【摘要】：目的:觀察分析SPR手術(shù)治療痙攣型腦癱的遠期臨床療效。資料與方法:選擇1998～2000年期間在濟南市市中區(qū)人民醫(yī)院行SPR手術(shù)的病人34例作回顧性分析。本組病例男28例,女6例,平均年齡8.6歲。(1)癱瘓情況:34例病人均被診斷為痙攣型腦癱,雙側(cè)癱24例,四肢癱8例,單癱2例。(2)并發(fā)癥情況:12例有語言障礙,6例智力低下,在其他醫(yī)院行內(nèi)收肌切斷術(shù)2例,合并扭轉(zhuǎn)性肌張力障礙1例。(3)行走功能:術(shù)前不能獨立行走5例,雙手扶持行走14例,能獨立行走但步態(tài)異常15例。(4)步態(tài)情況:不同程度尖足現(xiàn)象27例,交叉腿、剪刀步態(tài)26例,膝關(guān)節(jié)屈曲12例。(5)肌力:術(shù)前檢查下肢肌力3級者162側(cè),4級者440側(cè),5級者78側(cè)。(6)肌張力:Ⅱ級112側(cè),Ⅲ級352側(cè),Ⅳ級64側(cè)。(7)查體情況:髕陣攣陽性47側(cè),踝陣攣陽性53側(cè),巴彬斯基征陽性63側(cè)。髖關(guān)節(jié)半脫位1側(cè)。(8)術(shù)前常規(guī)X線片檢查,發(fā)現(xiàn)隱性脊柱裂11例。采用選擇性腰骶神經(jīng)后根切斷術(shù)進行治療。經(jīng)過15年+后(16～18年),進行隨訪,比較手術(shù)前后患者肌力、肌張力及肢體功能和步態(tài)的變化,并以此為臨床有效和無效的評估標準。結(jié)果:34例患者均行SPR手術(shù)治療,并全部進入結(jié)果分析。(1)患肢肌力:32例與術(shù)前相當或好于術(shù)前,2例較術(shù)前差。(2)肌張力改善:絕大部分患者肌張力降至正常,平均降低Ⅱ～Ⅲ級。(3)行走功能:腰骶神經(jīng)后根切斷術(shù)后25例(行走能力4～5級)可獨立行走,2例不能行走,其余患者的行走能力都得到不同程度的改善。(4)步態(tài)改善:尖足現(xiàn)象及交叉腿、剪刀步態(tài)均得到不同程度改善。(5)查體情況:絕大部分患者術(shù)后髕陣攣、踝陣攣消失,膝反射及踝反射基本正常。脊柱前凸6例(17.6%),脊柱側(cè)彎5例(14.7%)。(6)臨床效果:臨床有效32例,臨床無效2例�？傆行�94%。結(jié)論:實行手術(shù)個體化,嚴格掌握手術(shù)適應(yīng)癥,準確選擇神經(jīng)后根的切斷比例,加強手術(shù)后功能鍛煉,減少骨損傷,絕大部分患者可取得滿意療效,不同程度地提高和改善下肢運動功能。迄今為止,SPR仍是治療痙攣型腦癱的重要方法。
[Abstract]:Objective: to observe and analyze the long-term clinical effect of SPR operation on spastic cerebral palsy. Materials and methods: from 1998 to 2000, 34 patients who underwent SPR operation in the people's Hospital of the Central District of Jinan were selected and analyzed retrospectively. There were 28 males and 6 females with an average age of 8.6 years. (1) paralysis: 34 cases were diagnosed as spastic cerebral palsy, bilateral paralysis in 24 cases and quadriplegia in 8 cases. (2) complications: 12 cases with language disorder, 6 cases with mental retardation, 2 cases underwent adductor amputation in other hospitals, 1 case complicated with torsion dystonia. (3) walking function: 5 cases were unable to walk independently before operation, 5 cases were unable to walk independently before operation, 2 cases were treated with adductor amputation, 1 case was complicated with torsion muscular dystonia. (4) gait: 27 cases of pointed foot phenomenon, 26 cases of cross leg gait, 26 cases of scissors gait. (5) muscle strength of knee joint flexion in 12 cases. (5) muscle strength: 162 sides of lower limb muscle strength grade 3, 440 sides of grade 4, 78 sides of grade 5. (6) muscle tension: 112 sides of grade 鈪，

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