Hodgkinson I, Bérard C, Jindrich M L, Sindou M, Mertens P, Bérard J
Escale-Service de rééducation fonctionnelle pédiatrique, Centre Hospitalier Lyon-Sud, Lyon, France.
Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):259-67. doi: 10.1159/000099885.
Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields.
In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test.
18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery.
The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.
研究选择性背根切断术（SDR）对痉挛型脑瘫患儿骨科及功能方面的影响。
在一项前瞻性研究中，我们比较了同一组痉挛型脑瘫患儿在接受SDR手术前和术后1年的情况。这些患儿的痉挛状态导致运动技能习得停滞或出现骨科并发症。所有患儿术后均接受了6个月的强化物理治疗。我们通过4分制量表观察痉挛程度，通过3分制量表观察运动分离情况，通过测量活动范围、X线片上的髋关节移位情况评估骨科状况，并通过粗大运动功能测量量表（GMFM）和雅培量表评估功能。所有评估均由同一名物理治疗师进行。我们采用Wilcoxon统计检验比较结果。
18名四肢瘫患儿患有痉挛型脑瘫；他们的平均年龄为9岁（5.5 - 16.5岁）。我们观察到所有肌肉群的痉挛程度均有所降低；仅髋关节外展和伸展时的活动范围增加；髋关节移位情况无变化；GMFM总分增加了3.2%；1名患儿在SDR手术前在雅培量表上被评为IV级，术后被评为V级；3名患儿在SDR术后一年内计划接受骨科手术；16名患儿及其家属对手术结果非常满意。
痉挛程度的降低并不意味着能预防四肢瘫痉挛型脑瘫患儿的骨科问题。然而，我们观察到在目前评估量表范围之外的定性功能有所改善。
