CAJ | 학술논문

目的：探讨腰骶段选择性脊神经后根部分切断术（ selective posterior rhizotomy ，SPR）治疗脑瘫性下肢痉挛状态手术并发症的防治。方法：回顾性分析2000年1月至2012年9月经腰骶段SPR治疗并随访1年以上的2593例脑瘫性下肢痉挛状态患者的临床资料，分析术后并发症发生情况。结果：围手术期并发症情况：呼吸系统并发症包括支气管痉挛5例（0．19％）、吸入性肺炎4例（0．15％）；消化系统并发症包括腹胀145例（5．6％）、肠绞痛80例（3．1％）；泌尿系统并发症包括暂时性膀胱功能障碍54例（2．1％）、泌尿系感染6例（0．23％）；周围神经系统并发症包括下肢无力327例（12．6％）、下肢感觉障碍140例（5．4％）；中枢神经系统并发症包括头痛112例（4．32％）、癫痫发作4例（0．15％），无椎管内或颅内感染、椎管内血肿或颅内出血等；一般手术并发症包括腰背部疼痛1382例（53．3％）、切口感染延迟愈合5例（0．19％）、脑脊液漏8例（0．31％）。随访1年以上中远期并发症发生率：下肢运动能力下降7．33％（190／2593），下肢感觉障碍5．59％（145／2593），大小便障碍0．04％（1／2593），脊柱侧弯7．23％（31／429），胸椎后凸4．2％（18／429），腰椎滑脱10．49％（45／429），长期腰背痛9．72％（252／2593），未见性功能障碍。结论：腰骶段SPR是治疗脑瘫性下肢痉挛状态的安全的手术方法，选择合适病例、术中精细操作、术中神经电生理监测、加强围手术期管理及术后正规康复训练可有效降低术后并发症的发生率。
목적：탐토요저단선택성척신경후근부분절단술（ selective posterior rhizotomy ，SPR）치료뇌탄성하지경련상태수술병발증적방치。방법：회고성분석2000년1월지2012년9월경요저단SPR치료병수방1년이상적2593례뇌탄성하지경련상태환자적림상자료，분석술후병발증발생정황。결과：위수술기병발증정황：호흡계통병발증포괄지기관경련5례（0．19％）、흡입성폐염4례（0．15％）；소화계통병발증포괄복창145례（5．6％）、장교통80례（3．1％）；비뇨계통병발증포괄잠시성방광공능장애54례（2．1％）、비뇨계감염6례（0．23％）；주위신경계통병발증포괄하지무력327례（12．6％）、하지감각장애140례（5．4％）；중추신경계통병발증포괄두통112례（4．32％）、전간발작4례（0．15％），무추관내혹로내감염、추관내혈종혹로내출혈등；일반수술병발증포괄요배부동통1382례（53．3％）、절구감염연지유합5례（0．19％）、뇌척액루8례（0．31％）。수방1년이상중원기병발증발생솔：하지운동능력하강7．33％（190／2593），하지감각장애5．59％（145／2593），대소편장애0．04％（1／2593），척주측만7．23％（31／429），흉추후철4．2％（18／429），요추활탈10．49％（45／429），장기요배통9．72％（252／2593），미견성공능장애。결론：요저단SPR시치료뇌탄성하지경련상태적안전적수술방법，선택합괄병례、술중정세조작、술중신경전생리감측、가강위수술기관리급술후정규강복훈련가유효강저술후병발증적발생솔。
Objective:To investigate the complications of spastic cerebral palsy with selective posterior rhizotomy (SPR).Methods:In the study, 2 593 patients who had undergone SPR from January 2000 to September 2012 were followed-up for at least one year .The complications were classified .Results:Peri-operative complications:pulmonary system complications including bronchial spasm (5 cases, 0.19%) and aspiration pneumonia (4 cases, 0.15%);digestive system complications including abdominal bloa-ting (145 cases, 5.6%) and colic (80 cases, 3.1%);urinary system complications including tempora-ry bladder dysfunction (54 cases, 2.1%) and urinary tract infection (6 cases, 0.23%); peripheral nervous system complications including lower extremity weakness ( 327 cases, 12.6%) and lower extremity sensory disturbances ( 140 cases, 5.4%); central nervous system complications including headache (112 cases, 4.3%) and epileptic seizures (4 cases, 0.15%).None spinal or intracranial in-fection, intraspinal hematoma or intracranial hemorrhage were identified .General surgery complications including back pain (1 382 cases, 53.3%), delay wound healing caused by infection (5 cases, 0.19%) and cerebrospinal fluid leakage (8 cases, 0.31%).Long-term follow-up complications inclu-ding lower limb decreased exercise capacity ( incidence: 7.33%) and lower extremity sensory distur-bance (incidence:5.59%).Urination occurred in only one case and defecation function disturbance with no sexual dysfunction was identified .The incidences of scoliosis , thoracic kyphosis , spondylolisthe-sis and long-term back pain were 7.23%(31/429), 4.2%(18/429), 10.49%(45/429) and 9.72%respectively .Conclusion:SPR is one of the effective and safe surgical treatments for spastic cerebral pal-sy.Valid methods should be applied to reduce the incidence of postoperative complications , such as choosing the appropriate patients , meticulously operating in the surgery , assistance of electrophysiological guidance , reinforcing perioperative management and regular rehabilitation training after operation .