以選擇性背側神經根切除術及肌內酚劑神經阻斷術治療腦性麻痺病童痙攣之成效比較：初步報告

The Comparison Between Selective Posterior Rhizotomy and Phenol Intramuscular Neurolysis on the Treatment of Children with Cerebral Palsy: Preliminary Report

黃美涓(May-Kuen Wong) ； 陳嘉玲(Chia-Ling Chen) ； 雷大雅(Tai-Ngar Lui) ； 黃維彬(Wei-Pin Hwang) ； 蔡幸蓉(Hsing-Jung Tsai) ； 鄧復旦(Fuk-Tan Tang)

《中華民國復健醫學會雜誌》 25卷2期 (1997/12) Pp. 129-138

摘要

嚴重的肌肉痙攣常會影響腦性麻痺患者的功能，如何有效且長期地降低過高的肌肉張力，一直是臨床醫師致力研究的課題。本研究目的乃想要了解選擇性背側神經根切除術及肌內酚劑神經阻斷術治療腦性麻痺病童的效果。共收集31位純粹性痙攣型腦性麻痺病童，年齡在３至17歲，將之分成三組，A組接受選擇性背側神經根切除術及復健治療，B組接受肌內酚劑神經阻斷術及復健治療，及C組僅接受保守復健治療，當做對照組。手術前或復健前之臨床評估包括肌肉張力，手部握力檢查，運動功能及日常活動評估。於術後再重覆術前之評估。腦性麻痺病童經三種不同的治療後，肌肉張力的改善，以選擇性背側神經根切除術最為明顯，肌內酚劑神經阻斷術次之。上肢之肘縮肌之肌肉張力只有選擇性背側神經根切除術後有顯著的改善，但此三組在雙手握力上皆沒有顯著的改善。因此，對於較嚴重且廣泛性之肌肉痙攣，以選擇性背側神經根切除術較適應，至於較局部的肌肉痙攣則以肌內酚劑神經阻斷術為佳。其中3位病童由原本不會走路至開完刀後可用助行器走路，運動功能及日常活動的改善雖亦以選擇性背側神經根切除術較為顯著，但未達統計學上的差別，有可能是因追蹤的時間太短，希望將來能做長期的追蹤以瞭解其長期的療效。

關鍵字

腦性麻痺 ； 選擇性背側神經根切除術 ； 肌內酚劑神經阻斷術 ； 預後

並列摘要

Severe spasticity often causes functional impairment in children with cerebral palsy. It is the
issue that professionals have been working on to reduce the spasticity effectively and permanently. This study wants to find out the comparative effectiveness between the selective posterior rhizotomy and phenol intramuscular neurolysis on the treatment of the children with cerebral palsy. We collected 31 children with spastic cerebral palsy, aged 3 to 17, and divided the children into three groups. Group A received selective posterior rhizotomy and rehabilitation. Group B received phenol intramuscular neurolysis and rehabilitation. Group C received rehabilitation only. The preoperative evaluations included muscle tone by modified Ashworth scale, grasp strength of both hands, motor functions as well as activities of daily living by Minear's classification. The same evaluations were done 3 months later after treatments, to define the improvement. There were significant improvements in the muscle tones of hip adductors, ankle dorsiflexors and elbow flexors. Most were in the group A, followed group B. There was no significant change in the grasp strengths of hands among different treatments, even though it had significant change in the muscle tone of elbow flexors in group A. Therefore, the phenol intramuscular neurolysis was indicated for localized spasticity, and the selective posterior rhizotomy was prefered in severe and diffuse spasticity. Three children with cerebral palsy could ambulate with walker from non-walker after selective posterior rhizotomy. There was no significant difference among different treatments, although it showed improvement by using selective posterior rhizotomy for motor function as well as the activities of daily living by Minear's classification. The duration of follow-up may be too short or the subjects group was too small to detect the significant change. Further research and study are needed to find out the long-term effect.

並列關鍵字

cerebral palsy ； selective posterior rhizotomy ； phenol intramuscular neurolysis ； outcome