【摘要】 目的 通过多中心临床研究,探讨新型神经电生理监测协议指导下微创入路选择性神经后根离断术(single-level laminectomy selective dorsal rhizotomy,SL-SDR)联合康复治疗对于痉挛型脑瘫儿童的近期疗效。方法 回顾性分析上海市儿童医院、重庆医科大学附属儿童医院及湖南省儿童医院等于2015年11月至2021年8月期间收治的所有在新型神经电生理监测协议指导下行SL-SDR联合康复治疗,并获得至少6个月随访的痉挛型脑瘫患儿临床资料。收集患儿手术前及手术后末次随访时目标肌群肌张力、肌力、关节活动度、粗大运动功能分级系统(gross motor function classification system,GMFCS)分级及粗大运动功能66项(gross motor function measure-66 items,GMFM-66)评分情况,并评估患儿手术后运动功能变化。结果 共有435例符合入组标准的痉挛型脑瘫患儿纳入研究,其中男249例,女186例;手术年龄(8.2±2.3)岁(3.2～15.5岁)。术前标记目标肌群2 523组,受累关节2 133个。术中离断神经后根(小根)数为(9.3±3.8)枚/例,其中3 849枚(3 849/4 059,94.8%)符合离断50%神经截面积的标准。术后83例(83/435,19.1%)出现短期下肢浅感觉异常,经对症治疗1周后症状缓解,无一例出现长期并发症。患儿均获随访,随访时间(13.1±8.3)个月,目标肌群肌张力、肌力、关节活动度、GFMCS分级及GMFM-66评分均显著改善;术前GMFCS分级为Ⅱ、Ⅲ级者术后粗大运动功能改善情况优于Ⅳ、Ⅴ级者(134/309比8/105,P <0.01);术前GMFM-66评分≥50分者术后GMFM-66评分提升值高于术前CMFM-66评分<50分者[(7.65±3.39)分比(5.01±2.18)分,P <0.01];手术时年龄小于6岁者术后GMFCS分级改善情况好于年龄大于6岁者(106/249比36/165,P <0.01);术后GMFCS分级获改善患儿的平均年龄小于术后GMFCS分级无改善患儿的平均年龄[(6.1±1.0)岁比(11.6±1.7)岁,P <0.01]。结论 新型神经电生理监测协议指导下SL-SDR联合康复治疗肢体痉挛瘫痪型脑瘫安全、有效,术后近期预后良好。更多还原

【Abstract】 Objective To evaluate the efficacy of single-level laminectomy selective dorsal rhizotomy(SL-SDR)guided by novel neuroelectrophysiological monitoring protocol followed by intensive rehabilitation for children with spastic cerebral palsy. Methods For evaluating the changes of motor function,clinical data were retrospectively reviewed for 435 children with spastic cerebral palsy undergoing SL-SDR followed by intensive rehabilitation for at least 6 months from November 2015 to August 2021 at Shanghai Children’s Hospital,Affiliated Children’s Hospital of Chongqing Medical University and Hunan Children’s Hospital. The relevant parameters included objective muscle tone,strength and joint range of movement(ROM). The scores of gross motor function classification system(GMFCS)and gross motor function measure-66 items(GMFM-66)were recorded at preoperation and at least 6 months postoperation. Results There were 249 boys and 186 girls with an average age of(8. 2 ± 2. 3)(3. 2-15. 5)years. And 2,523 objective muscles and 2,133 objective joints were confirmed preoperatively and(9. 3 ± 3. 8)dorsal rootlets resected during SL-SDR. Dorsal rootlets(94. 8%)were removed by > 50%. And 83 cases(19. 1%)had transient superficial paresthesia in lower extremities and recovered within 1 week. There was no long-term side effect of SL-SDR. Within a mean follow-up period of(13. 1± 8. 3)months after SL-SDR,significant improvements occurred with regards to muscle tone,strength,joint ROM,GMFCS level and GMFM-66 score as compared with baseline levels. GMFCS level of children with preoperative GMFCS level Ⅱ/Ⅲ(134/309,43. 4%)was significantly better than that of children with level Ⅳ/Ⅴ(8/105,7. 6%)(P < 0. 01);The improvement of GMFM-66 score in children with preoperative GMFM-66 score > 50 was greater than that in others[(7. 65 ± 3. 39)vs.(5. 01 ± 2. 18),P < 0. 01];The improvement of GMFCS level in children aged under 6 years at the time of operation was significantly better than that in others[(106/249)vs.(36/165),P <0. 01]. The mean age of children with improvements in GMFCS level post-operation was younger than those without improvements[(6. 1 ± 1. 0)vs.(11. 6 ± 1. 7),P < 0. 01]. Conclusion SL-SDR guided by novel neuroelectrophysiological monitoring protocol can safely and effectively treat all types of spastic cerebral palsy and its short-term prognosis is decent.更多还原