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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (01) : 19 -22. doi: 10.3877/cma.j.issn.2095-123X.2021.01.005

所属专题： 文献；

周围神经疾患

椎板间入路脊神经后根切断术治疗下肢痉挛性瘫痪
陈业涛1, 吴月奎1,†(), 苗素华1, 张玉琪1   
  1. 1. 100040　北京，清华大学玉泉医院神经外科
  • 收稿日期:2021-01-17 出版日期:2021-02-15
  • 通信作者: 吴月奎

Posterior rhizotomy with interlaminar approach for spastic diplegia in cerebral palsy

Yetao Chen1, Yuekui Wu1,†(), Suhua Miao1, Yuqi Zhang1   

  1. 1. Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100049, China
  • Received:2021-01-17 Published:2021-02-15
  • Corresponding author: Yuekui Wu
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陈业涛, 吴月奎, 苗素华, 张玉琪. 椎板间入路脊神经后根切断术治疗下肢痉挛性瘫痪[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(01): 19-22.

Yetao Chen, Yuekui Wu, Suhua Miao, Yuqi Zhang. Posterior rhizotomy with interlaminar approach for spastic diplegia in cerebral palsy[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(01): 19-22.

目的

评估椎板间入路脊神经后根切断术（SPR）治疗下肢痉挛性瘫痪的疗效及安全性。

方法

回顾性分析清华大学玉泉医院神经外科自2019年7月至2020年4月行椎板间入路SPR治疗的20例下肢痉挛性瘫痪患者的临床资料，术后随访1年，对患者的一般资料、治疗前后改良Ashworth量表（MAS）和粗大运动功能分级系统评估量表（GMFCS）等数据进行分析。

结果

本组20例患者全部完成椎板间入路操作，术后MAS分级及GMFCS评分较术前明显改善。

结论

椎板间入路对骨性结构无破坏，对脊柱稳定性影响更小，同时不增加手术风险，是暴露神经根更合理的术式。

关键词: 椎板间入路, 下肢痉挛性瘫痪, 脊神经后根切断术
Objective

To evaluate the efficacy and safety of selective posterior rhizotomy (SPR) through interlaminar approach in the treatment of spastic paralysis of lower limbs.

Methods

The clinical data of 20 patients with spastic paralysis of the lower extremities treated by SPR through interlaminar approach, admitted to Neurosurgery Department of Yuquan Hospital of Tsinghua University from July 2019 to April 2020, were retrospectively analyzed. The patients were followed up for 1 year. The general data, modified Ashworth score (MAS) and gross motor function classification system score (GMFCS) before and after surgery were analyzed.

Results

All the 20 patients completed the operation of interlaminar approach. The scores of MAS and GMFCS were significantly improved after operation.

Conclusion

Interlaminar approach has no damage to the bony structure, less impact on the stability of the spine, and does not increase the risk of operation, so it is a more reasonable operation to expose the nerve root.

Key words: Interlaminar approach, Lower limb spastic paralysis, Posterior rhizotomy
图1 选择性脊神经后根切断术术中资料
表1 20例患者股四头肌、股二头肌和小腿三头肌术前及术后MAS分级统计
MAS分级 股四头肌 股二头肌 小腿三头肌
术前 术后 术前 术后 术前 术后
0 0 5 0 5 0 10
1 1 9 0 15 2 10
1+ 10 6 3 0 3 0
2 7 0 13 0 12 0
3 2 0 3 0 2 0
4 0 0 1 0 1 0
表2 20例患者术前及术后GMFCS评分统计
GMFCS评分 术前 术后
Ⅰ 1 5
Ⅱ 6 11
Ⅲ 7 3
Ⅳ 5 1
Ⅴ 1 0
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