Abdennebi B, Bougatene B
Department of Neurosurgery, Salim Zémirli Hospital, El Harrach, Algiers, Algeria.
Acta Neurochir (Wien). 1996;138(8):917-20. doi: 10.1007/BF01411279.
Fifty-eight patients with a mean age of 24 years (range 5 to 65 years) who underwent selective neurotomies (SN) for harmful spasticity focalized to the lower limb are presented. In 43 of the patients who suffered spastic foot, SN was directed to the tibial nerve. In 10 others who had spastic knee flexors, the target was the hamstring branches of the sciatic trunk. In the remaining 5 patients, SN concerned both nerves. The aim of the section was to reduce partially the number of the fascicles conveying the excessive spasticity. A stimulation of the nerve above and below the section is performed to check the effectiveness of surgery on the corresponding muscle(s). At long-term follow-up evaluation (mean duration: 4.2 years), this study shows that 40 patients (i.e., 68.9% of the cases) experienced a better quality of life, related to the disappearance or a notable regression of the spasticity in 72.4% of the cases and to improved motor capacities in 65.5% of the cases. Post-operative complications were few, consisting of talus foot in 2 cases and dysaesthesias of the foot on the plantar aspect in 3 cases. This study shows that SN is able to take its place in the surgical armamentarium for treating disabling localized spasticity when it cannot be successfully controlled by rehabilitation and medical therapy. An appropriate candidate selection and intensive postoperative rehabilitation are mandatory to obtain good and long lasting results.
本文介绍了58例平均年龄24岁（5至65岁）的患者，他们因下肢局限性有害痉挛接受了选择性神经切断术（SN）。在43例患有足部痉挛的患者中，SN针对胫神经。在另外10例患有膝部屈肌痉挛的患者中，目标是坐骨神经干的腘绳肌分支。其余5例患者中，SN涉及两条神经。手术目的是部分减少传递过度痉挛的束支数量。在手术部位上方和下方刺激神经，以检查手术对相应肌肉的有效性。在长期随访评估（平均时长：4.2年）中，本研究表明，40例患者（即68.9%的病例）生活质量得到改善，72.4%的病例痉挛消失或显著减轻，65.5%的病例运动能力得到改善。术后并发症较少，2例出现距骨足，3例出现足底足部感觉异常。本研究表明，当康复和药物治疗无法成功控制致残性局部痉挛时，SN能够在治疗手术手段中占据一席之地。必须进行适当的候选者选择和强化术后康复，以获得良好且持久的效果。
