摘要
目的:总结近10年来临床报道疗效较为肯定的痉挛型脑性瘫痪相关外科治疗方法的现状、进展与发展方向。资料来源:应用计算机检索NCBIEntrezPubMed熏OVID电子期刊全文数据库、EBSCO数据库1978-01/2005-04相关痉挛性脑性瘫痪外科治疗的文章,检索词为“spasticity,cerebralpalsy,selectiveposteriorrhizo-tomies”,限定文章语言种类为“English”;计算机检索CNKI1994-01/2004-04相关痉挛性脑瘫外科治疗的文章,检索词为“痉挛性脑瘫,手术”。资料选择:对资料进行初审,纳入标准:有关痉挛性脑瘫手术治疗的历史、原理、应用解剖及基础研究、方法、预后及发展趋势等。排除标准:文献中重复研究、综述、非手术治疗方面的文章。资料提炼:共收集83篇相关文献,最后23篇文献符合纳入标准。23篇文献中16篇涉及选择性脊神经后根切除术术式的发展、改良、预后,其中又包括4篇关于选择性脊神经后根切除术术中肌电图监测的应用;7篇涉及痉挛性脑瘫外科治疗新方法、新术式。资料综合:痉挛型脑瘫的手术治疗主要有选择性脊神经后根切除术、选择性周围神经切断术、选择性脊神经后根非切断性机械灭活及矫形手术等,但越来越多的临床报道证明,选择性脊神经后根切除术是一种解除痉挛改善功能的有效且较成熟的方法,明显优于其他疗法。术中电生理监测结果的有效性和判断标准仍存在广泛争议。结论:痉挛性脑瘫的外科治疗近10年来虽在手术方法多样化方面取得了很大进展,但单一手术有时未必达到满意的解痉效果,除选择性脊神经后根切除术以外的各类神经手术均因缺乏足够的长期的疗效评估而难以得到广泛的认同。发展一种更安全、微创、有效、持久及普遍适用的标准的治疗方法及术中肌电监测的应用,甚至脑内原发病灶的治疗,是目前痉挛性脑瘫外科治疗研究发展的根本方向所�
OBJECTIVE： To summarize the recent status, development and developing direction of relevant surgical treatment, the therapeutic effects of which has been confirmed, for spastic cerebral palsy （SCP） in the last ten years.
DATA SOURCES： Relevant articles related to SCP from January 1978 to April 2005 were searched with computer in NCBI Entrez PubMed and Journals@Ovid Full Text and EBSCO database with the key words of ＂spasticity, cerebral palsy, selective posterior rhizotomies＂ in English; Meanwhile, relevant Chinese articles about SCP from January 1994 to April 2004 were retrieved in China National Knowledge Infrastrncture （CNKI） with the key words of ＂spasticity, cerebral palsy ,operation＂.
STUDY SELECTION： Data were retrieved in the first trial. Inclusive criteria： Articles about history,principle,applied anatomy and basic research, clinical method,prognosis as well as developing direction etc. Exclusive criteria： Repetitive studies, reviews and non-operation treatments.
DATA EXTRACTION： A total of 83 relevant literatures were collected, 23 articles were in accordance with the inclusive criteria, 16 of which related to the development, improvement, and prognosis of selective posterior rhizotomy, among them there were 4 articles concerning with the application of electromyologram （EMG） in selective posterior rhizotomy; 7 referred to new method and new operation style of surgical treatment for SCP.
DATA SYNTHESIS： Surgical treatment of SCP mainly included selective posterior rhizotomy, microsurgical selective peripheral neurotomy, and orthomorphia, whereas more and more clinical reports proved that selective posterior rhizotomy was an effective and mature method in ameliorating functions and relieving spasm, which was remarkably better than others. Efficacy and judging stand of electrophysiological monitoring remains controversial. CONCLUSION： Great development has been achieved in diversified surgical treatments for SCP in the last ten years,while satisfactory effects o
出处
《中国临床康复》
CSCD
北大核心
2006年第20期124-126,共3页
Chinese Journal of Clinical Rehabilitation
基金
国家"九七三"计划资助项目(2003CB515300)
国家"八六三"计划资助项目(2002AA205071)~~
