摘要目的 探讨神经内镜下选择性脊神经后根切断术(SPR)治疗脑损伤后肢体肌痉挛的效果及安全性.方法 回顾性纳入2015年1月至2016年8月新乡市中心医院神经外科采用SPR治疗的88例脑损伤后肢体肌痉挛患者.术后采用Russman-Gage标准、Ashworth标准评估肢体肌痉挛程度及肌张力.术后3周检测患肢表面肌电和感觉神经、运动神经的传导速度.术后3、8周采用Fugl-Meyer下肢运动功能量表(FMA-L)评估下肢运动功能,采用功能性步行分级(FAC)量表评估步行能力,测量患者的步幅、跨距、步速及趾偏角距离参数.随访患者的临床疗效.结果 88例患者术后肢体肌痉挛均缓解.术后3周,88例患者胫骨前肌的积分肌电值(iEMG)较术前升高[分别为(1.5±0.2)mV、(0.5±0.2)mV,P＜0.001],腓肠肌较术前降低[分别为(0.7±0.3)mY、(1.2±0.2)mY,P＜0.001].头部[(39.7±3.1)ms]和L2后正中部[(18.5±3.5)ms]的皮质体感诱发电位潜伏期均较术前[分别为(34.9±3.5) ms、(13.3±2.3) ms]延长(均P＜0.001);头部[(4.9±1.1) cm/ms]和腘部～L2[(4.8±1.3) cm/ms]感觉神经传导速度较术前[分别为(6.6±1.4)cm/ms、(6.3±1.5)cm/ms]降低(均P＜0.001).术后3、8周,88例患者的FMA-L和FAC量表评分、步幅、跨距及步速均较术前呈升高趋势(均P＜0.05),趾偏角呈下降趋势(P＜0.01).88例患者的随访时间为6.2 ～26.6个月,平均(12.2±6.4)个月.94.3％ (83/88)的患者下肢痉挛缓解;93.7％ (74/79)跟腱反射消失;复查均未见脊柱变形.结论 对脑损伤后肢体肌痉挛患者采用经神经内镜下SPR治疗,可有效解除肢体肌痉挛症状,促进运动功能恢复.

abstractsObjective To evaluate the efficacy and safety of endoscopic selective posterior/dorsal rhizotomy (SPR) in the treatment of limb spasticity following brain injury in adults.Methods A total of 88 patients with limb spasticity following brain injury treated with SPR from January 2015 to August 2016 at Department of Neurosurgery,Xinxiang Central Hospital were retrospectively enrolled into this study.Russman-Gage standard and Ashworth standard were used to evaluate the degree of limb spasticity and muscle tension after operation.Surface electromyography (SMG) and evoked potential (EP) were used to measure the sensory and motor nerve conduction velocities of affected limbs 3 weeks after operation.Lower extremity motor function was assessed with the Fugl-Meyer scale in lower extremity (FMA-L) at 3 and 8 weeks after operation.Walking ability was assessed with the Functional ambulation category (FAC) scale,and parameters of patients' stride,stride distance,stride speed and toe deflection angle distance were measured.All patients were followed up clinically after operation.The follow-up included observing the remission of limb spasticity and reviewing the lumbar spine radiographs.Results The spasticity of extremities was alleviated in 88 patients after operation.Three weeks after operation,the integrated electromyogram (iEMG) of tibialis anterior muscle in 88 patients was higher than that before operation (1.5 ±0.2 mV vs.0.5 ±0.2 mY,P ＜0.001),while the gastrocnemius muscle was lower than that before operation (0.7 ± 0.3 mV vs.1.2 ± 0.2 mV,P ＜ 0.001).After detection,latency of cortical somatosensory evoked potential (SEEP) in the dorsomedian part of the head(39.7 ± 3.1 ms) and L2 (18.5 ± 3.5 ms) was longer than that before operation (34.9 ±3.5 ms,13.3 ±2.3 ms,both P＜0.001).The sensory nerve conduction velocities in head (4.9 ± 1.1 cm/ms) and popliteal region to L2 (4.8 ± 1.3 cm/ms) region were lower than those before operation (6.6 ± 1.4 cm/ms,6.3 ± 1.5 cm/ms,both P ＜0.001).At 3-8 weeks post operation,the scores of FMA-L and FAC scales,stride length,stride distance and stride speed of 88 patients were higher than those before operation (all P ＜ 0.05),while the deflection angle of toes was lower (P＜0.01).The rising trend time of 88 patients ranged from 6.2 to 26.6 months,with an average of 12.2 ± 6.4 months.There were 83 (83/88,94.3％) patients who had relief of spasticity in lower limbs and 74 (74/79,93.7％) whose Achilles tendon reflex disappeared.No spinal deformity was found in the reexamination.Conclusion The neuroendoscopic SPR treatment for limb spasticity after brain injury could effectively relieve the symptoms of limb spasticity and promote the recovery of motor function.It seems safe and worthy of clinical application and promotion.