目的 探讨高选择性周围神经部分切断术(HSPN)治疗上肢痉挛性偏瘫的疗效。方法 回顾性分析应用HSPN治疗的上肢痉挛性偏瘫29例患者的临床资料,随访时间6个月。比较患者手术前后不同时间点肌张力、肌力、疼痛的情况和生活能力。结果 屈肘肌肌张力术后1周(1.48±0.51)、术后6个月(2.21±0.73)较术前(3.93±0.80)均降低,差异有统计学意义(P<0.05);屈腕肌肌张力术后1周(1.41±0.50)、术后6个月(1.69±0.81)也较术前(4.13±0.71)降低,差异有统计学意义(P<0.05),术后6个月屈腕肌肌张力评分较术后1周增加,但仍低于术前水平。患者屈肘肌力术后1周(3.14±0.35)较术前(3.55±0.51)降低,术后6个月(3.34±0.48)较术后1周增加,但差异均无统计学意义;屈腕肌力术后1周(2.41±0.57)较术前(3.28±0.80)降低,术后6个月(2.97±0.73)较术后1周增加,差异均有统计学意义(P<0.05)。术后6个月Brrtel评分(84.86±19.41)较术前(75.86±20.58)和术后1周(77.86±19.62)均增高。8例术前疼痛的患者术后1周、术后6个月疼痛逐渐缓解,7例患者术后出现疼痛,术后6个月时疼痛均得到缓解。结论 HSPN在降低痉挛性偏瘫患者肌张力的同时能够保留随意运动功能,改善患者的生活能力及术前疼痛,是有效的手术治疗方法。
Abstract
Objective To evaluate the efficacy of highly selective partial neurectomy (HSPN) for upper limb spastic hemiplegia. Methods A retrospective analysis was conducted on 29 patients with upper limb spastic hemiplegia who underwent HSPN, with a follow-up period of 6 months. The muscle tone, muscle strength, pain condition, and activities of daily living of the patients at different time points before and after the surgery were compared. Results The muscle tone scores showed that the elbow flexor tone at 1 week (1.48±0.51) and 6 months (2.21±0.73) after surgery were lower than preoperative levels (3.93±0.80), and the difference was statistically significant (P＜0.05). The muscle tone of the flexor wrist muscles was also lower at 1 week (1.41±0.50) and 6 months (1.69±0.81) after surgery than preoperative levels (4.13±0.71) , and the difference was statistically significant (P＜0.05). The wrist flexor tone at 6 months increased compared to 1 week after surgery, but remained significantly lower than preoperative levels. Muscle strength scores indicated that elbow flexor strength at 1 week postoperatively (3.14±0.35) decreased compared to preoperative levels (3.55±0.51), and increased at 6 months postoperatively (3.34±0.48), but the differences were not statistically significant. Wrist flexor strength at 1 week postoperatively (2.41±0.57) was significantly lower than preoperative levels (3.28±0.80) (P＜0.05), and increased at 6 months postoperatively (2.97±0.73) compared to 1 week (P＜0.05). Barthel Index scores at 6 months (84.86±19.41) were significantly higher than both preoperative (75.86±20.58) and 1 week postoperative values (77.86±19.62). Among 8 patients with preoperative pain, pain was gradually alleviated at 1 week and 6 months after surgery, and 7 patients developed postoperative pain, but the pain was relieved at 6 months after surgery. Conclusions HSPN can reduce the muscle tone of patients with spastic hemiplegia while preserving the voluntary motor function, improving the activities of daily living and relieving preoperative pain, and it is an effective surgical treatment method.
关键词
偏瘫 /
痉挛 /
神经切断 /
肌张力
Key words
hemiplegia /
spasm /
neurectomy /
muscle tone
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