摘要目的 随访观察痉挛型脑性瘫痪(简称脑瘫)患儿腰骶部选择性脊神经后根切断术(SPR)对腰椎稳定性的影响.方法 回顾性纳入2012年1月至2017年12月中日友好医院神经外科采用SPR治疗的90例痉挛型脑瘫患儿,平均年龄为(9.5±3.5)岁.采用配对t检验,比较手术前与末次随访时腰椎前凸角(Cobb法)、腰骶角、弓顶距离、前突指数及Cobb角的差异.观察术后腰椎畸形的发生情况.结果 术后随访6～60个月,平均(27.0±12.8)个月.术前前凸角平均为(36.1±1.8)°,术后为(39.9±2.6)°,差异有统计学意义(P =0.029);而腰骶角[(33.1±1.4)°对比(33.6±1.4)°]、弓顶距离[(15.6±1.3)mm对比(17.3±1.2)mm]、前突指数[(14.9±1.7)mm对比(18.7±2.2)mm]及Cobb角[(5.9±0.9)°对比(7.3±0.9)°],手术前后差异均无统计学意义(均P＞0.05).90例患者中,术前9例(10.0％)有腰椎畸形,其中脊柱侧弯7例、腰椎滑脱2例;术后24例(26.7％)患者存在腰椎畸形,其中脊柱侧弯18例,腰椎滑脱6例(均为Ⅰ度滑脱);术前有脊柱侧弯的7例患者,2例在术后有不同程度的改善,5例有所加重.结论 腰骶段SPR对痉挛型脑瘫患儿术后腰椎稳定性不会构成严重影响.

abstractsObjective To investigate the lumbar spine stability in children with spastic cerebral palsy (SCP) following modified selective posterior rhizotomy (SPR).Methods A total of 90 cases of SCP underwent lumbosacral SPR at Neurosurgery Department of China-Japan Friendship Hospital from January 2012 to December 2017 and were retrospectively enrolled into this study.Paired t-test was used to compare the differences of lordosis angle (Cobb's method),lumbosacral angle,arch-vertex distance,Cobb's angle before and after surgery (final follow-up) to observe the occurrence of lumbar spine deformity post operation.Results Postoperative follow-up lasted for 6-60 months with an average of 27.0 ± 12.8 months.The average preoperative and postoperative lordosis angles were 36.1° ± 1.8° and 39.9° ± 2.6° respectively,which had statistical difference (P =0.029).Pre-and post-operative lumbosacral angles [33.1 ° ± 1.4° vs.33.6° ± 1.4°],arch-vertex distance (15.6 ± 1.3 mm vs.17.3 ± 1.2 mm),Cobb's angle[5.9° ±0.9° vs.7.3° ±0.9°].Those difference were not statistically significant (P ＞0.05).Of 90 patients,9 (10.0％) had lumbar deformities before surgery,including 7 cases of scoliosis and 2 cases of lumbar spondylolisthesis.After operation,24 (26.7％) cases had lumbar spinal deformities,18 reported scoliosis,and 6 had Ⅰ ° lumbar spondylolisthesis.Among the 7 cases with scoliosis before operation,2 were improved to different degrees after operation and 5 were aggravated.Conclusion Little effect on lumbar spine stability is found among children with spastic cerebral palsy in long-term study following SPR.