[EFFECTIVENESS OF APONEUROSIS BRISEMEN FOR TREATMENT OF SPASTIC PALSY AFTER SPINAL CORD INJURY].

OBJECTIVE

To study the effectiveness of aponeurosis brisemen in treating spastic palsy after spinal cord injury.

METHODS

Between March 2006 and March 2012, 28 patients (42 limbs, including 26 upper limbs and 16 lower limbs) with spastic palsy after spinal cord injury underwent aponeurosis brisemen, and the clinical data were retrospectively analyzed. Of 28 cases, 19 were male and 9 were female with an average age of 35.5 years (range, 17-52 years) and a mean disease duration of 12 months (range, 8-16 months); there were 20 cases of traumatic cervical spinal cord injury, 5 cases of traumatic thoracic spinal cord injury, and 3 cases of iatrogenic injury after decompressing thoracic spinal stenosis. After aponeurosis brisemen, the limbs were fixed with plaster cast for 4 weeks, then functional exercise was done after removal of plaster cast. Fugel-Meyer scoring system was used to evaluate motor function, the Ashworth classification to evaluate the change of muscle tension, and Barthel index to evaluate the activities of daily living.

RESULTS

The operation was completed successfully in all patients. Elbow flexion dysfunction was caused by excessive release in one limb, which was cured after tightening operation. All patients were followed up 1-6 years (mean, 3.5 years). At 6 months after operation and last follow-up, the muscle tension was significantly decreased (P < 0.05). At 6 months, the effect was excellent in 20 positions (47.62%), effective in 12 (28.57%), improved in 6 (14.29%), ineffective in 4 (9.52%); at last follow-up, the effect was excellent in 20 positions (47.62%), effective in 14 (33.33%), improved in 5 (12.02%), ineffective in 3 (7.14%); and no significant difference was found between at 6 months after operation and at last follow-up (χ2 = 0.932, P = 0.365). At 6 months after operation and last follow-up, Fugel-Meyer score and Barthel index were significantly increased when compared with preoperative ones (P < 0.05), significant differences were also shown between at 6 months after operation and at last follow-up (P < 0.05).

CONCLUSION

Aponeurosis brisemen combined with the functional training is an effective and safe procedure for treating spastic palsy after spinal cord injury. It is useful to decrease muscle tension and improve life quality and motor function.