目的 观察选择性脊神经后根部分切断术(SPR)结合踝足矫形器(AFO)治疗脑瘫伴踝痉挛的长期疗效.方法 回顾性分析25例痉挛型脑瘫伴严重踝痉挛病人的临床资料,均行SPR治疗,术后2～3周佩戴AFO进行康复训练.根据Ashworth评分和下肢运动功能评分评估病人踝痉挛及下肢运动功能改善情况.结果 所有病人随访(24.6±10.5)个月.Ashworth评分和下肢运动功能评分:术前(4.0±0.5)分和(2.5±0.7)分,术后2周(2.5±0.7)分和(3.0±0.8)分,术后6个月(1.9±0.4)分和(3.7±0.8)分,术后12个月(1.8±0.2)分和(4.2±0.6)分;手术前后Ashworth评分和下肢运动功能评分差异均有统计学意义(P＜0.05).结论 SPR可明显改善脑瘫病人的踝痉挛症状,术后采用AFO进行康复治疗可促进运动功能恢复,且效果稳定.%Objective To explore the long-term therapeutic effect of selective posterior rhizotomy (SPR) with ankle foot orthosis (AFO) for the treatment of cerebral palsy-associated ankle spasticity. Methods Clinical data of 25 patients with cerebral palsy-associated serious ankle spasticity were analyzed retrospectively. The SPR was performed in all the patients, and then rehabilitation with AFO was started after 2-3 weeks. The improved conditions of ankle spasticity and lower limb motor function were evaluated according to the Ashworth score and lower limb motor function score. Results All the patients were followed up for 24.6±10.5 months. The Ashworth score and lower limb motor function score were 4.0±0.5 and 2.5±0.7 before operation, 2.5±0.7 and 3.0±0.8 two weeks after operation, 1.9±0.4 and 3.7±0.8 six months after operation and 1.8±0.2 and 4.2±0.6 twelve months after operation respectively. There was a statistical significance in differences between preoperation and postoperation in Ashworth score and lower limb motor function score (P<0.05). Conclusions SPR can obviously improve the symptom of ankle spasticity in cerebral palsy patients. Rehabilitative treatment with AFO can promote the rehabilitation of motor function after SPR, and the therapeutic effect is stable.
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