的痉挛性脑瘫（Ashworth 分级 III-IV 级）患者均纳入研究。评估术前和术后的 Ashworth 分级和粗大运动功能分类系统（GMFCS）水平，以及术后肌力、感觉和膀胱功能的任何变化。最后一次随访时，询问患者的主要护理人员，根据日常生活活动（ADL）的 6 项内容，用 0-5 分制来评估手术对护理相关的影响。
研究期间，7 例痉挛性脑瘫患者（5 男 2 女）接受了 MDT 治疗，年龄 6-21 岁。6 例为痉挛性双瘫，1 例为痉挛性偏瘫。所有患者术前各受累肌群的 Ashworth 分级均为 3-4 级。4 例痉挛性双瘫患者双侧行 L3-S1 水平 MDT，2 例痉挛性双瘫伴痉挛性膀胱患者双侧行 L3-S4 水平 MDT，1 例右侧痉挛性偏瘫患者行 C5-T1 水平和右侧 L3-S1 水平 MDT。所有患者术后的 Ashworth 分级均改善至 0-1 级。平均 Ashworth 分级从术前的 3.14±0.378 改善至术后的 0.29±0.488（P 值=0.000）。大多数护理人员表示，他们进行物理治疗、体位摆放、穿衣、行走和保持患者个人卫生的能力有所提高。6 名患者的护理人员表示，他们可能会向其他类似患者推荐 MDT。
MDT 是一种降低痉挛性脑瘫肢体痉挛的经济有效的方法，特别是对于那些无法承受 ITB 泵放置费用的患者。
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