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目的探讨改良选择性腰骶段脊神经后根部分切断术治疗痉挛型脑瘫下肢痉挛状态的疗效。方法回顾分析显微手术治疗的1455例痉挛型脑瘫患者下肢痉挛状态,全部采用改良选择性腰骶部脊神经后根部分切断术。结果平均随访21.8个月。随访期间痉挛状态缓解率为94.8%,步态功能改善率为85.6%,生活质量提高率为89.7%。6.2%患者存在随访期间未完全缓解的下肢感觉障碍或异常,肌无力者占15.5%,术后发生一过性尿失禁7例(0.5%),一过性尿潴留17例(1.2%)。随访期间无永久性二便障碍发生。术后下肢痉挛状态不同程度复发72例(4.9%)。结论改良选择性腰骶部脊神经后根部分切断术是治疗痉挛型脑瘫下肢痉挛状态安全有效的手术方法。合理选择病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效、减少并发症及复发的关键。
Objective To investigate the curative effect of improving the spasticity of spastic cerebral palsy lower extremity by partial posterior rhizotomy of selective lumbosacral spinal nerve. Methods Retrospective analysis of microsurgical treatment of 1455 cases of spastic cerebral palsy in patients with lower extremity spasticity, all with modified selective lumbosacral spinal nerve root posterior partial cut. The results were followed up for an average of 21.8 months. During the follow-up period, the remission rate of spasticity was 94.8%, gait function improvement rate was 85.6%, and quality of life improvement rate was 89.7%. 6.2% of the patients had sensory dysfunction or abnormalities of the lower extremities that were not completely relieved during follow-up. Myasthenia gravis accounted for 15.5%, postoperative urinary incontinence was 7 (0.5%) and transient urinary retention was found in 17 (1.2%) patients. No permanent bodily disability occurred during follow-up. Postoperative spasm of lower extremity recurrence in varying degrees in 72 patients (4.9%). Conclusion Improved selective lumbosacral spinal nerve root posterior root partial septal surgery is a safe and effective surgical treatment of spastic cerebral palsy spasticity. Rational selection of cases, familiar with the local anatomy, master the microsurgical skills and adhere to long-term regular rehabilitation training is to ensure efficacy, reduce complications and recurrence of the key.