This study investigated the prevalence and severity of lower urinary tract symptoms (LUTS) in children with spastic cerebral palsy (SCP) and evaluated the effect of selective dorsal rhizotomy (SDR) in alleviating these symptoms. The study also explored the correlation between postoperative LUTS improvement and intraoperative electrophysiological findings. Prospective data were collected from a consecutive cohort of 247 children with SCP who underwent SDR and were retrospectively analyzed. Pre- and post-operative assessments included muscle tone, motor function, LUTS and intraoperative electrophysiology data were analyzed. Preoperatively, 94 patients (38.1%) had LUTS, and the severity of LUTS negatively correlated with motor function (R=-0.32, P < 0.0001). After SDR, muscle tone decreased, motor function improved (P < 0.0001), and LUTS resolved in 49/94 patients (52.1%). LUTS improvement correlated with a higher proportion of sensory nerves evoking anal sphincter EMG > 20µV. SDR effectively reduces spasticity, improves motor function, and alleviates LUTS in most children with SCP. Intraoperative neurophysiology may predict improvements, warranting further research.

Background Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. Methods We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children’s. Hospital from January 2018 to March 2023. Altogether 168 cases with complete intraoperative neurophysiological recordings of the FT were selected for further analysis. Triggered EMG recordings of the filum originated from two main types of surgeries: selective dorsal rhizotomy (SDR) and fatty filum transection. Results 96 cases underwent SDR and 72 cases underwent fatty filum transection. Electrical stimulation of the FT with fatty infiltration did not elicit electromyographic activity in the monitored muscles with the maximum stimulus intensity of 4.0 mA, while the average threshold for FT with normal appearance was 0.68 mA, and 89 out of 91 FT could elicit electromyographic responses in monitored channels. The threshold ratio of filum to motor nerve roots at the same surgical segment was significantly higher in patients with fatty filum, and a cut-off point of 21.03 yielded an area under curve of 0.943, with 100% sensitivity and 85.71% specificity. Conclusion Filum with normal appearance can elicit electromyographic activity in the lower limbs/anal sphincter similar to the performance of the cauda equina nerve roots. The threshold of fatty filum is different from that of normal appearing FT. Triggered EMG plays an important role in untethering surgeries.

BACKGROUND AND OBJECTIVES: Selective dorsal rhizotomy (SDR) reduces spasticity in children with spastic cerebral palsy (CP). Intraoperative neurophysiology, triggered electromyography (trigger-EMG) is crucial in guiding sensory rootlet selection, but its reproducibility during SDR surgery has not been fully investigated. The objective of this study was to evaluate the reproducibility of trigger-EMG during SDR performed in children with spastic CP. METHODS: A retrospective review was performed for cases where dorsal roots were stimulated twice 1 to 2 minutes apart during SDR using a specific protocol. With single-pulse stimulation of 0.2 ms width having a gradually increasing intensity from 0.01 mA until the EMG amplitude is >200 μV. Criteria were established to evaluate trigger-EMG reproducibility. RESULTS: This study showed that the reproducibility of trigger-EMG was excellent, as the most responsive channels in the second stimulation trial were the same as those in the first one in 90.1% of the roots stimulated. In addition, the 3 most responsive channels were mostly the same between the first and second stimulation trials in 96.9% of the roots tested. Furthermore, when comparing the evoked EMG pattern since the beginning to the end point between the 2 stimulation trials in all 131 roots, the amplitudes of trigger-EMG in 3 most responsive channels were similar to each other, particularly the most responsive one. Amplitudes of each phase in each EMG evoked were also similar to each other. CONCLUSION: The excellent reproducibility of trigger-EMG, as demonstrated by its consistent activation of specific spinal motor circuits, provides a solid foundation for future research. Further investigation into the underlying electrophysiological mechanisms of this reproducibility could inform the development of more refined stimulation protocols and data analysis techniques. These advancements hold promise for enhancing the accuracy of dorsal root selection during SDR and ultimately improving clinical outcomes for patients with spastic CP.

