Decq P, Cuny E, Filipetti P, Fève A, Kéravel Y
Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil.
Neurochirurgie. 1998 Sep;44(3):175-82.
The aim of this study was to review the principle of peripheral neurotomy for the treatment of lower limb spasticity. The importance of clinical assessment is stressed (with particular focus on motor block) for determining the best surgical indications.
Between 1989 and 1997, 392 neurotomies were performed in 277 patients in the neurosurgery department of the Henri Mondor Hospital, Créteil, France. Surgical technique consisted in partial and segmental resection, involving each motor collateral branch of muscles with excessive spasticity. For the lower limb, the most frequent neurotomy was performed on collateral branches of the posterior tibial nerve (66%) for the spastic foot.
Preoperative motor block provided the advantage of "mimicking" the effect of the neurotomy and therefore gave the patients an idea of the expected result of surgery. For the spastic foot, posterior neurotomy led to the disappearance of ankle clonus in all patients. When antagonist muscles were present, splints were no longer needed after neurotomy. Cinematic analysis showed that tibial neurotomy improved angular variations of the second rocker of the ankle during stance.
Peripheral neurotomies are simple and safe procedures for the treatment of lower limb spasticity and should be routinely used in general neurosurgery practice.
本研究旨在回顾周围神经切断术治疗下肢痉挛的原理。强调了临床评估（尤其关注运动阻滞）对于确定最佳手术适应症的重要性。
1989年至1997年间，法国克雷泰伊亨利·蒙多医院神经外科对277例患者实施了392例神经切断术。手术技术包括部分和节段性切除，涉及痉挛过度的肌肉的每个运动侧支。对于下肢，最常见的神经切断术是针对痉挛性足部对胫后神经的侧支进行（66%）。
术前运动阻滞具有“模拟”神经切断术效果的优势，因此让患者对手术预期结果有了概念。对于痉挛性足部，后侧神经切断术使所有患者的踝阵挛消失。当存在拮抗肌时，神经切断术后不再需要夹板。电影分析表明，胫神经切断术改善了站立时踝关节第二摆动期的角度变化。
周围神经切断术是治疗下肢痉挛的简单且安全的手术，应在普通神经外科实践中常规使用。
