Subramanian N, Vaughan C L, Peter J C, Arens L J
Department of Biomedical Engineering, University of Cape Town, Observatory, South Africa.
J Neurosurg. 1998 Jun;88(6):1014-9. doi: 10.3171/jns.1998.88.6.1014.
Selective dorsal rhizotomy is a neurosurgical procedure performed for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used.
Eleven children with spastic diplegia (mean age at initial surgery 7.8 years) were evaluated preoperatively in 1985 and then at 1, 3, and at least 10 years after surgery. For comparison, 12 age-matched healthy individuals were also studied. Retroreflective targets were placed over the hip, knee, and ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and analysis of the gait parameters. An analysis of variance yielded a significant time effect (p < 0.05), and post hoc comparisons revealed differences before and after surgery and with respect to the healthy volunteers. The knee and hip ranges of motion (59 degrees and 44 degrees, respectively, for healthy volunteers) were significantly restricted in children with spastic diplegia prior to surgery (41 degrees and 41 degrees, respectively), but were within normal limits after 10 years (52 degrees and 45 degrees, respectively). The knee and hip midrange values (31 degrees and 3 degrees, respectively, for healthy volunteers), indicative of posture, were significantly elevated preoperatively (42 degrees and 15 degrees) and increased sharply at 1 year (56 degrees and 18 degrees), but by 10 years they had decreased to within normal limits (36 degrees and 9 degrees). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point.
Selective dorsal rhizotomy is an effective method for alleviating spasticity. Furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can also be obtained.
选择性脊神经后根切断术是一种用于缓解脑瘫患儿痉挛状态的神经外科手术，但其长期功能疗效仍不明确。作者试图通过一项客观的前瞻性研究来解决这一问题，该研究采用了定量步态分析。
1985年对11例痉挛型双瘫患儿（初次手术时平均年龄7.8岁）进行了术前评估，然后在术后1年、3年和至少10年进行评估。作为对照，还研究了12名年龄匹配的健康个体。在髋、膝和踝关节上放置反光标记物，对每个人的步态进行录像。随后将视频数据输入计算机，以提取和分析步态参数。方差分析显示时间效应显著（p < 0.05），事后比较揭示了手术前后以及与健康志愿者之间的差异。痉挛型双瘫患儿术前膝关节和髋关节活动范围（健康志愿者分别为59度和44度）明显受限（分别为41度和41度），但10年后恢复到正常范围（分别为52度和45度）。反映姿势的膝关节和髋关节中间位置角度（健康志愿者分别为31度和3度）术前显著升高（分别为42度和15度），术后1年急剧增加（分别为56度和18度），但到10年时已降至正常范围内（分别为36度和9度）。步长和速度术后有所改善，但10年后仍未达到正常范围。手术10年后，这些患者不仅活动范围增加，而且能在接近正常的中间位置进行活动。
选择性脊神经后根切断术是缓解痉挛的有效方法。此外，作者提供的证据表明，通过改善步态衡量，还可获得持久的功能益处。