This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children’s Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed. The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)理念联合竖脊肌平面阻滞(erector spinae plane block,ESPB)麻醉用于小儿脊髓栓系手术后镇痛的效果.方法 回顾性分析2020年1月至2022年11月上海交通大学医学院附属儿童医院神经外科收治的79例脊髓栓系患儿临床资料.2020年1月至2021年3月收治的40例为常规组,2021年4月至2022年11月收治的39例为ERAS+ESPB组.比较两组患儿术后3 d内疼痛程度、各项临床功能转归以及并发症发生率等.结果 两组患儿术后24 h、48 h、72 h的疼痛评分差异均有统计学意义(P＜0.001);时间因素与组别因素的交互效应有统计学意义(F=9.566,P＜0.001).进一步分析术后不同时间点和组别的单独效应,发现常规组术后24 h、术后48 h疼痛评分差异无统计学意义(P=0.180)、术后72 h疼痛评分较术后24 h、术后48 h明显降低(P＜0.001);ERAS+ESPB组疼痛评分随着时间的延长而明显降低(P＜0.001);术后24 h、48 h、72 h三个时间点ERAS+ESPB组的疼痛评分均明显低于常规组(P＜0.001).在术后临床功能转归中,ERAS+ESPB组住院天数较常规组明显减少[(9.23±1.13)d比(13.85±2.9)d,t=4.683,P=0.022]、按压镇痛泵次数较常规组明显减少[(5.67±1.94)次比(9.18±2.65)次,t=3.818,P=0.031]、下肢功能锻炼开始时间较常规组明显缩短[4.62±0.66)d比(7.75±0.54)d,t=8.689,P=0.006];两组拔除导尿管的时间差异无统计学意义[(6.66±0.84)d 比(6.51±0.72)d,t=1.665,P=0.249].ERAS+ESPB组术后并发症发生率较常规组明显降低[7.7％(3/39)比25％(10/40),x2=4.302,P=0.038].结论 对于脊髓栓系患儿实施ERAS理念联合ESPB麻醉管理可以有效控制术后早期疼痛,加快临床功能恢复,减少并发症,缩短住院时间,提高患儿生活质量.

Selective dorsal rhizotomy (SDR) can reduce the spasticity in patients with spastic cerebral palsy (SCP) and thus improve the motor function in these patients, but different levels of improvement in motor function were observed among patients after SDR. The aim of the present study was to subgroup patients and to predict the possible outcome of SDR based on the pre-operational parameters. A hundred and thirty-five pediatric patients diagnosed with SCP who underwent SDR from January 2015 to January 2021 were retrospectively reviewed. Spasticity of lower limbs, the number of target muscles, motor functions, and other clinical parameters were used as input variables for unsupervised machine learning to cluster all included patients. The postoperative motor function change is used to assess the clinical significance of clustering. After the SDR procedure, the spasticity of muscles in all patients was reduced significantly, and the motor function was promoted significantly at the follow-up duration. All patients were categorized into three subgroups by both hierarchical and K-means clustering methods. The three subgroups showed significantly different clinical characteristics except for the age at surgery, and the post-operational motor function change at the last follow-up in these three clusters was different. Three subgroups clustered by two methods could be identified as "best responders", "good responders" and "moderate responders" based on the increasement of motor function after SDR. Clustering results achieved by hierarchical and K-means algorithms showed high consistency in subgrouping the whole group of patients. These results indicated that SDR could relieve the spasticity and promote the motor function of patients with SCP. Unsupervised machine learning methods can effectively and accurately cluster patients into different subgroups suffering from SCP based on pre-operative characteristics. Machine learning can be used for the determination of optimal responders for SDR surgery.

Background:Spastic cerebral palsy (CP) is a prevalent cause of motor dysfunction in children, with patients often experiencing secondary musculoskeletal deformities, including tibial torsion. This study aimed to investigate the short-term effect of selective dorsal rhizotomy (SDR) on tibial torsion in children with spastic CP.Methods:We conducted a retrospective review of children with spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, between July 2019 and November 2022. Pre- and post-operative physical assessments were examined.Results:A total of 148 children were included in the study. After SDR, there was a significant decrease in muscle tone in the lower limb muscle groups. Joint range of motion in the lower limbs also increased post-surgery. Bilateral transmalleolar angle (TMA) showed a significant increase after the surgery, and 21% limbs classified as internal tibial torsion before SDR changed into normal angle post-operatively. Limbs with better improvement after SDR derived from younger patients and had lower muscle tone in the hamstring muscles when compared to those that did not show improvement.Conclusions:SDR has the potential to increase TMA in children with spastic CP. Limbs classified as internal tibial torsion are more likely to improve after SDR if they have lower muscle tone in the hamstring muscles and are derived from younger patients.

