Progress on the surgical treatment of limb spasmolysis, orthopedic surgery, and functional reconstruction in patients with cerebral palsy
Ning Bo1, Zhang Hailong1, Zhi Jianwen1, Wang Pohao1, Yang Han1, Zhang Shaocheng2
1Department of Neurosurgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China; 2Department of Orthopedics, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Military Medical University, Shanghai 200433, China
Abstract：Objective To summarize the research progress on the surgical treatment of cerebral palsy with spasmolysis, orthopedic surgery, and functional reconstruction. Methods Relevant literatures on the diagnosis and treatment of cerebral palsy that were published from January 2000 to June 2021 in CNKI, Wanfang Data, PubMed, and other Chinese and English databases were searched. Forty-seven literatures were finally included to summarize and analyze the data from three aspects, namely, the spasmolysis, orthopedic surgery, and functional reconstruction of cerebral palsy, literatures with inaccessible full text, inconsistent content, redundant topics, and low quality were excluded. Results Current surgical methods for the treatment of cerebral palsy include spasmolytic surgery and orthopedic surgery. (1) Spasmolytic surgery includes selective posterior rhizotomy (SPR) and selective peripheral neurotomy (SPN). SPR could widely reduce limb muscle tension and is more suitable for tetanic limb spasm than SPN. In comparison, SPN is suitable for focal spasm because of its precision and small trauma effect in reducing single muscle tension in a muscle group. (2) Orthopaedic surgery can adjust muscle tension; release spasm; and relieve or correct deformities by tendon transfer, lengthening, or shortening (including Achilles tendon lengthening, hamstring release, posterior tibial muscle lengthening, anterior tibial muscle transposition, and adductor amputation). Orthopedic surgery is used as an important supplement to spasmolysis, and patients with cerebral palsy often need to receive SPR/SPN to relieve spasm before orthopedic surgery. (3) Limb function reconstruction surgery, which involves modified peripheral nerve transposition, includes nerve transfer graft surgery, vascularized intercostal nerve transfer, and side-to-side suture interfascicular of peripheral nerves. Conclusion The surgical treatment of cerebral palsy is very important. Individualized and staged surgical plan, combined with the application of limb spasmolysis, orthosis, and modified nerve transposition, plays a positive role in alleviating limb spasm, correcting malformation, and rebuilding limb function after central nervous system injury.
宁波, 张海龙, 植剑文, 王泊浩, 杨寒, 张少成. 脑性瘫痪患者肢体解痉、矫形与功能重建的手术治疗研究进展[J]. 中华解剖与临床杂志, 2022, 27(8): 596-600.
Ning Bo, Zhang Hailong, Zhi Jianwen, Wang Pohao, Yang Han, Zhang Shaocheng. Progress on the surgical treatment of limb spasmolysis, orthopedic surgery, and functional reconstruction in patients with cerebral palsy. Chinese Journal of Anatomy and Clinics, 2022, 27(8): 596-600.
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2022, Vol. 27 
