摘要
[目的]探讨痉挛性脑瘫患儿马蹄足的外科治疗方法和疗效。[方法]对1 321例以马蹄足为主要表现的痉挛性脑瘫患儿施行不同的外科手术方式进行治疗。分别于术前、术后和随访期间应用临床痉挛指数和踝关节活动度对患儿手术疗效进行评估。采用方差分析比较术前和术后临床痉挛指数和关节活动度的变化,应用儿童日常生活活动能力评定量表(ADL)对患儿术后运动功能的改善进行评估。[结果]1 321例患儿中随访1 310例,2 608侧肢体。平均随访时间27个月。患儿术后和随访期间的临床痉挛指数均较术前明显减低(P<0.05)。踝关节活动度均较术前明显增大(P<0.05)。术后短期功能改善率76%,随访期间改善率93%。其中,A术式术后复发率16%,D术式术后复发率19%,B、C、E(或并D)术式术后复发率5%。0.4%患儿术后短期出现明显的小腿三头肌肌力下降。0.2%患儿术后出现小腿后外侧的疼痛、麻木等感觉障碍。[结论]胫神经选择性切断术或脊神经后根选择性切断术(SPR)与肌腱延长或松解术相结合是治疗痉挛性脑瘫患儿马蹄足畸形较为有效的手术方式。
[Objective]To explore the surgical strategies and clinical efficacy for equines of spastic cerebral palsy in children.[Method]Total 1 321 spastic cerebral palsy children with equines underwent different surgical approaches.The clinical spastic index（CSI）,range of motion（ROM） of the ankle and activities of daily living rating scale（ADL） were applied to assess the clinical outcome of the children before and after surgery.Analysis of variance was explored.[Result]Total 1 310 children with 2 608 limbs were followed up.It showed that the SCI of the children postoperative and follow-up were significantly decreased comparing with values of preoperative（both P 0.05）.And the ankle joint ROM of the children postoperative and follow-up were significantly increased than values of preoperative（both P 0.05）.The ADL revealed that the mean improvement rate was 76% after surgery,and 93% during follow-up.Among them all,the recurrence rate of surgical approach A was 16%,that of D was 19%,and that of surgical approach B、C、E（orD） was 5%.0.4% of the children appeared muscle strength decline short-term after surgery.0.2% of the children showed reversible sensory disability.[Conclusion]The selective tibial neurotomy or selective posterior rhizotomy combined with tendon lengthening or surgical approach is effect to the treatment of spastic cerebral palsy with equines.The treatment for spastic equines is more appropriate to choose individualized surgery.The different types of equines are applied for surgical approaches.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第18期1833-1836,1847,共5页
Orthopedic Journal of China
关键词
痉挛性脑瘫
马蹄足
外科手术
痉挛指数
关节活动度
spastic cerebral palsy
equinus
surgical procedures
clinical spastic index
range of motion
