摘要：

目的: 探讨选择性脊神经后根切断术治疗单纯型遗传性痉挛性截瘫相关下肢痉挛的有效性和安全性。方法: 纳入2021年1月至2023年2月在华中科技大学同济医学院附属协和医院行选择性脊神经后根切断术的9例单纯型遗传性痉挛性截瘫患者，评价手术前后髋内收肌、股四头肌、小腿三头肌和腘绳肌肌张力[Ashworth量表(AS)]，股角、腘窝角和足背屈角角度，下肢粗大运动功能[粗大运动功能分级系统(GMFCS)]，并记录术后并发症。结果: 共9例患者均顺利完成手术，术后均未发生严重并发症。手术前后髋内收肌(F=43.568，P=0.000)、股四头肌(F=43.000，P=0.000)、小腿三头肌(F=59.200，P=0.000)和腘绳肌(F=116.138，P=0.000)AS评分差异有统计学意义，其中术后1 d和12个月髋内收肌(P=0.000，0.000)、股四头肌(P=0.000，0.000)、小腿三头肌(P=0.000，0.000)和腘绳肌(P=0.000，0.000)AS评分低于术前。与术前相比，术后5 d股角(t=-17.812，P=0.000)和腘窝角(t=-12.791，P=0.000)增大，足背屈角缩小(t=14.050，P=0.000)。术前与术后12个月GMFCS评分差异无统计学意义(t=1.000，P=0.347)。结论: 对于处于稳定期的单纯型遗传性痉挛性截瘫患者，选择性脊神经后根切断术可以作为缓解下肢痉挛的一种安全、有效方法。

关键词: 痉挛性截瘫, 遗传性, 痉挛, 下肢, 脊神经根切断术, 神经电生理监测

Abstract:

Objective: To evaluate the efficacy and safety of selective posterior rhizotomy (SPR) for the treatment of pure hereditary spastic paraplegia (PHSP)-associated lower limb spasticity. Methods: Nine patients with PHSP were admitted to Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2021 to February 2023. The Ashworth Scale (AS) score of hip adductors, quadriceps femoris, triceps surae and hamstring, femoral angle, popliteal fossa angle and dorsiflexion angle of foot, and Gross Motor Function Classification System (GMFCS) score before and after surgery were analyzed. Postoperative complications were recorded. Results: All 9 patients completed SPR. No serious complication was observed. The AS score before and after surgery were significantly different of hip adductors (F=43.568, P=0.000), quadriceps femoris (F=43.000, P=0.000), triceps surae (F=59.200, P=0.000) and hamstring (F=116.138, P=0.000). The AS score of hip adductors (P=0.000, 0.000), quadriceps femoris (P=0.000, 0.000), triceps surae (P=0.000, 0.000) and hamstring (P=0.000, 0.000) 1 d and 12 months after surgery were significantly decreased comparing with those before surgery. The femoral angle (t=-17.812, P=0.000) and popliteal angle (t=-12.791, P=0.000) 5 d after the surgery were significantly increased comparing with those before surgery, while the dorsiflexion angle of foot 5 d after surgery was significantly decreased comparing with that before surgery (t=14.050, P=0.000). The GMFCS score before and 12 months after surgery were no significantly different (t=1.000, P=0.347). Conclusions: SPR has good efficacy and safety for the treatment of PHSP-associated lower limb spasticity.

Key words: Spastic paraplegia, hereditary, Spasm, Lower extremity, Rhizotomy, Neurophysiological monitoring