目的 研究选择性脊神经后根部分切断术治疗偏侧肢体痉挛性瘫痪患儿下肢痉挛的疗效及对血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、转化生长因子β1(human trans-forming growth factor β1,TGF-β1)浓度的影响. 方法 选取2014年3月至2015年12月我院收治的偏侧肢体痉挛性瘫痪患儿40例为观察对象,所有患儿均采用选择性脊神经后根部分切断术,比较治疗前后患侧下肢肌群张力和患儿基底节区代谢产物水平. 结果 小腿三头肌群、腘绳肌、髋内收肌群手术前的肌张力均显著高于手术后的肌张力(P＜0.05).对侧基底节区Cho/NAA术后较术前升高,而NAA/Cr较术前降低,具有显著性差异(均P＜0.05).术后患儿NSE水平为(16.4 ±4.1) μg/L,明显低于术前的(28.9 ±8.2)μg/L(P=0.000);而术后TGF-β1水平为(64.2±31.5) ng/L,明显高于术前的(32.4 ± 24.7) ng/L,具有显著性差异(P =0.001). 结论 选择性脊神经后根部分切断术治疗偏侧肢体痉挛性瘫痪患儿下肢痉挛的疗效较佳,可有效改善患儿各肌肌群张力,调节血清NSE和TGF-β1水平.%Objective To study the curative effect of the selective posterior lumbar rhizotomy for children with spastic paralysis of the lower extremities spasm and to explore the changes of serum neuron specific enolization enzyme (NSE) and transforming growth factor-beta 1 (TGF-β1).Methods From March 2014 to December 2015,there were 40 children with lower limb spasm underwent selective posterior lmnbar rhizotomy.Their Cho/Cr、Cho/NAA、NAA/Cr ratio in the basal ganglia using PRESS135 and PRESS35 sequence,and serum NSE and TGFβ1 level were studied.Results After operation,the muscle tensions of leg triceps,hamstrings and hip adduction muscles obviously decreased (all P ＜ 0.05).Cho/NAA of the contra-lateral basal ganglia region increased,while NAA/Cr decreased simultaneously (P ＜ 0.05).The postoperative serum level of NSE was (16.4 ± 4.1) μg/L,which was lower than (28.9 ± 8.2) μg/L of pre-peration,and TGFβ1 was (32.4 ± 24.7) ng/L,which was lower than (64.2 ± 31.5) ng/L of pre-peration (P ＜ 0.05).Conclusion It is demonstrated of good clinical effects of the selective posterior lumbar rhizotomy for children with spastic paralysis of the lower extremities spasm,which can both improve the children's symptoms,and regulate serum NSE and TGFβ1 levels.
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