北京大学学报(医学版) ›› 2015, Vol. 47 ›› Issue (1): 160-164.

• 论著 • 上一篇    下一篇

腰骶段选择性脊神经后根切断术治疗脑瘫性下肢痉挛状态手术并发症

邵旭,于炎冰△,张黎,徐晓利,许骏,刘江,刘红举,杨文强   

  1. (北京大学中日友好临床医学院神经外科,北京100029)
  • 出版日期:2015-02-18 发布日期:2015-02-18

Complications of selective posterior rhizotomy for lower limb spasticity of cerebral palsy

SHAO Xu, YU Yan-bing△, ZHANG Li, XU Xiao-li, XU Jun, LIU Jiang, LIU Hong-ju, YANG Wen-qiang   

  1. (Department of Neurosurgery, China-Japan Friendship Hospital of Peking University, Beijing 100029, China)
  • Online:2015-02-18 Published:2015-02-18

摘要: 目的:探讨腰骶段选择性脊神经后根部分切断术(selective posterior rhizotomy,SPR)治疗脑瘫性下肢痉挛状态手术并发症的防治。方法:回顾性分析2000年1月至2012年9月经腰骶段SPR治疗并随访1年以上的2 593例脑瘫性下肢痉挛状态患者的临床资料,分析术后并发症发生情况。结果:围手术期并发症情况:呼吸系统并发症包括支气管痉挛5例(0.19%)、吸入性肺炎4例(0.15%);消化系统并发症包括腹胀145例(5.6%)、肠绞痛80例(3.1%);泌尿系统并发症包括暂时性膀胱功能障碍54例(2.1%)、泌尿系感染6例(0.23%);周围神经系统并发症包括下肢无力327例(12.6%)、下肢感觉障碍140例(5.4%);中枢神经系统并发症包括头痛112例(4.32%)、癫痫发作4例(0.15%),无椎管内或颅内感染、椎管内血肿或颅内出血等;一般手术并发症包括腰背部疼痛1 382例(53.3%)、切口感染延迟愈合5例(0.19%)、脑脊液漏8例(0.31%)。随访1年以上中远期并发症发生率:下肢运动能力下降7.33%(190/2 593),下肢感觉障碍5.59%(145/2 593),大小便障碍0.04%(1/2 593),脊柱侧弯7.23%(31/429),胸椎后凸4.2%(18/429),腰椎滑脱10.49%(45/429),长期腰背痛9.72%(252/2 593),未见性功能障碍。结论:腰骶段SPR是治疗脑瘫性下肢痉挛状态的安全的手术方法,选择合适病例、术中精细操作、术中神经电生理监测、加强围手术期管理及术后正规康复训练可有效降低术后并发症的发生率。

关键词: 脊神经根切断术, 脑性瘫痪, 肌痉挛状态, 下肢, 手术后并发症

Abstract: Objective: To investigate the complications of spastic cerebral palsy with selective posterior rhizotomy (SPR).Methods: In the study, 2 593 patients who had undergone SPR from January 2000 to September 2012 were followed-up for at least one year. The complications were classified.Results: Peri-operative complications: pulmonary system complications including bronchial spasm (5 cases, 0.19%) and aspiration pneumonia (4 cases, 0.15%); digestive system complications including abdominal bloating (145 cases, 5.6%) and colic (80 cases, 3.1%); urinary system complications including temporary bladder dysfunction (54 cases, 2.1%) and urinary tract infection (6 cases, 0.23%); peripheral nervous system complications including lower extremity weakness (327 cases, 12.6%) and lower extremity sensory disturbances (140 cases, 5.4%); central nervous system complications including headache (112 cases, 4.3%) and epileptic seizures (4 cases, 0.15%). None spinal or intracranial infection, intraspinal hematoma or intracranial hemorrhage were identified. General surgery complications including back pain (1 382 cases, 53.3%), delay wound healing caused by infection (5 cases, 0.19%) and cerebrospinal fluid leakage (8 cases, 0.31%). Longterm follow-up complications including lower limb decreased exercise capacity (incidence: 7.33%) and lower extremity sensory disturbance (incidence: 5.59%). Urination occurred in only one case and defecation function disturbance with no sexual dysfunction was identified. The incidences of scoliosis, thoracic kyphosis, spondylolisthesis and long-term back pain were 7.23% (31/429), 4.2% (18/429), 10.49% (45/429) and 9.72% respectively.Conclusion: SPR is one of the effective and safe surgical treatments for spastic cerebral palsy. Valid methods should be applied to reduce the incidence of postoperative complications, such as choosing the appropriate patients, meticulously operating in the surgery, assistance of electrophysiological guidance, reinforcing perioperative management and regular rehabilitation training after operation.

Key words: Rhizotomy, Cerebral palsy, Muscle spasticity, Lower extremity, Postoperative complication

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