Hemiplegia is mainly caused by brain lesions, common sequelae caused by stroke, brain trauma, encephalitis and other diseases, which not only brings pain to patients themselves, but also brings economic and mental pressure to families. Therefore, reducing the disability rate and improving the quality of life of patients with hemiplegia is the purpose of treatment!
Although patients with
mild hemiplegia can still move, when they walk, their upper limbs are often flexed, like a “hand-held basket”, their lower limbs are straightened, and they draw half a circle in one step, like a “foot circle”. This special walking posture is called hemiplegic gait.
Professor
Chang Chongwang introduced that in the early stage of hemiplegia, there were many manifestations of decreased muscle tension and muscle strength. With the recovery of brain function in the later stage, the compensatory reaction of increased muscle tension began to appear first, but the compensatory reaction of increased muscle tension in the early stage was unstable and could fluctuate with drug treatment and rehabilitation training. Muscle tension generally reaches a stable level in about a year. One of the important indications of FSPR is that the muscle tension is constant and greater than or equal to grade 3.
Therefore, the operation time is generally one year after the occurrence of hemiplegia when the muscle tension is stable.
So, how should FSPR and SPN be chosen?
FSPR (functional selective posterior rhizotomy), under the monitoring of spinal cord nerve stimulator and electromyograph, is a highly selective cutting of la fibers, eliminating muscle afferent impulses and alleviating muscle spasm, which has become the most effective method to relieve muscle spasm and improve motor dysfunction in hemiplegic patients.
Clinically, it can be divided into lumbar FSPR surgery and cervical FSPR surgery. Cervical surgery can solve upper limb spasm, and lumbar surgery can solve lower limb spasm.
The
purpose of the operation is to adjust the muscle tension in an all-round way, and to solve the pain of muscle spasm in patients for a long time, steadily and thoroughly, so as to provide a prerequisite for the recovery of motor function.
SPN surgery (selective peripheral nerve constriction) is suitable for patients with single and localized local spasm, but not for patients with high local muscle tension after FSPR or FSPR. It is suitable for patients over 1 year old.
The
purpose of the operation is to remove the redundant muscle tension and retain the original muscle tension and motor function, so as to improve the motor ability of the limbs.
What are the differences
between FSPR and SPN?
FSPR is a selective spinal nerve (there are 31 pairs of spinal nerves, among which several pairs are selected). The posterior root (the anterior root of the spinal nerve-the motor function of the main muscle, and the posterior root-the sensory function of the main body) is partially cut, and the anterior root is not involved; In SPN, the peripheral nerves (such as the sciatic nerve or the branches of the tibial nerve, brachial plexus and their branches), which are the mixed nerves of the anterior and posterior roots of the spinal nerves, are partially cut. Both can reduce muscle tone, but the latter can damage motor nerve fibers.
Reminder: If hemiplegic patients with severe lumbosacral spinal canal deformity or cervical spinal canal stenosis are not suitable for FSPR surgery, or their families do not agree to FSPR surgery, combined SPN surgery can be used, that is, multiple peripheral nerve SPN surgery combined with one or several operations to treat spasticity in multiple parts.
