摘要
目的探讨胸_(1)脊神经根切断治疗手痉挛性瘫痪的临床效果。方法回顾性分析2006年10月至2021年7月在北京积水潭医院接受胸_(1)脊神经根切断术治疗的7例手痉挛性瘫痪患者的临床资料。其中男4例,女3例;脑外伤5例,脑瘫2例;从脑外伤或脑瘫发病到手术的时间为1~18年,平均(6.7±5.9)年。所有患者均为单侧肢体受累,屈指肌肌张力3级6例、2级1例,屈指肌肌力4级4例、3级3例。观察术后患者屈指肌肌张力和肌力的恢复情况,以及手功能改良House上肢功能分级(House Functional Classification,HFC)的变化。结果所有患者手术顺利,术后随访6~36个月,平均(15.4±10.3)个月。7例患者末次随访时屈指肌肌张力均较术前降低2个等级且肌力无减弱,疗效评定均为优。术后早期屈指肌肌力均有明显降低,至末次随访时均恢复到术前水平。3例患者末次随访时手功能改良HFC分级由术前的2级增至5级或以上,恢复了手的主动抓握及日常使用功能。7例患者最终的手功能改良HFC分级由术前的(1.6±0.8)级提高到末次随访时的(4.0±1.7)级。术后第1天7例患者均有小指及前臂内侧感觉麻木,至末次随访时均恢复正常。结论胸_(1)脊神经根切断术治疗手屈指痉挛性瘫痪效果满意,值得临床应用。
Objective To investigate the clinical application and effect of the neurotomy of thoracic spinal nerve root 1(T1)for the treatment of spastic paralysis of the hand.Method From October 2006 to July 2021,8 patients with spastic paralysis of the hand were admitted to our department and underwent a neurotomy of T1 nerve root.The data of these patients were analyzed retrospectively.Finally,there were 7 patients enrolled in this study,including 4 males and 3 females.The average age was(22.4±11.5)years(range,3-46 years).There were 5 cases suffered with brain trauma and 2 cases suffered with cerebral palsy.The interval from onset of cerebral palsy or traumatic brain injury to surgery ranged from 1 to 18 years,with an average of(6.7±5.9)years.Six cases were of grade 3 in the flexor muscle tone assessment according to the Modified Ashworth Scale,and one of grade 2.Four cases were of grade 4 in the flexor muscle strength assessment according to MRC Scale and three of grade 3.All patients were involved with one unilateral limb.Result The patients were followed up for(15.4±10.3)months(range,6-36 months).At final follow-up,the flexor muscle tone of 7 patients was reduced by 2 grades compared with that before operation.The outcomes were excellent for all the 7 patients.The flexor muscle strength decreased significantly at early stage after operation,and recovered to the preoperative condition at the last follow-up.The grade of hand function in patients increased from grade 2 preoperatively to grade 5 or above postoperatively,and the active grip function and daily use function of the hand were restored.The final grade of hand function of the 7 patients was improved from 1.6 before surgery to 4 at final follow-up.On the first day after operation,all 7 patients had numbness in the little finger and medial forearm,which recovered to normal at the last follow-up.Conclusion T1 neurotomy was proved to be effective in the treatment of spastic paralysis of the hand.
作者
杨辰
李文军
李峰
栗鹏程
薛云皓
王树锋
Yang Chen;Li Wenjun;Li Feng;Li Pengcheng;Xue Yunhao;Wang Shufeng(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijng 100035,China)
出处
《中国医刊》
CAS
2023年第1期59-62,共4页
Chinese Journal of Medicine
基金
国家重点研发计划(2022YFC3602800)
卫健委手功能重建重点实验室/上海市周围神经显微外科重点实验室开放课题(20DZ2270200)。
关键词
运动神经元损伤
手痉挛性瘫痪
屈曲挛缩
胸1脊神经根切断
Motor neuron injury
Spastic paralysis of the hand
Flexion contracture
Radiculotomy of thoracic spinal nerve root 1
