Observation And Analysis Of Long-term (>15years) Effects On Selective Posterior Rhizotomy For Treatment Of Spastic Cerebral Palsy In 34 Cases

Objective:Observation and analysis of long-term(>15years)effects on selective posterior rhizotomy for treatment of spastic cerebral palsy in 34 cases.Methods:Thirty-four patients with cerebral palsy ,who underwent SPR in ji nan city central district people’s hospital between 1998～2000,were selected to analyze retrospectively the long-term therapeutic effects of SPR .The group includes 28 males and 6 females,the average age is 8.6 years.(1)Palsy:All the 34 cases were diagnosed as spastic cerebral palsy,24 cases of diplegia,8 cases of tetraplegia,2 cases of monoplegia.(2)Complication: There were 12 cases of language disorder,6 cases of mental retardation,2 cases of adductor disruption in other hospital before operation,and 1 case of torsion spasm.(3)Walking:Five patients could not walk without supporting before operation,14 cases could walk limpingly with both hands pulled,and 15 patients could walk independently with gait abnormality.(4)Gait:There were 27 cases of sharp foot to different extents,26 of crossing leg or scissors gait,and 12 cases of knee joint bent.(5)Muscle strength:Preoperative examination showed that grade Ⅲ strength was found in 162 sides of lower extremities,IV in 440 sides,and V in 78 sides.(6)Muscular tension:There were 112 sides of grade Ⅱ,352 sides of grade III,and 64 sides of gradeⅣ.(7)Physical examination:There were 47 sides of patella clonus,53 sides of ankle clonus,63 sides of Babinski Sign(positive),1 side of partial dislocation of hip joint.(8)X-ray :Preoperative routine X-ray examination showed that there were 11cases of cryptomerorachischisis.Selective posterior rhizotomy(lumbosacral dorsal root nerves)was performed in the treatment.After 15 +years follow-up,muscle strength,muscular tension,limb function and gait were measured and compared before and after operation ,which were used as evaluation criteria of effectiveness or ineffectiveness.Results:All the 34 patients underwent operation treatment ,and were involved in the result analysis.(1)Muscle strength of affected extremity:Muscle strength was improved or unchanged in 32 cases,and was decreased only in 2 cases .(2)Muscle tension:Muscle tension of affected extremity was recovered to normal or nearly normal in almost all of the 34 cases,decreased averagely grade Ⅱ-Ⅲ.(3)Walking ability:After SPR on lumbosacral dorsal root nerves,25 patients(4 grade and 5 grade)could walk independently,2 patients could not walk.The rest of patients gained an obvious improvement in walking ability to different extents.(4)Gait:Sharp foot ,crossing leg and scissors gait were improved to different extents.(5)Physical examination:Patella clonus and ankle clonus disappeared in almost all of the 34 patients after operation,knee jerk and ankle jerk was recovered or relieved to normal.Lordosis and lateral curvature were found in 6 cases and 5 cases.(6)Clinical effect:After 15 years (16～18 years) ,effectiveness was in 32 cases,ineffectiveness in 2 cases,and the total effective rate was 94%.Conclusion:Actualizing individualized operation,understanding operative indication strictly,confirming rates of dorsal root nerve fibers dissection,strengthening postoperative functional training,decreasing bone injury,most patients can have satisfactory effects,and their motor function is improved and promoted to different extents.Up till now,SPR is still an important surgical therapy for spastic cerebral palsy.