| At present,the incidence of cerebral Palsy in China is increasing year by year,and the rate of morbidity is high,so that its treatment has become a hot spot for scholars at home and abroad.Selective Posterior Rhizotomy(SPR)was initiated by Xu Lin in the Asian region in the 1990s with satisfactory results.It could effectively reduce the muscle tension of children with spastic cerebral palsy while improving limb function.And then it could increase the degree of joint activity,so that many children with cerebral palsy has achieved self-care and returned to society.In the course of nearly 30 years of development,some scholars have found that SPR can not only improve the lower extremity spasm,but also improve the upper limb paralysis and improve the upper limb function.In addition,some scholars have found that it can improve salivation,epilepsy,and recognition.But all these discoveries need further research.Objective:Through the observation of the clinical cases of the enrolled group,whether the fine movement of the upper limbs in the spastic cerebral palsy which were treated with lumbosacral segment Selective Posterior Rhizotomy(SPR)was improved compared with the pre-operative.Methods:Patients who were diagnosed with spastic cerebral palsy from December 2017 to February 2019 and who met the inclusion criteria of this study were divided into group A and B according to the surgical segment(L4,L5,S1 and L5,S1).There were 11 children in group A,aged 4-5 years,7 boys and 4 girls.There were 17 children in group B,aged 4-5 years,9 boys and 8 girls.They all accepted musle strength test,muscle tension test and Hand function grading test in the time of preoperative and 2weeks,6 months after operation.And they all accepted Carroll hand function test and FMFM fine exercise scale test in the time of preoperative and 2 weeks,6 months after operation.We took the surgical method which was reported by Xu Lin.The nerve threshold tester was used during the operation to observe the limb activity,and the threshold was measured.According to the threshold value,the nerve bundle was selectively cut off,and the resection ratio was generally within 20%-50%.The data obtained were all analyzed by SPSS software in the group before and after comparison and between group A and B.Results:2 of 28 cases were lost to follow-up.10 patients in group A and 16 patients in group B were followed up.(1)The lower extremity muscle tension in group A and B decreased significantly after operation,while the shoulder,elbow and wrist joint muscle tension decreased after operation.(2)MACS:A and B groups improved more 6 months after operation compared with 2 weeks after operation in MACS.(3)UFET:The significant difference was found between pre-operation and post-operation in the left hand(P=0.028<0.05)and right hand(P=0.021<0.05)of the upper extremity evaluation test of Carroll in group A.There is no significant difference in the right hand(P=0.070>0.05)in group B,but we found significant difference in the left hand(P=0.006<0.05)in group B.Then we did not find significant difference both left(P=0.897>0.05)and right(P=0.454>0.05)hand between group A and B.(4)FMFM:There is significant difference between pre-operation and post-operation both in group A(P=0.008<0.05)and B(P=0.001<0.05).And we did not find significant difference between group A and B(P=0.054>0.05).Conclusion:Selective posterior rhizotomy of the lumbosacral segment can improve the fine movement of the upper limbs of the child and improve the ability of daily living.And the efficacy is obvious. |
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