Aly Ahmed, Elmaghraby Mostafa, Dapaah Andrew, Hall Benjamin, Sneade Christine, Pettorini Benedetta
Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, L14 5AB, UK.
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Childs Nerv Syst. 2024 Dec 18;41(1):61. doi: 10.1007/s00381-024-06720-1.
This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.
A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.
Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.
SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.
本研究调查了选择性背根切断术（SDR）对合并痉挛和肌张力障碍的脑瘫（CP）患者的肌张力障碍和肌张力障碍姿势的影响。
2013年5月至2022年9月在英国一个超区域中心进行了一项前瞻性单中心研究。纳入所有接受SDR治疗的痉挛、肌张力障碍和/或肌张力障碍姿势的儿童。主要结局指标是术前和术后对肌张力障碍姿势的评估。肌张力障碍严重程度采用巴里 - 奥尔布赖特肌张力障碍（BAD）量表进行测量。
257例患者（年龄3 - 18岁）接受了SDR。43例患者有肌张力障碍，52例表现出无肌张力障碍的肌张力障碍姿势。在3个月随访时（n = 29），粗大运动功能分类系统（GMFCS）水平趋于下降，在6个月时（n = 25）恢复到基线水平。2例患者术后需要调整药物。肌张力障碍组的肌张力障碍水平保持不变。在肌张力障碍姿势组中，33例患者无变化，21例有所改善。
对于精心挑选的肌张力障碍或肌张力障碍姿势患者，SDR可能有益，且不会使这些情况恶化。最佳的患者选择、明确的手术目标沟通和多学科参与至关重要。
