Msaddi A K, Mazroue A R, Shahwan S, al Amri N, Dubayan N, Livingston D, Moutaery K R
Department of Neurosurgery, Riyadh Armed Forces Hospital, Saudi Arabia.
Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):251-8. doi: 10.1159/000099884.
Spasticity represents the most handicapping sequelae of cerebral palsy in children. In this study, 28 children with spastic cerebral palsy were treated over the last 4 years by microsurgical selective peripheral neurotomy: 28 times the posterior tibial nerve for spastic foot deformity, 3 times the ulnar and median nerves for spastic flexion of wrist and fingers, 2 times the sciatic nerve for spastic knee flexion associated with spastic foot deformity and 3 times obturator nerves for spastic adductors. Results on spasticity with follow-up ranging from 3 to 48 months were as follows: spastic foot deformity was corrected in all patients with pure spasticity, 2 out of the 3 children with ulnar and median neurotomy improved, knee flexion and hip adduction were improved in the other 5 patients. Selective peripheral neurotomy is an effective procedure in the treatment of segmental harmful spasticity after failure of a well-conducted conservative treatment associating physiotherapy and antispasmodic medications. It must be performed before the fixed deformities and other orthopedic complications arise.
痉挛是儿童脑瘫最具致残性的后遗症。在本研究中，过去4年里对28例痉挛型脑瘫患儿进行了显微外科选择性周围神经切断术治疗：针对痉挛性足畸形切断胫后神经28次，针对手腕和手指痉挛性屈曲切断尺神经和正中神经3次，针对伴有痉挛性足畸形的痉挛性膝关节屈曲切断坐骨神经2次，针对痉挛性内收肌切断闭孔神经3次。随访3至48个月的痉挛情况结果如下：所有单纯痉挛型患者的痉挛性足畸形均得到矫正，3例接受尺神经和正中神经切断术的患儿中有2例病情改善，另外5例患者的膝关节屈曲和髋关节内收情况得到改善。在充分实施结合物理治疗和抗痉挛药物的保守治疗失败后，选择性周围神经切断术是治疗节段性有害痉挛的有效方法。必须在出现固定畸形和其他骨科并发症之前进行该手术。