Objective:This study aimed to investigate the electro-neurophysiological characteristics of the ventral and dorsal nerves at the L2 segment in a quantitative manner.Methods:Medical records of consecutive patients who underwent single-level approach selective dorsal rhizotomy (SDR) from June 2019 to January 2022 were retrospectively reviewed. Intraoperative electro-neurophysiological data were analyzed.Results:A total of 74 males and 27 females were included in the current study with a mean age of 6.2 years old. Quadriceps and adductors were two main muscle groups innervated by L2 nerve roots in both ventral and dorsal nerve roots. Dorsal roots have a higher threshold than that of the ventral ones, and muscles that first reached 200 µV innervated by dorsal roots have longer latency and smaller compound muscle action potential (CMAP) than those of the ventral ones. Supervised machine learning can efficiently distinguish ventral/dorsal roots using threshold + latency or threshold + CMAP as predictors.Conclusion:Electro-neurophysiological parameters could be used to efficiently differentiate ventral/dorsal fibers during SDR.

目的 探讨脑电双频指数(bispectral index,BIS)在儿童单椎板入路选择性神经后根离断术(single-level selective dorsal rhizotomy,SL-SDR)中的应用价值.方法 回顾性分析2019年3月至2022年3月在上海市儿童医院行SL-SDR手术、且全程进行BIS监测的痉挛型脑瘫患儿临床资料.根据术中神经电生理监测期间是否发生肌电干扰,将患儿列入肌电干扰组(D组)和无肌电干扰组(N组),收集两组患儿性别、年龄、体重、脑瘫类型、术前粗大运动功能分级、静脉麻醉维持方案以及药物剂量、神经根阈值比等;同时收集D组患儿自神经电生理刺激开始至首次出现肌电干扰期间的BIS值和N组患儿自神经电生理刺激开始至刺激结束期间的BIS值,并进行对比分析.结果 本研究共纳入43例SL-SDR患儿,其中D组22例,N组21例.两组一般情况、脑瘫类型、粗大运动功能分级、麻醉方案及剂量、阈值比等方面比较,差异均无统计学意义(P＞0.05).D组BIS值(53.4±7.2)明显高于N组(46.1±9.4),差异有统计学意义(t=11.889,P=0.007).Logistic回归分析结果显示,SL-SDR术中神经电生理监测期间的BIS值是发生肌电干扰的独立风险因素[OR值=1.154、95％CI(1.035～1.287),P=0.01].结论 SL-SDR术中神经电生理监测期间BIS值是发生肌电干扰的独立风险因素,BIS值≥51可作为预测发生肌电干扰的指标.

目的 探索终丝脂肪变性(fatty filum,FT)患儿手术中体感诱发电位(somatosensory e-voked potential,SSEP)的应用价值.方法 回顾性分析上海市儿童医院2016年1月至2021年12月确诊并行脊髓栓系松解术治疗的48例FT患儿临床资料,其中男29例,女19例;年龄2个月至12岁.25例因排便或排尿异常、3例因背部疼痛就诊后确诊FT,另有20例因筛查发现背部皮肤异常确诊FT.患儿均接受脊髓栓系松解术治疗,并在脊髓栓系松解前及松解后l h分别进行双下肢SSEP监测.随访患儿术后康复情况,并与术前症状进行比较,评定出症状改善、无变化或加重.根据术前影像学提示脊髓圆锥位于L1-L2椎间盘以上或以下,将患儿分为圆锥正常组或圆锥低位组.比较两组患儿脊髓栓系松解前后双下肢SSEP参数变化(主要为P37潜伏期、N45潜伏期及P37-N45波幅),并探索年龄与SSEP参数的相关性.结果 25例排便或排尿异常患儿手术后末次随访时症状改善24例,无变化1例;3例术前腰背部疼痛患儿术后均症状改善.圆锥低位组25例患儿术前双下肢P37-N45波幅中位数较圆锥正常组更低(左侧:0.3 μV比0.7 μV,P＜0.01;右侧:0.5 μV比0.8 μV,P＜0.05).脊髓栓系松解后所有患儿双下肢P37-N45波幅较术前增大(左侧:1.1μV比0.6 pV,P＜0.0 001;右侧:1.1 μV比0.6 μV,P＜0.0001).年龄与脊髓栓系松解后双下肢P37-N45波幅的变化幅度呈负相关(左侧:r=-0.45,右侧:r=-0.44,P值均＜0.01),该负相关性主要体现在圆锥低位组患儿中(左侧:r=-0.51,P＜0.05;右侧:r=-0.57,P＜0.01).结论 脊髓栓系松解术能改善FT患儿的临床症状.SSEP波 幅能监测和发现脊髓圆锥低位FT患儿的潜在神经功能损伤.尽早手术解除异常的脊髓圆锥牵拉,可能有助于受损神经功能的恢复.

