Zhan Qijia,Wu Shuihua,Xiao Bo,et al.Short-term efficacy of single-level laminectomy selective dorsal rhizotomy guided by novel neuroelectrophysiological monitoring protocol for children with spastic cerebral palsy: a multicenter retrospective clinical study[J].Journal of Clinical Pediatric Surgery,,21():523-529.[doi:10.3760/cma.j.cn101785-202202065-005]
Short-term efficacy of single-level laminectomy selective dorsal rhizotomy guided by novel neuroelectrophysiological monitoring protocol for children with spastic cerebral palsy: a multicenter retrospective clinical study
- Keywords:
- Cerebral Palsy/CO; Cerebral Palsy/SU; Muscle Spasticity/CO; Muscle Spasticity/SU; Neurophysiological Monitoring/MT; Rhizotomy/MT; Treatment Outcome; China
- Abstract:
- Objective To evaluate the efficacy of single-level laminectomy selective dorsal rhizotomy (SL-SDR) guided by novel neuroelectrophysiological monitoring protocol followed by intensive rehabilitation for children with spastic cerebral palsy.Methods For evaluating the changes of motor function, clinical data were retrospectively reviewed for 435 children with spastic cerebral palsy undergoing SL-SDR followed by intensive rehabilitation for at least 6 months from November 2015 to August 2021 at Shanghai Children’s Hospital, Affiliated Children’s Hospital of Chongqing Medical University and Hunan Children’s Hospital.The relevant parameters included objective muscle tone, strength and joint range of movement (ROM).The scores of gross motor function classification system (GMFCS) and gross motor function measure-66 items (GMFM-66) were recorded at preoperation and at least 6 months postoperation.Results There were 249 boys and 186 girls with an average age of (8.2±2.3)(3.2-15.5) years.And 2, 523 objective muscles and 2, 133 objective joints were confirmed preoperatively and (9.3±3.8) dorsal rootlets resected during SL-SDR.Dorsal rootlets (94.8%) were removed by>50%.And 83 cases (19.1%) had transient superficial paresthesia in lower extremities and recovered within 1 week.There was no long-term side effect of SL-SDR.Within a mean follow-up period of (13.1±8.3) months after SL-SDR, significant improvements occurred with regards to muscle tone, strength, joint ROM, GMFCS level and GMFM-66 score as compared with baseline levels.GMFCS level of children with preoperative GMFCS level Ⅱ/Ⅲ (134/309, 43.4%) was significantly better than that of children with level Ⅳ/Ⅴ(8/105, 7.6%) (P<0.01);The improvement of GMFM-66 score in children with preoperative GMFM-66 score>50 was greater than that in others[(7.65±3.39) vs.(5.01±2.18), P<0.01];The improvement of GMFCS level in children aged under 6 years at the time of operation was significantly better than that in others[(106/249) vs.(36/165), P<0.01].The mean age of children with improvements in GMFCS level post-operation was younger than those without improvements[(6.1±1.0) vs.(11.6±1.7), P<0.01].Conclusion SL-SDR guided by novel neuroelectrophysiological monitoring protocol can safely and effectively treat all types of spastic cerebral palsy and its short-term prognosis is decent.
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Memo
收稿日期:2022-02-28。
基金项目:上海市科学技术委员会"科技创新行动计划"项目（20Y11905800）；湖南省出生缺陷协同防治科技重大专项（2019SK1010）
通讯作者:周渝冬,Email:382766271@qq.com