关键词:脑性麻痹;选择性脊神经后根切断术
摘要 目的:探讨轻度脑瘫的治疗方法及软组织手术适应证。方法:34例随机分两组,A组软组织手术组17例,行不同的软组织矫形术;B组SPR手术组17例,行神经后根不同比例的切除术。结果:SPR手术组术后,痉挛性症状全部消失,肌张力恢复正常,尖足行走及剪刀步消失,腱反射亢进术后1个月后消失,踝阵挛及病理反射亦全部消失。软组织手术组,痉挛性症状术后不能消失。肌张力不变,尖足行走消失,腱反射仍亢进。功能评价:所有患儿术前均不能单腿站立或站立不稳,在SPR手术组的17例中,术后半年能较稳定的单腿站立者10例,占58.8%,而软组织手术组17例中,术后半年能较稳定的单腿站立只有8例,占47.1%,两组患儿术后均能较稳定的在宽广场地上行走,但SPR组术后对躯干的控制能力较软组织手术组好。表现为行走稳定,左、右转动自如。结论:两者均能较明显的改善行走的步态,但各自不同。
Selective PosteriorRhizotomy and Soft Tissue Operation on Spastic Ce rebral Palsy
Wang Qiugen, Wu Yuesong, Nian Shensheng, et al. Department of Orth opaedics,
Shanghai Changhai Hospital, Shanghai 200433
Abstract Objective: To compare the results of selectiveposterior rhizotomy(SPR)and soft tissue operation on children with spastic cerebral palsy.Methods: Thirty-four children with cerebral palsy were randomized into two groups:A) 17patients underwent soft tissue corrective surgery and B) 17 patients underwent SPR.Results: In group A there was residual spasm. Musculart ension remained unchanged andtiptoeing disappeared. Hyperreflexia persisted. In group B spasm was eliminated. Musculartension returned to normal. Tiptoeing an dscissors gait disappeared. Hyperreflexiadiminished one month post-operatively. Both groups showed improvement in gait. Morepatients from group A than group B could stand steadily on one foot six monthspost-operatively(10 vs 8). Group B patients had better control of trunk than group Aevidenced by steadier gait and easier turning of the body. Conclusion: Both soft tissueoperation and SPR improved the gait of children with cerebral palsy, although the benefitof each operation may differ.
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