目的 探讨闪光视觉诱发电位(flash visual evoked potential,F-VEP)监测在儿童鞍区肿瘤手术中的应用价值.方法 回顾性分析2020年1月至2021年12月上海市儿童医院神经外科收治的20例鞍区肿瘤患儿临床资料,按年龄将患儿分为两组:1～6岁组(10例)和7～14岁组(10例),均在静脉吸入复合麻醉下行肿瘤切除术,术中行F-VEP监测,比较不同导联不同刺激频率(0.7～2.0 Hz)下F-VEP的波幅,确定合适的刺激参数及主要观察指标.于术后第14天对所有患儿进行视力检查,评估术中观察指标与术后视力的相关性,证实其应用价值.结果 1～6岁组患儿中,在刺激频率(1.4 Hz)下,O1-Fz、O2-Fz、Oz-Fz三个导联 F-VEP 的 N75-P100 峰间值(A1)和 P100-N145 峰间值(A2)均高于其他刺激频率(0.7、1.0、2.0 Hz)下相应导联的A1、A2(P＜0.05);不同导联之间比较,O2-Fz或Oz-Fz导联的A1、A2均高于O1-Fz导联(P＜0.05);在任一导联中,F-VEP的A2波幅均高于A1(P＜0.05).7～14岁组中,在刺激频率(0.7 Hz)下,O1-Fz、O2-Fz、Oz-Fz三个导联的A1、A2均高于其他频率(1.0、1.4、2.0 Hz)下相应导联的A1、A2(P＜0.05);不同导联之间比较,O2-Fz或Oz-Fz导联的A1、A2均高于O1-Fz导联(P＜0.05);在任一导联中,A2波幅均高于A1(P＜0.05).20例鞍区肿瘤患儿中,3例F-VEP波幅值较基线升高,术后视力较术前改善;8例波形无变化,其中2例术后视力较术前改善,6例无明显改变;6例波形呈可逆性变化,先降低后升高,其中3例术后视力无明显改变,3例较术前改善;3例波形持续降低,其中2例波幅下降小于50％,术后视力无明显改变;1例波幅下降大于50％,术后视力下降.结论 针对患儿年龄选择合适的电生理刺激参数,可在儿童鞍区肿瘤手术中获得稳定的F-VEP波形.术中F-VEP监测有助于避免损伤视神经、视交叉等视觉通路,可最大程度保护患儿视力,对术后视觉功能的评判有一定的临床实用价值.

脊神经后根离断能有效抑制痉挛性脑性瘫痪患儿处于兴奋-抑制失衡状态的脊髓前角α运动神经元兴奋性,从而达到降低其对应肌群肌张力、改善患儿运动功能的目的.但由于人体仅双下肢感觉相关的脊神经后根就有数十枚,如何精准选择需要毁损的脊神经后根一直是临床面临的棘手问题.脊神经诱发肌电监测为这一难题提供了极具操作性的解决方案,为获得稳定及有效的诱发肌电数据,选择性神经后根离断术(selective dorsal rhizotomy,SDR)中麻醉程度、监测肌群及电刺激参数等有一定的规范和要求.串刺激及单刺激是目前较为常用的肌电诱发刺激模式.刺激模式不同,会导致对于脊神经后根的最终"选择"不同.因此,探寻一个安全、有效、量化并能适度降低痉挛肌群肌张力的术中脊神经后根"选择"方案是SDR手术及术中神经电生理监测团队未来的研究方向.

