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目的 :用周围神经侧侧吻合术治疗肢体痉挛性脑瘫并探讨其机制。方法 :对 16例肢体痉挛性脑瘫患者采用正常神经干与病变神经干的侧侧吻合术 ,即将支配痉挛肌群的主要神经干与相对正常的邻近神经干的近端显露出 5～ 6cm后相互靠拢 ,切开两神经相邻面的神经外膜和束膜 1～ 2cm ,直至神经纤维裸露后相互紧密对合再吻合其束外膜。结果 :经 10～ 39个月 (平均 2 4个月 )的随访 ,所有患者的肢体痉挛、畸形均有明显的缓解 ,其中 6例患儿已无明显的痉挛发作 ,恢复了患肢的主要功能 ,并随着时间的延长而继续改善。未发现供体神经功能明显障碍。结论 :周围神经侧侧吻合术是治疗肢体痉挛性脑瘫的有效方法之一 ,术后痉挛肌群可获得部分正常的神经支配从而改变大脑皮层定位。
OBJECTIVE: To treat limb spastic cerebral palsy with lateral nerve anastomosis and to explore its mechanism. Methods: Sixteen cases of limb spastic cerebral palsy patients with normal trunk and diseased nerve trunk lateral anastomosis, which will dominate the muscle spasm of the main trunk and the relative normal proximal nerve trunk revealed 5-6cm proximal to each other Closer, incision of the two nerves adjacent to the surface of the epineurium and fascia 1 ~ 2cm, until the nerve fibers are barely close to each other and then match the beam of their outer membrane. Results: After 10 to 39 months (mean, 24 months), all patients had obvious symptoms of limb spasm and deformity. Six of them had no obvious spasticity and recovered the main function of limb , And continue to improve as time goes on. No significant neurological dysfunction was found in donor. Conclusion: Peripheral nerve anastomosis is one of the effective methods for the treatment of spastic cerebral palsy. Postoperative spastic muscle can obtain partial normal innervation to change cerebral cortex localization.