PDF(Pubmed)
Abstract：
BACKGROUND: Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.
METHODS: The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.
RESULTS: There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.
CONCLUSIONS: SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.
METHODS: The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.
RESULTS: There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.
CONCLUSIONS: SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.
摘要：
背景：脑瘫（CP）是儿童运动功能障碍的主要原因。选择性背根切断术（SDR）在长期痉挛控制中起着重要作用。然而,关于SDR对术后痉挛治疗要求和脊柱上效应的影响的数据有限，以及CP患者背神经根的刺激反应。
方法：当前的研究包括35名接受SDR的个体的运动功能结局，痉挛,巴氯芬剂量变化,肉毒毒素注射频率,和痉挛相关的矫形手术。我们还报告了在我们机构接受特别提款权的112个人的刺激反应。
结果：在最后一次随访中，粗大运动功能测量值（GMFM）-66评分存在显着差异，当只考虑走动儿童而不考虑非走动儿童时，该差异仍然存在。在所有随访点，SDR后上肢和下肢的Ashworth评分均显着降低。SDR后巴氯芬剂量和肉毒杆菌毒素注射需求显著下降，但在需要骨科干预方面没有显著差异。总共测试了5502个背神经根，显示右侧刺激强度降低，等级增加，腰骶部水平下降。
结论：SDR可改善短期随访期间的粗大运动评分，但在减少手术后巴氯芬剂量和肉毒杆菌毒素注射需求方面具有额外的益处。它们刺激切片后神经根的反应增加了有限的可用数据和我们对CP中发生的病理变化的理解。
方法：当前的研究包括35名接受SDR的个体的运动功能结局，痉挛,巴氯芬剂量变化,肉毒毒素注射频率,和痉挛相关的矫形手术。我们还报告了在我们机构接受特别提款权的112个人的刺激反应。
结果：在最后一次随访中，粗大运动功能测量值（GMFM）-66评分存在显着差异，当只考虑走动儿童而不考虑非走动儿童时，该差异仍然存在。在所有随访点，SDR后上肢和下肢的Ashworth评分均显着降低。SDR后巴氯芬剂量和肉毒杆菌毒素注射需求显著下降，但在需要骨科干预方面没有显著差异。总共测试了5502个背神经根，显示右侧刺激强度降低，等级增加，腰骶部水平下降。
结论：SDR可改善短期随访期间的粗大运动评分，但在减少手术后巴氯芬剂量和肉毒杆菌毒素注射需求方面具有额外的益处。它们刺激切片后神经根的反应增加了有限的可用数据和我们对CP中发生的病理变化的理解。
