论文部分内容阅读
目的:观察选择性脊神经背根切断术(SDR)联合多模式技术治疗痉挛型脑瘫(SCP)的疗效和安全性。方法:选择青岛大学上海临床医学院上海德济医院神经外科自2016年6月至2019年6月采用单椎板入路的SDR联合术中肌电监测、显微神经外科等微创、精准的多模式技术治疗的31例SCP患者,所有患者术后接受规律的物理治疗。评估并比较患者术前及术后1个月、3个月、6个月的徒手肌力检查(MMT)分级、改良Ashworth分级(MAS)、Berg平衡量表(BBS)评分、粗大运动功能评估表(GMFM)-88评分、功能独立性量表(FIM)评分。结果:与术前比较,术后1、3、6个月患者的MMT分级增加,MAS分级降低,GMFM-88评分增加,BBS评分增加,FIM评分增加,差异有统计学意义(n P<0.05)。与术后1个月比较,术后6个月患者的MMT分级增加,MAS分级降低,GMFM-88评分增加,FIM评分增加,差异有统计学意义(n P<0.05)。与术后3个月比较,术后6个月患者的MAS分级降低,差异有统计学意义(n P<0.05)。31例患者术后均出现下肢一过性肌无力、感觉麻木。n 结论:SDR联合微创、精准的多模式技术是治疗SCP有效、安全的外科治疗方法。“,”Objective:To observe the clinical efficacy and safety of selective dorsal rhizotomy (SDR) combined with multi-modal techniques in spastic cerebral palsy (SCP).Methods:Thirty-one SCP patients, admitted to our hospital from June 2016 to June 2019, were chosen in our study; these patients received SDR combined with multi-modal techniques(single-level laminectomy, and intraoperative electromyography monitoring combined with micro-neurosurgery); and all patients received regular physical therapy postoperatively. Grading of manual muscle test (MMT) and grading modified Ashworth scale (MAS), and scores of Gross Motor Function Measure-88 (GMFM-88), Berg balance scale (BBS) and Functional Independence Measure (FIM) before surgery, and one, three, and 6 months after surgery were evaluated and compared.Results:As compared with those before surgery, significantly increased MMT grading, statistically decreased MAS grading, and significantly increased GMFM-88 scores, BBS scores, and FIM scale scores one, 3, and 6 months after surgery were recorded in these patients (n P<0.05). As compared with those one month after surgery, significantly increased MMT grading, statistically decreased MAS grading, and significantly increased GMFM-88 scores and FIM scores 6 months after surgery were recorded in these patients (n P<0.05). As compared with those 3 months after surgery, statistically decreased MAS grading 6 months after surgery were recorded in these patients (n P<0.05). There were no severe complications as CNS infection, cerebrospinal fluid leakage, incontinence, spondylolisthesis or spinal deformity, but only transient muscle weakness and numbness of lower limbs.n Conclusion:SDR combined with multi-modal techniques is a safe and effective method for patients with SCP, which is minimally invasive, accurate and safe.