Efficacy Of Selective Partial Peripheral Neurotomy Combined With Tenolysis In The Treatment Of Spastic Cerebral Palsy Of Lower Extremities

Background: Cerebral palsy（CP）refers to a series of syndromes caused by non-progressive brain injury and developmental defects from conception to infancy,mainly characterized by dyskinesia and abnormal posture.The main causes of this disease include one or more factors such as preterm delivery,hyperbilirubinemia,neonatal hypoxia and ischemia caused by respiratory distress.Spastic cerebral palsy is the most common type of cerebral palsy,accounting for about 60% to 70% of the total number of children with cerebral palsy.The main features are motor retardation and increased skeletal muscle tension,especially in the lower extremities.And with the growth of age,children due to increased muscle tone,muscle spasm for a long time,and even secondary to fixed deformities.At present,there is no specific cure and fixed operation for cerebral palsy in the world,and the uncertain treatment effect and prognosis bring heavy burden to many families and society.Objective: For children with spastic cerebral palsy of lower extremities,the efficacy and safety of highly selective peripheral neurotomy（SPN）combined with tenolysis of lower extremities were compared in terms of muscle tension,gross motor function and gait before and after operation.Methods:The data of children with spastic cerebral palsy of lower extremities treated by SPN combined with tenolysis of lower extremities in our hospital from January 2014 to May 2021 were collected.32 cases were selected as subjects,including12 cases of SPN of anterior branch of obturator nerve and 28 cases of SPN of tibial nerve（8 cases were treated with SPN and SPN of tibial nerve）.At the same time,it is combined with one or more soft tissue orthopedic operations,such as adductor muscle release,hamstring release,gastrocnemius slip or posterior tibial muscle preposition.The muscle tone score,gross motor function,gait index and the incidence of postoperative complications were compared before operation and 3 months and 6 months after operation.Results: Among the 32 children in this group,there were 14 cases with preoperative muscle tension score 2 points,17 cases with preoperative muscle tension score 3 points,and 1 case with muscle tension score 4 points.All children’s muscle tension scores decreased after operation,and the muscle tension remission rate was100%.At the same time,the indexes of gross motor function and gait at 3 and 6 months after operation were significantly better than those before operation,and the difference was statistically significant（P < 0.05）.All the incisions were healed in grade I / A,and the muscle strength of the posterior calf muscle group decreased in 2 cases,which recovered to more than grade 4 after postoperative systematic rehabilitation training,and no complications occurred in the other children after operation.Conclusion: Selective partial peripheral neurotomy（SPN）combined with tenolysis of lower extremities can reduce the muscle tension of children with spastic cerebral palsy of lower extremities to a certain extent,relieve partial spasticity of lower extremities,improve gross motor function and correct gait.It is a reasonable and effective surgical method in the treatment of some children with spastic cerebral palsy of lower extremities,and the postoperative complications are low,and the safety is also worth affirming.