Clinical Observation Of The Effect Of Lumbosacral SPR On Lower Limb Motor Function In Children With Spastic Cerebral Palsy

Cerebral palsy(CP)is a kind of clinical syndrome that seriously affects people’s life quality and national economic development.Its treatment has always been the focus and difficulty in the medical field.Spastic cerebral palsy or mixed cerebral palsy with spasticity account for the largest proportion in the classification of cerebral palsy.At present,selective posterior rhizotomy(SPR)is the most effective surgical treatment to improve the spasticity of cerebral palsy patients.SPR has been used to treat cerebral palsy for more than 100 years,and its curative effect has been widely recognized by experts and scholars at home and abroad.Lower extremity motor dysfunction has always been an important factor affecting the quality of life of patients with cerebral palsy and their families.Foreign scholars have done a lot of clinical studies,which confirmed that SPR can significantly improve the motor dysfunction of lower extremity in patients with cerebral palsy.However,in recent years,there are few studies on the motor function of lower extremity in patients with cerebral palsy after SPR in China.Objective to explore the effect of lumbosacral SPR on the motor function of lower limbs in patients with cerebral palsyMethods from November 2018 to December 2019,a prospective study was carried out in 36 patients with cerebral palsy who underwent selective posterior rhizotomy of lumbosacral nerve in the Department of Orthopaedics,Dongzhimen Hospital,Beijing University of traditional Chinese medicine.The average age was(7.69±2.47)years,including 26 males and 10 females.The patients were assessed with Modified Ashworth Classification and the active and passive range of motion of hip,knee and ankle before operation,2 weeks after operation and 3～6 months after operation.GMFM-88 was used to evaluate the gross motor function of patients before and 3～6 months after operation.SPSS 25.0 was used to compare the data before and after operation.Results 4 of 36 patients with cercbral palsy were lost to follow-up,and the remaining 32 patients were followed up.The lower limbs muscle tension of 32 patients with cerebral palsy was improved in different degrees at 2 weeks after operation and 3-6 months after operation.The muscle tension of hip joint was not improved significantly at 2 weeks after operation and 3-6 months after operation compared with that before operation,and the muscle tension of knee joint and ankle joint was significantly reduced.The scores of area D,area E and total scores of 32 patients were significantly improved at 3-6 months after operation compared with those before operation.(p<0.05).Passive range of motion The hip flexion angle,hip extension angle,hip adduction angle,knee extension angle and ankle plantar flexion angle of 32 patients with cerebral palsy had no significant difference among before operation,2 weeks after operation and 3-6 months after operation(p>0.05);The hip abduction angle,knee flexion angle and ankle dorsal extension angle of patients with cerebral palsy increased significantly at 2 weeks after operation and 3-6 months after operation compared with those before operation(p<0.05).Active range of motion The hip flexion angle,hip extension angle,hip adduction angle,knee extension angle and ankle plantar flexion angle of 32 patients with cerebral palsy had no significant difference at 2 weeks after operation compared with before operation(p>0.05);The hip abduction angle,knee flexion angle and ankle dorsal extension angle of patients with cerebral palsy increased significantly at 2 weeks after operation compared those with before operation(p<0.05).The hip flexion angle,hip extension angle,hip adduction angle and knee extension angle of patients with cerebral palsy had no significant difference between 3-6 months after operation and before operation(p>0.05);the hip abduction angle,knee flexion angle,ankle plantar flexion angle and ankle dorsal extension angle of patients with cerebral palsy increased significantly at 3-6 months after operation compared with those before operation(p<0.05).Conclusion Lumbosacral selective posterior rhizotomy can effectively improve the motor function of the lower limbs in patients with cerebral palsy,which has a signifi-cant short-term effect and is worthy of wide promotion and application.