摘要
目的观察腰骶段选择性脊神经后根部分切断术(SPR)治疗痉挛型脑性瘫痪(CP)的手术并发症及其防治策略。方法回顾性纳入2003年3月至2016年11月于北京大学第一医院丰台医院神经外科行腰骶段SPR手术并获1年以上随访的痉挛型CP患者508例。采用改良Ashworth痉挛量表评级标准评估手术疗效(≤2级为痉挛缓解),观察围手术期(手术后至出院前)和中远期并发症(随访>1年)的发生率,分析发生的原因、防治措施及转归等。结果508例患者中,围手术期痉挛缓解率为93.7%(476例)。其中183例(36.0%)出现围手术期并发症,包括下肢无力76例(15.0%),腹胀、腹痛39例(7.7%),下肢感觉障碍29例(5.7%),低颅压性头痛18例(3.5%),暂时性尿潴留9例(1.8%),切口愈合不良5例(1.0%),切口脑脊液漏3例(0.6%),切口感染2例(0.4%),吸入性肺炎2例(0.4%)。76例下肢无力患者中,65例(85.5%)经康复锻炼后改善;29例下肢感觉障碍中,25例(86.2%)转为中远期并发症。所有患者随访17~36个月,平均(22.5±5.4)个月。508例中,共174例(34.3%)出现中远期并发症,其中长期腰背痛51例(10.0%),脊椎不稳或半脱位38例(7.5%),下肢运动功能下降31例(6.1%),脊柱侧弯29例(5.7%),下肢感觉障碍25例(4.9%)。结论腰骶段SPR治疗痉挛型CP有效率高。围手术期并发症多为暂时性,经正确处理多可在术后2周内痊愈;中远期并发症一般不会对患者的生命质量构成严重影响。
Objective To study the complications of lumbosacral selective posterior rhizotomy (SPR) for the treatment of spastic cerebral palsy and to provide the prevention strategies. Methods We retrospectively reviewed the surgical outcome and postoperative complications of 508 patients with spastic cerebral palsy who underwent SPR surgery at Department of Neurosurgery of Beijing Fengtai Hospital, The First Hospital of Peaking University from March 2003 to November 2016 and were followed up for more than one year. The complications were divided into 2 main categories: perioperative complications (from post operation to discharge) and medium to long-term (follow-up of over 1 year) complications. Incidence, causes, treatment approaches of complications as well as outcomes were analyzed. Results A total of 508 patients were included in this cohort. The overall response rate (modified Ashworth spasm scale≤2 grade) was 93.7% (476/508). Perioperative transient complications included lower extremity weakness in 76 (15.0%) cases, abdominal pain in 39 (7.7%), lower extremity sensory deficit in 29 (5.7%), headache related to low intracranial pressure in 18 (3.5%), transient urinary retention in 9 (1.8%), slow incision healing in 5 (1.0%), cerebrospinal fluid leakage in 3 (0.6%), incision infection in 2 (0.4%), and aspiration pneumonia in 2 (0.4%). All patients were followed up for 17-36 months, with an average of 22.5±5.4 months. Medium to long-term complications during follow-up included chronic back pain in 51(10.0%) cases, instability or subluxation of spine in 38 (7.5%), lower extremities dyskinesia in 31 (6.1%), scoliosis in 29 (5.7%), and lower extremity sensory deficit in 25 (4.9%). Conclusions The operation of SPR seems to be highly effective for the treatment of spastic cerebral palsy. Perioperative complications are mostly transient and can be resolved within 2 weeks following proper treatment. Medium to long-term complications usually have no significant negative effect on the patient's quality of life.
作者
桑林
郑重
解飞
葛留锁
周峰
马延山
Sang Lin;Zheng Zhong;Xie Fei;Ge Liusuo;Zhou Feng;Ma Yanshan(Department of Neurosurgery,Beijing Fengtai Hospital ,The First Hospital of Peking University,Beijing 100971 ,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2019年第1期16-19,共4页
Chinese Journal of Neurosurgery
关键词
脑性瘫痪
手术后并发症
脊神经后根切断术
Cerebral palsy
Postoperative complications
Selective posterior rhizotomy
