選擇性背神經根切除術於處理痙攣型腦性麻痺之成效：初步報告

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

中華民國復健醫學會雜誌

20期（1992 / 12 / 01）

125 - 130

繁體中文

發症的機會亦因而提高。臨床上處理肌肉痙攣的方法很多，包括治療性運動、藥物、支架、酚劑神經阻斷、骨科矯正手術等，以上之治療方法均可維持一定之時效。如何有效且長期的降低過高的肌肉張力，以改善病人的功能，一直是臨床醫師致力研究的課題。榮民總醫院復健醫學部於80年8月與小兒神經外科合作，針對兩位雙邊痙攣型腦性麻痺患者施行選擇性背神經根切除術，分別為四歲及八歲男孩，手術前均可使用助行器行走，但因下肢嚴重的肌肉痙攣，使功能及動作品質大受影響。手術前之評估包括詳細之神經檢查、功能評估、語言及智力測驗、平衡及足壓測試，過程並做錄影。手術由小兒神經外科醫師主持，做兩側由第二腰椎到第一薦椎的選擇性背神經根切除，由復健科醫師以八頻道肌電圖機器施以手術中判讀，以達到切除之高度 選擇性及精確性。手術均進行順利，術後肌肉痙攣顯著降低，下肢感光無明顯障礙，兩位患者住院前後各約一個月，每天接受積極的復健治療。因已無嚴重之肌肉痙攣，故可直接做肌力、耐力及功能訓練，他們的功能及動作品質均呈穩定且持續的改善，將在術後三個月、六個月及十二個月重覆手術前各項評估，以視改善之程度。

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.