highly selective dorsal rhizotomy

High-selective severing of the posterior root of the spinal nerve for spastic paralysis. Spastic sputum is one of the types of cerebral palsy (referred to as cerebral palsy), accounting for 30% to 50% of cerebral palsy. Surgical treatment of cerebral palsy is mainly for the treatment of spastic paralysis, and surgery is not the main treatment for cerebral palsy. It is impossible to recover from severe cerebral palsy, but it is important to develop a reasonable comprehensive treatment plan. Treatment of diseases: cerebral palsy Indication High-selective severing of the posterior root of the spinal nerve is applicable to: 1. Severe multiple tendons and increased muscle tone, Ashworth IV or above, and minors over 5 years of age. 2, severe paralysis with limb stiffness affects daily life and rehabilitation training. 3, the trunk muscles and limb muscles have a certain function. 4, normal or near normal intelligence, can cooperate with rehabilitation training. Contraindications 1, low muscle tone, poor muscle strength, poor motor function. 2, fixed bone and joint deformity and contracture. 3, mental retardation without movement function. 4, the spine has obvious deformity and dysplasia. 5, there are bronchospasm and epilepsy. Preoperative preparation Anesthesia and position: general anesthesia. Take the prone position, the head is low and the feet are high, and the hips are flexed. Surgical procedure 1, cutting and revealing Take the midline incision from the waist 2~1, separate the muscles, expose the lumbar 2~5 lamina, expose the dura mater and cut it longitudinally, and lift the edge with a mosquito clamp or lift the wire to prevent the cerebrospinal fluid from overflowing. Locate the lumbar 2~1 nerve at the exit of the intervertebral foramen, and find the confluence point of the anterior and posterior anterior and posterior branches, ie, the dural hole. The nerve root near the dorsal side of the dura mater is the posterior root. . When looking for, pay attention to the fact that the anterior root and the posterior root are not connected in the dural cavity. When they go out from the dural sac, they gradually come together. When the dural sac is worn out, the anterior root is below and then The root is on. They are separated by a thin film, and the outer surface is covered with a total sheath. When reaching the intervertebral foramen, a large part (spine ganglion) containing cell components appears in the posterior root, from which the posterior root and the surrounding area are worn. The sensory fibers of the nerves are then joined together to form the spinal nerve roots. The thickened part of the ganglion can be used as a marker of the posterior root. In the neck surgery, the prolapsed neck and neck flexion position is taken, and the posterior median longitudinal incision is made. The laminae of the affected side of the neck 4-7 are exposed and the dura of the semi-vertebral lamina is incision, and the neck 4 to chest 1 are exposed. After the nerve roots are small bundles, the threshold is low and the small bundles of the posterior roots are cut off proportionally. Generally, the neck 5 is 35%, the neck 6 is 56%, the neck 7-8 is about 55%, and the chest 1 is about 40%. 2, electrical stimulation and selectively cut off the nerve roots Under the operating microscope or magnifying glass, each of the posterior root bundles is bluntly separated by a microsurgical instrument. The number of small bundles of each rear root is not the same, generally 5 to 7 bundles. Carefully separate the small bundles, lift them with nerve hooks or rubber membranes, and use an electrical stimulator (electromyograph or pulse electrical stimulator) to stimulate the small bundles of the posterior roots to induce tendon. Threshold values of each small bundle-induced tendon were measured by electromyography or by limbometry and marked and recorded one by one, and the posterior root beamlets with low threshold were selected to be cut proportionally. In addition to the low threshold, these small beams are accompanied by a small range of continuous clonic. The posterior root beamlets with a low threshold are cut proportionally to block the r-loop of spinal cord reflexes to reduce muscle tone and relieve tendon. The posterior root beamlets with high thresholds should be preserved to prevent postoperative sensory disturbances. 3, the ratio of nerve root root cutting There are different reports and there is no uniform standard. The average is about 35%. According to most reports, the posterior root resection of the lumbar 2 is 20% to 25%, the posterior root resection of the lumbar 3 is 15% to 20%, the posterior root resection of the lumbar 4 is 10% to 15%, and the resection of the lumbar 5 is 25% to 30%. 25% to 30%. However, it should be based on muscle tone and muscle strength. If the muscle tension is high, the cutting ratio of the muscle strength can be higher, and vice versa. 4, closed the incision Thoroughly stop bleeding and tightly suture the dural incision to prevent postoperative cerebrospinal fluid leakage. In the dural cavity, appropriate saline can be injected to supplement the amount of cerebrospinal fluid loss, which can prevent postoperative adhesion of the cauda equina. When the dural has been swelled and there is no cerebrospinal fluid leakage, the surgical incision is closed according to the layer, and the rubber is placed in the incision. Drainage strip to prevent epidural hematoma. complication According to reports in the literature, early postoperative fever, urinary retention, cerebrospinal fluid leakage, bronchospasm, hematuria, abdominal pain, etc., the late stage is mainly spinal instability, spinal deformity and hip dislocation, muscle weakness.