Objective:To evaluate the efficacy of single-level laminectomy selective dorsal rhizotomy (SL-SDR) guided by novel neuroelectrophysiological monitoring protocol followed by intensive rehabilitation for children with spastic cerebral palsy.Methods:For evaluating the changes of motor function, clinical data were retrospectively reviewed for 435 children with spastic cerebral palsy undergoing SL-SDR followed by intensive rehabilitation for at least 6 months from November 2015 to August 2021 at Shanghai Children's Hospital, Affiliated Children's Hospital of Chongqing Medical University and Hunan Children's Hospital.The relevant parameters included objective muscle tone, strength and joint range of movement (ROM). The scores of gross motor function classification system (GMFCS) and gross motor function measure-66 items (GMFM-66) were recorded at preoperation and at least 6 months postoperation.Results:There were 249 boys and 186 girls with an average age of (8.2±2.3)(3.2-15.5) years.And 2, 523 objective muscles and 2, 133 objective joints were confirmed preoperatively and (9.3±3.8) dorsal rootlets resected during SL-SDR.Dorsal rootlets (94.8%) were removed by>50%.And 83 cases (19.1%) had transient superficial paresthesia in lower extremities and recovered within 1 week.There was no long-term side effect of SL-SDR.Within a mean follow-up period of (13.1±8.3) months after SL-SDR, significant improvements occurred with regards to muscle tone, strength, joint ROM, GMFCS level and GMFM-66 score as compared with baseline levels.GMFCS level of children with preoperative GMFCS level Ⅱ/Ⅲ (134/309, 43.4%) was significantly better than that of children with level Ⅳ/Ⅴ(8/105, 7.6%) ( P<0.01); The improvement of GMFM-66 score in children with preoperative GMFM-66 score>50 was greater than that in others[(7.65±3.39) vs.(5.01±2.18), P<0.01]; The improvement of GMFCS level in children aged under 6 years at the time of operation was significantly better than that in others[(106/249) vs.(36/165), P<0.01]. The mean age of children with improvements in GMFCS level post-operation was younger than those without improvements[(6.1±1.0) vs.(11.6±1.7), P<0.01]. Conclusion:SL-SDR guided by novel neuroelectrophysiological monitoring protocol can safely and effectively treat all types of spastic cerebral palsy and its short-term prognosis is decent.

For decades, intraoperative neurophysiological monitoring (IONM) has been used to guide selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). Electromyography (EMG) interpretation methods, which are the core of IONM, have never been fully discussed and addressed, and their importance and necessity in SDR have been questioned for years. However, outcomes of CP patients who have undergone IONM-guided SDR have been favorable, and surgery-related complications are extremely minimal. In this paper, we review the history of evolving EMG interpretation methods as well as their neuroelectrophysiological basis.

Purpose Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population. Methods In the current study, we retrospectively conducted a cohort review of cases younger than 14 years of age diagnosed with spastic quadriplegic or diplegic CP who undergone our modified protocol-guided SL-SDR in the Department of Neurosurgery, Children’s Hospital of Shanghai since July 2016 to November 2017 with at least 12 months post-op intensive rehabilitation program (pre-op GMFCS level-based). Clinical data including demographics, intra-operative EMG responses interpretation, and relevant assessment of included cases were taken from the database. Inclusion and exclusion criteria were set for the selection of patients in the current study. Muscle tone (modified Ashworth scale) and strength of those spastic muscles (muscle strength grading scale), range of motion (ROM) of those joints involved, the level of Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure 66 items (GMFM-66) score of those cases were our focus. Results A total of 86 eligible cases were included in our study (62 boys). Among these patients, 61.6% were quadriplegic. Pre-operatively, almost 2/3 of our cases were with GMFCS levels II and III. Mean age at the time of surgery in these cases was 6.2 (3.5–12) years. Pre-op assessment marked 582 target muscles in these patients. Numbers of nerve rootlets tested during SDR procedure were between 52 and 84 across our cases, with a mean of 66.5 ± 6.7/case. Among those tested (5721 in 86 cases), 47.9% (2740) were identified as lower limb-related sensory rootlets. Our protocol successfully differentiated sensory rootlets which were considered to be associated with spasticity of target muscles across all our 86 cases (ranged from 3 to 21). Based on our protocol, 871 dorsal nerve rootlets were sectioned 50%, and 78 were cut 75%. Muscle tone of those target muscles reduced significantly right after SL-SDR procedure (3 weeks post- vs. pre-op, 1.7 ± 0.5 vs. 2.6 ± 0.7). After an intensive rehabilitation program for 19.9 ± 6.0 months, muscle tone continued to decrease to 1.4 ± 0.5. With the reduction of muscle tone, strength of those target muscles in our cases improved dramatically with statistical significance achieved (3.9 ± 1.0 at the time of last follow-up vs. 3.3 ± 0.8 pre-op), and as well as ROM. Increase in GMFCS level and GMFM-66 score was observed at the time of last follow-up with a mean of 0.4 ± 0.6 and 6.1 ± 3.2, respectively, when compared with that at pre-op. In 81 cases with their pre-op GMFCS levels II to V, 27 (33.3%) presented improvement with regard to GMFCS level upgrade, among which 4 (4.9%) even upgraded over 2 levels. Better results with regard to upgrading in level of GMFCS were observed in cases with pre-op levels II and III when compared with those with levels IV and V (24/57 vs. 3/24). Upgrading percentage in cases younger than 6 years at surgery was significantly greater than in those older (23/56 vs. 4/25). Cases with their pre-op GMFM-66 score ≥ 50 had greater score increase of GMFM-66 when compared with those less (7.1 ± 3.4 vs. 5.1 ± 2.8). In the meanwhile, better score improvement was revealed in cases when SDR performed at younger age (6.9 ± 3.3 in case ≤ 6 years vs. 4.7 ± 2.7 in case > 6 years). No permanent surgery-related complications were recorded in the current study. Conclusion SL-SDR when guided by our newly modified rhizotomy protocol was still feasible to treat pediatric CP cases with spastic quadriplegia and diplegia. Cases in this condition could benefit from such a procedure when followed by our intensive rehabilitation program with regard to their motor function.

