Verreydt Ineke, Hanssen Britta, Molenaers Guy, De Beukelaer Nathalie, Vandekerckhove Ines, Papageorgiou Eirini, Huenaerts Catherine, Ortibus Els, Van Campenhout Anja, Desloovere Kaat
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Dev Med Child Neurol. 2025 Jun;67(6):812-820. doi: 10.1111/dmcn.16162. Epub 2024 Nov 18.
To investigate the effect of selective dorsal rhizotomy (SDR) on an integrated outcome set 1-year post-SDR, in a cohort of children with spastic cerebral palsy (CP).
Fifteen children with bilateral spastic CP (median age 8 years 8 months [interquartile range 3 years 3 months], 11 males, four females, eight in Gross Motor Function Classification System (GMFCS) level II, seven in GMFCS level III) were measured pre- and 1-year post-SDR. Clinical scales and goniometry assessed plantar flexor spasticity, range of motion, strength, and selectivity. Spasticity was also quantified via an instrumented assessment. Medial gastrocnemius macroscopic muscle morphology (absolute and normalized muscle belly, tendon and muscle-tendon unit length, cross-sectional area, muscle volume) was assessed using ultrasound. Gait profile score, ankle and knee gait variable scores, walking speed, cadence, and step length were extracted from gait analysis. Gross motor function was assessed using the Gross Motor Function Measure-66 item set. Wilcoxon signed-rank test was used to analyse pre- and post-SDR changes. A reference database was used to qualitatively judge muscle growth post-SDR with respect to muscle growth of children with spastic CP without SDR intervention.
Significant changes (p < 0.05) were seen for spasticity, selectivity, all absolute morphology parameters, normalized tendon and muscle-tendon unit length, and all gait parameters, except walking speed and cadence. Muscle growth of children with and without SDR was comparable.
SDR is an effective spasticity reducing treatment and does not adversely affect natural muscle growth in spastic CP.
在一组痉挛型脑瘫（CP）儿童中，研究选择性背根切断术（SDR）术后1年对综合结局指标的影响。
对15例双侧痉挛型CP儿童（中位年龄8岁8个月[四分位间距3岁3个月]，男11例，女4例，8例处于粗大运动功能分类系统（GMFCS）Ⅱ级，7例处于GMFCSⅢ级）在SDR术前及术后1年进行测量。采用临床量表和角度测量法评估跖屈肌痉挛、活动范围、力量和选择性。还通过仪器评估对痉挛进行量化。使用超声评估腓肠肌内侧宏观肌肉形态（绝对和标准化的肌腹、肌腱及肌-腱单元长度、横截面积、肌肉体积）。从步态分析中提取步态轮廓评分、踝关节和膝关节步态变量评分、步行速度、步频和步长。使用粗大运动功能测量-66项集评估粗大运动功能。采用Wilcoxon符号秩检验分析SDR术前和术后的变化。使用参考数据库定性判断SDR术后肌肉生长情况，并与未接受SDR干预的痉挛型CP儿童的肌肉生长情况进行比较。
痉挛、选择性、所有绝对形态学参数、标准化肌腱及肌-腱单元长度以及除步行速度和步频外的所有步态参数均有显著变化（p < 0.05）。接受和未接受SDR治疗的儿童肌肉生长情况相当。
SDR是一种有效的减轻痉挛的治疗方法，对痉挛型CP患儿的自然肌肉生长无不利影响。
