To Research The Clinical Curative Effect Of Improved Selective Posterior Rhizotomy In 91 Spastic Cerebral Palsy Patients Injuried Pyramidal Tract

Objective: To observe the curative effect of improved selective posterior rhizotomy in spastic cerebral palsy patients injuried pyramidal tract .Methods: Collected 91 spastic celebral plasy patients injuried pyramidal tract from February 2007 to September 2008,of which 69 cases were male, female 22 cases,64 cases were in 4-14-year-old,the others were15-24-year-old .All patients were implemented an improved selective posterior rhizotomy.Getted into the subdural cavity through each half neural scute from up to down, and retainned the small joints both side, maked carefully out the posterior root, and then divided them into 4 to 10 small beams, each beam was cutted off 5~10mm in the same plane by the same percentage. The amount of bleeding during operation,the time taken in operation,complications,walking ability in postoperation,the improvement of muscular tension,the gait and the pathologic reflex were observered.Results: The shortest operation time was 60 minutes,and the longest was 180 minutes.The average time for 2 segments was about 90 minutes,It needed to extend the operation time about 20 minutes each additional segment; The least amount of bleeding was 15ml and the most was 600ml,66 cases were lower 50ml,17 were between 50ml and 100ml,and the other were more than 100ml. 5 cases needed blood transfusion,all of them were more older than 14 years,and 4 cases were operated more than four segment among them; After opration ,2 cases had headache,vomiting,, 3 cases had delayed wound union, 2 cases had short-term involuntary tremor of lower limbs ,1 case had urinary retention,2 cases amyasthenia slightly;81 cases` spasm was relieved completely, 10cases` spasm was improved apparently , the total efficiency was 100%; According to WangBo's method ,43 cases had score 5 in walking ability, 30 cases had score 4 and 12 cases had score 3,the total efficiency was 93.5%,there was significant difference between preoperative and postoperative as p<0.01with paired-sampies t test ;49 cases improved the gait apparently,and the others improved slightly,the total efficiency was 82.4%; After operation, about 17 cases the knee hyperreflexia (including trepidation sign)disappeared completely,and 5 cases received some of improvement .60 cases ankle clonus were relieved ,27 cases were alleviated.Babinski sign were relieved in all patients.Conclusion: Improved selective posterior rhizotomy in the treatment of the spastic cerebral palsy injuried pyramidal tract shows the character of shorter operative time, less bleeding, fewer complications, obviously improving the muscular tension,gait and pathologic reflex.