Dauleac Corentin, Luaute Jacques, Rode Gilles, Afif Afif, Sindou Marc, Mertens Patrick
Service de Neurochirurgie Fonctionnelle, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France.
Université Lyon I, Université Claude Bernard, Lyon, France.
Neurosurgery. 2023 Apr 1;92(4):862-869. doi: 10.1227/neu.0000000000002287. Epub 2022 Dec 23.
Selective tibial neurotomy (STN) has already demonstrated its effectiveness to reduce foot deformities and spasticity, but assessment according to a goal-centered approach is missing.
To evaluate the effectiveness of STN associated with a postoperative rehabilitation program for the treatment of the spastic foot, according to a goal-centered approach.
Interventional study (before-after STN and rehabilitation program) with observational design including consecutive adult patients with spastic foot, who received STN followed by a rehabilitation program, was performed. The primary outcome measure was the achievement of individual goals at the 1-year follow-up using the Goal Attainment Scaling methodology (with T-score). The secondary outcomes measures were the Modified Ashworth Scale and the modified Rankin Score.
A total of 104 patients were included. At the 1-year follow-up, 228/252 (90.5%) goals were achieved: 62/252 (24.6%) were achieved as initially expected, 86/252 (34.1%) were achieved better than initially expected, and 80 (31.7%) were achieved much better than initially expected. The mean T-score was significantly increased at the 1-year follow-up (61.5 ± 10.5) compared with the preoperative period (38.1 ± 2.9, P < .00001), and 95/104 (91.3%) patients had a T-score ≥50, meaning that these patients have achieved their goals. At follow-up, spastic deformities were all significantly decreased ( P < .0001), the Modified Ashworth Scale was significantly lower for each muscle targeted ( P < .0001), and the modified Rankin Score was significantly decreased ( P < .0001) allowing the patient population to improve from a moderate to a slight disability status.
This study showed that STN, associated with a postoperative rehabilitation program, successfully achieve personal goals in patients with spastic foot.
选择性胫神经切断术（STN）已证明其在减轻足部畸形和痉挛方面的有效性，但缺乏以目标为中心的评估方法。
根据以目标为中心的方法，评估STN联合术后康复计划治疗痉挛性足的有效性。
采用干预性研究（STN和康复计划前后），观察性设计，纳入连续的成年痉挛性足患者，接受STN后进行康复计划。主要结局指标是使用目标达成量表方法（T评分）在1年随访时实现个体目标。次要结局指标是改良Ashworth量表和改良Rankin评分。
共纳入104例患者。在1年随访时，228/252（90.5%）个目标得以实现：62/252（24.6%）个目标按最初预期实现，86/252（34.1%）个目标实现程度优于最初预期，80个（31.7%）目标实现程度远优于最初预期。与术前相比，1年随访时平均T评分显著提高（61.5±10.5），术前为（38.1±2.9，P<.00001），95/104（91.3%）患者T评分≥50，这意味着这些患者实现了他们的目标。随访时，痉挛性畸形均显著减轻（P<.0001），每个目标肌肉的改良Ashworth量表评分显著降低（P<.0001），改良Rankin评分显著降低（P<.0001），使患者群体从中度残疾状态改善为轻度残疾状态。
本研究表明，STN联合术后康复计划能成功实现痉挛性足患者的个人目标。