Objective To evaluate the efficacy of novel protocol guided single-level laminectomy selective dorsal rhizotomy (SL-SDR) plus intensive rehabilitation for children with spastic cerebral palsy and explore the relevant prognostic factors.Methods A retrospective analysis was conducted for the clinical data of 67 children with spastic cerebral palsy undergoing novel protocol guided SL-SDR plus intensive rehabilitation from September 2015 to October 2016.Analysis was conducted for muscular tone,joint range of movement,muscular strength,gross motor function classification system (GMFCS) grading and gross motor function measure-66 (GMFM-66) scores pre,6 months post and at least 12 months post-operation.Multivariate Logistic regression was employed for identifying the prognostic factors.Results During a mean follow-up period of 12.7 months,downgrading level of GM FCS was one (n=22) and two (n=4).Forty-one cases maintained original grade and there was no upgrading.Downgrading of GMFCS was significantly better in cases with baseline GMFCS Ⅱ/Ⅲ (20/37 vs.6/23,P=0.034) and cases ≤ 6 years (20/31 vs.6/29,P=0.001)than those of Ⅳ/Ⅴ aud ＞6 years.Improvement of GMFM-66 was significantly better in cases with baseline GMFCS Ⅰ-Ⅲ (13.4±2.8 vs.8.7±4.6,P=0) and cases ≤6 years (13.5±3.6 vs.9.8±3.9,P=0) than those of Ⅳ/Ⅴ and ＞ 6 years respectively.Multivariate Logistic regression demonstrated that age (OR:0.491,95％ CI:0.324 0.743,P=0.001) and preoperative status of GM FCS (OR:0.225,95％ CI:0.086-0.589,P=0.002)were independent factors associated with GMFCS downgrading at 12 months post-operatively.Multivariate Logistic regression analysis revealed that age (OR:0.575,95％ CI:0.404-0.820,P=0.002) and preoperative GMFCS (OR:0.103,95％ CI:0.031-0.344,P=0) were independent prognostic factors for an improvement of GMFM-66 at least 10 points at 12 months post-operatively.Conclusions Gross motor functions of children with spastic cerebral palsy undergoing novel protocol guided SL-SDR plus intensive rehabilitation improve dramatically at 12 months after the treatment.And more benefits are available for those with baseline GMFCS level Ⅰ-Ⅲ and aged under 6 years.

目的:分析小儿脊髓栓系综合征(TCS)患儿术后再次导尿的影响因素.方法:回顾性分析152例TCS患儿的临床资料,分析年龄、术前存在尿潴留、术前排尿训练、术中神经电生理监测、手术时间、术后尿管留置时间、术后导尿管夹管方法、导尿管拔除时机等因素对再次导尿的影响.结果:年龄、术前存在尿潴留、术中采用神经电生理监测、术后导尿管夹管方法和拔管时机是术后再次导尿的影响因素,差异有统计学意义(P<0.05).结论:TCS患儿术后再次导尿率受多个因素的影响,临床上应积极规避消极因素,减少患儿痛苦,降低再次导尿率.