選擇性背神經根切斷術對腦性麻痺病童步態之成效

Gait changes in Cerebral Palsy Children after Selective Posterior Rhizotomy

嚴重的肌肉痙攣不但大大的影響腦性麻痺病童的功能，也會造成步態的異常。而近年來醫學上常以選擇性背神經根切斷術來改善患者的肌肉痙攣。本研究的主要目的是要探討選擇性背神經根切斷術在治療痙攣型腦性麻痺步態上的成效。本研究共收集13位年齡介於3至17歲屬於純粹性痙攣型腦性麻庳的病童，在進行手術前與手術後的9個月至1年間各施予步態分析評估；並額外選取17位年齡、性別相配之正常兒童做為病童手術前後比對步態改善的依據。步態分析乃利用連續性足底壓步態分析儀(computer dynography, CDG)來評估受測者步行時足底作用力變化的情形。經9個月至1年的追蹤，開刀後病童在作用力線、步態週期圖及後足、中足、前足之最大垂直作用力百分比在治療後統計上有明顯的進步，但在平均步行速度、步頻、單腳及雙腳支撐期時間、平均步長、步長之穩定性及對稱性、步態週期中腳跟支撐期、腳板支撐期及腳尖離地期之平均垂直作用力並沒有顯著的改善。因此，腦性痲痺病童經選擇性背神經根切斷術後，雖然在與時間及空間特性有關的步態數上沒有明顯的改善，但由於促使足底壓重新分佈，使得與足底負荷有關的參數上有明顯的進步。

Severe spasticity in children with cerebral palsy(CP)not only causes functional impairment, but also results in gait abnormalities. Selective posterior rhizotomy (SPR)is one of the major methods used to reduce spasticity. In this study, we used a computer dynography (CDG)gait analysis system to assess the effects of SPR on the gait in 13 children (aged3-17 years)with spastic CP. Seventeen age- and sex-matched healthy children were included as a control group. The gait was evaluated with CDG preoperatively and again 9 months after SPR. After SPR, the grades of gait line, cyclogram shape, and percentage of maximum vertical hindfoot, midfoot and forefoot force improved significantly. However, SPR did not significantly improve the walking velocity, cadence, single and double support phase time, step length, or symmetry and consistency index of step length. Also the maximum vertical force during gait cycle did not improve significantly after SPR. In conclusion, the distribution of ground reaction forces improved significantly in children with CP after SPR, although the temporal-spatial gait parameters did not change significantly.