Central limb spasticity is a common complication after central nervous system injury, in which hand flexion spasticity often leads to the loss of the patient’s ability to move. Reducing muscle tone and relieving spasticity are the prerequisites for restoring limb function. T1 rhizotomy, which has been proposed in recent years, has proven to be effective in the treatment of central hand flexion spasticity. This consensus summarizes the etiology, symptoms, functional assessment of central hand flexion spasticity, and surgical indications for T1 rhizotomy, surgical principles and procedures, and rehabilitation program. The standardized protocol of T1 rhizotomy for the treatment of central hand flexion spasticity is proposed for the reference of clinicians in the process of diagnosis and treatment, with the aim of further improving the treatment level for central hand flexion spasticity.
目的:回顾立体定向脑深部微电极记录引导下的术治疗书写痉挛的方法及疗效,探讨治疗的机理。方法:运用脑深部微电极记录引导下立体定向技术,对10例书写痉挛患者实施了丘脑腹中间核(Vim)和丘脑腹嘴核(Vo)的毁损术,进行疗效分析。结果: 10例患者术后书写功能即刻恢复正常,2例出现的感觉异常和构音障碍的可逆性手术并症,无永久性手术并发症,1～2年的随访疗效稳定无复发。结论:选择性丘脑切开是治疗书写痉挛的有效、安全的治疗手段。
Objective To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies. Methods The spastic bladder models were established in 12 male dogsand were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2(group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3(group B), rhizotomy of the anterior roots of S2 and S3(group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological -observation, the changes of all functional data were recorded and comparedbetween pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the halfanterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120±30), (100±30)ml and (120±20) cm H2 O, respectively before rhizotomy. Results After rhizotomy, the bladder capacity in 4 groups amounted to (150±50), (180±50), (230±50), and (400±50) ml, respectively; and the urine evacuation volume were (130±30), (180±50), (100±50) and (50±30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed. Conclusion The effectof selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.
ObjectiveTo observe the possibility of hyper selective neurectomy (HSN) of triceps branches combined with partial neurotomy of S2 nerve root for relieving spastic equinus foot. Methods Anatomical studies were performed on 12 adult cadaveric specimens. The S2 nerve root and its branches were exposed through the posterior approach. Located the site where S2 joined the sciatic nerve and measured the distance to the median line and the vertical distance to the posterior superior iliac spine plane, and the S2 nerve root here was confirmed to have given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. Between February 2023 and November 2023, 4 patients with spastic equinus foot were treated with HSN of muscle branches of soleus, gastrocnemius medial head and lateral head, and cut the branch where S2 joined the sciatic nerve. There were 3 males and 1 female, the age ranged from 5 to 46 years, with a median of 26 years. The causes included traumatic brain injury in 2 cases, cerebral hemorrhage in 1 case, and cerebral palsy in 1 case. The disease duration ranged from 15 to 84 months, with a median of 40 months. The triceps muscle tone measured by modified Ashworth scale (MAC) before operation was grade 3 in 2 cases and grade 4 in 2 cases. The muscle strength measured by Daniels-Worthingham manual muscle test (MMT) was grade 2 in 1 case, grade 3 in 1 case, and 2 cases could not be accurately measured due to grade 4 muscle tone. The Holden walking function grading was used to evaluate lower limb function and all 4 patients were grade 2. After operation, triceps muscle tone, muscle strength, and lower limb function were evaluated by the above grading. Results The distance between the location where S2 joined the sciatic nerve and median line was (5.71±0.53) cm and the vertical distance between the location and posterior superior iliac spine plane was (6.66±0.86) cm. Before joining the sciatic nerve, the S2 nerve root had given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. All the 4 patients successfully completed the operation, and the follow-up time was 4-13 months, with a median of 7.5 months. At last follow-up, the muscle tone of the patients decreased by 2-3 grades when compared with that before operation, and the muscle strength did not decrease when compared with that before operation. Holden walking function grading improved by 1-2 grades, and there was no postoperative hypoesthesia in the lower limbs. Conclusion HSN of triceps branches combined with partial neurotomy of S2 nerve root can relieve spastic equinus foot without damaging other sacral plexus nerves.