痉挛性脑瘫髋关节发育异常的外科治疗

脑性瘫痪简称脑瘫,是目前导致全世界儿童肢体残疾的主要疾病之一.痉挛性脑瘫以锥体系受损为主,继发性肌肉骨骼问题已成为其研究热点,其中髋关节发育不良及髋关节脱位在行走不能及严重型痉挛性脑瘫患儿中发生率越来越高.患儿出生时髋关节一般正常,约2岁左右开始出现股骨头外侧偏移为特征的髋关节发育不良,约4～12岁可发展为髋关节半脱位或脱位,约25％～75％的病例最终进展为影响日常生活的疼痛性、退行性髋关节炎.外科手术治疗配合系统的康复训练,可以改善痉挛性脑瘫儿童的步态和姿势,维持髋关节功能,提高其生活质量和社会参与度.本文就痉挛性脑瘫继发髋关节发育异常的术前评估、外科手术方式的选择、预后等研究进展进行综述.

Surgical management of hip problem of spastic cerebral palsy in children

Cerebral palsy (CP) is the most common disability in childhood.As a non-progressive neurological disturbance in developing fetal or irnfant brain,it affects posture and movement and involves a changing clinical presentation across the years spanning childhood.Spastic cerebral palsy is due to damaged cone system.And hip dysplasia is under intense researches.Hip joint in children with CP is thought to be essentially normal at birth and progressive displacement towards dislocation impacts care,comfort and function.With advancing age,there is a higher incidence of subluxation or dislocation.And 25％-75％ of these hips becoming painful so as to decrease the ambulatory patient's capability of walking or standing.Despite effective preventions,orthopedic surgeons always perform surgery for hip subluxation or dislocation in severely affected CP patients.The goal of these procedures is to retain located,mobile and painless hips.This paper offers a latest summary of research progress of preoperative assessments,surgical procedures and prognosis of hip dysplasia in children with spastic CP.