Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands; Rehabilitation Centre Klimmendaal, Arnhem, Netherlands.
Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands.
J Rehabil Med. 2024 Sep 10;56:jrm39947. doi: 10.2340/jrm.v56.39947.
Selective neurotomy has been suggested as a permanent treatment for focal spasticity. A systematic literature review was performed to investigate the efficacy of selective neurotomy regarding focal lower limb spasticity.
A systematic search in PubMed, Medline, Cochrane, and Embase databases was carried out. Studies were included if they reported on the following outcomes: muscle tone, muscle strength, pain, ankle range of motion and/or walking speed, after selective lower limb neurotomy in any type of upper motor neuron syndrome.
A total of 25 non-randomized and/or uncontrolled studies and 1 randomized controlled study were selected. The included studies reported improvements in terms of leg muscle tone, pain, passive range of ankle motion, and walking speed.
The results suggest that selective neurotomy is effective for reducing lower limb spasticity, without any negative effects on walking speed. However, this conclusion is primarily based on uncontrolled case series, whereas conclusions on clinical efficacy should preferably be based on comparison with a reference treatment through (randomized) controlled trials. Future studies should also include quantitative, validated functional assessment tools to further establish the efficacy of selective neurotomy as long-lasting treatment for patients with focal lower limb spasticity.
选择性神经切断术被认为是治疗局灶性痉挛的一种永久疗法。本系统文献回顾旨在调查选择性神经切断术治疗局灶性下肢痉挛的疗效。
在 PubMed、Medline、Cochrane 和 Embase 数据库中进行了系统检索。如果研究报告了以下结果，则将其纳入：选择性下肢神经切断术后任何类型的上运动神经元综合征患者的肌肉张力、肌肉力量、疼痛、踝关节活动范围和/或步行速度。
共选择了 25 项非随机和/或非对照研究和 1 项随机对照研究。纳入的研究报告了腿部肌肉张力、疼痛、被动踝关节活动范围和步行速度的改善。
结果表明，选择性神经切断术可有效降低下肢痉挛，且对步行速度无任何负面影响。然而，这一结论主要基于非对照病例系列研究，而关于临床疗效的结论最好应基于与参考治疗方法（随机）对照试验的比较得出。未来的研究还应包括定量、验证有效的功能评估工具，以进一步确立选择性神经切断术作为局灶性下肢痉挛患者长期治疗的疗效。
