The Efficacy Of Selective Posterior Rhizotomy For Children With Spastic Cerebral Palsy:A Meta Analysis

Objective: To evaluate the effect of selective posterior rhizotomy for children with spastic cerebral palsy by meta analysis,and to provide evidence for its clinical rational application and further research.Method: Two evaluators independently conducted literature search,quality evaluation and data extraction.A computer was used to search 7 databases,including CNKI,Wanfang,VIP,CBMdisc,Cochrane library,Pubmed and Embase.The time ranged from foundation of databases to December 2018.Randomized controlled trials of selective posterior rhizotomy for the treatment of children with spastic cerebral palsy in strict accordance with inclusion and exclusion criteria.Stata 12.0 statistical software was used for Meta analysis.Standardized mean difference(SMD)was used in measurement data as the study effect index,while enumeration data used OR value as the study effect index.95% confidence interval(CI)was used as the analytical statistics of the therapeutic effect.The results were expressed by the “forest map”,and the publication bias test was conducted on the included studies,and the sensitivity analysis of the meta analysis results was performed.Results: In the end,5 literatures were included.188 patients who had the spastic cerebral palsy.96 patients were included in the experimental group(the selective posterior rhizotomy+physiotherapy),while 92 patients were contained in the control group(physiotherapy).All the five studies belonged to the randomized controlled trial.There was no statistical difference in the baseline situation of each study.The quality evaluation results showed that the literature quality was all considered as the level B.Meta analysis results showed:(1)The improvement on the lower limb muscle tension:There were two studies reported Ashworth scale score,including 66 patients.There was no statistical difference in the improvement of lower limb muscle tension between the experimental group and the control group[SMD=1.34,95%CI(-0.35,3.04),z=1.55,P=0.121].(2)Gross movement improvement: There were four studies reported GMFM88 scale score,including 158 patients.There was no statistical difference in the improvement of gross movement between the experimental group and the control group[SMD=-0.12,95%CI(-0.38,0.13),z=0.96,P=0.335].(3)Gait status improvement:There were three studies reported the gait status,including 135 patients.There was no statistical difference in the improvement of gait status between the experimental group and the control group[OR=0.92,95%CI(0.74,1.15),z=0.71,P=0.478].(4)Stride length improvement: There were three studies reported the stride length situation,including 121 patients.There was no statistical difference in the improvement of stride length between the experimental group and the control group[SMD=0.09,95%CI(-0.20,0.38),z=0.60,P=0.549].(5)Velocity improvement: There were two studies reported the velocity,including 53 patients.There was no statistical difference in the improvement of velocity between the experimental group and the control group[SMD=-0.09,95%CI(-0.64,0.46),z=0.32,P=0.752].Conclusion: Selective posterior rhizotomy has no statistically significant advantage in the treatment of lower limb muscle tension,gross movement,gait status,stride length and velocity in children with spastic cerebral palsy.