Selective Postetior Rhixotomy in the management of Spastic Cerebral Palsy
楊翠芬(Tsui-Fen Yang)；潘筱萍(Sheau-Ping Pan)；白偉男(Woei-Nan Bair)；李淑娥(Shu-Er Lee)；詹瑞棋(Rai-Chi Chan)；邱然偉(Jan-Wei Chiu)；高致娟(Chih-Chuan Kao)；鄭玲宜(Ling-Yee Cheng)；黃棣棟(Tai-Tong Wong)；徐道昌(Tao-Chung Hsu)
選擇性背神經根切除術 ； 痙攣型腦性麻痺
|Volume or Term/Year and Month of Publication||
20期（1992 / 12 / 01）
125 - 130
Severe muscular spasticity in cerebral palsy not only causes functional impairment and difficulty in daily care, but also increases the incidence of musculoskeletal complication which includes joint contracture and deformity. Clinically, many ways are used to reduce muscle spasticity, such as therapeutic exercise, antispastic medication, orthosis, phenol intramuscular neuroloysis and orthopedic surgery, etc. Basically, their effects are transient and can last for variable duration. To reduce spasticity efficiently and for long term period if not permenantly is the issue many professionals have been working on. Selective posterior rhizotomy for two spastic diplegic cerebral palsy were performed in August, 1991. They were four and eight years old seperately. Becuase of severe spasticity over lower extremities, they were using walker for ambulation with severe scissoring gait before operation. Their locomotion function and quality of funcition were also impaired. Detailed neurologic examination, motor function evaluation, speech and cognitive evaluation, sitting balance, forceplate test and three minutes' locomotion distance had been done before operation. A narrow laminectomy from L2 to L5 was done by pediatric neurosurgeon during the day of operation. Then using an eight channels EMG machine Viking I to do the intraoperative monitoring, selective posterior rhizotomy of L2 to S1 bilaterally were performed. Both of them tolerated the procedure well. Marked reduction of spasticity over lower extremities were noted immediately after operation without impairment of sensation. They had been hospitalized for about one month and received intensive rehabilitative therapy including muscle strengthening, endurance and functional training during their hospitalization. Their locomotion function and quality of function have been showing stable and continuous improvement after operation. They continue to receive therapy after discharge. The same evaluations which were done before operation will be performed again three, six and twelve months after operation to define the improvement in locomotion function.