1090例脑性瘫痪外科手术治疗统计分析

目的分析我国脑性瘫痪（cerebralpalsy，CP）的病因、手术年龄分布、临床特征和外科治疗方法，为了解我国CP发病情况、病情特点、外科治疗状况等提供大样本的临床参考资料。方法回顾性分析1990年9月至2007年12月行外科手术治疗的CP患者1090例，采用SPSSl2软件对资料进行统计学分析。结果1090例脑瘫患者中，男760例，女330例；手术时年龄3～41岁，其中3～5岁167例，6～10岁356例，11—15岁304例，16～25岁218例，26岁以上45例；CP病因中早产占29％、难产窒息占23．9％，明显高于出生后的其他原因，有16％不确定发病原因；CP分型中双下肢痉挛型最多占41％，其次是偏瘫痉挛型25．5％和四肢瘫痉挛型12．1％；20．09％合并流涎，4．59％合并癫痫；术前徒手跛行53％，扶物站立行走31．5％，不能站立行走者15．5％；51．2％智力低于正常，重度智力障碍者占4．1％；语言表达能力低于正常者占53．2％，完全失语占2．8％。1090例cP共实施手术2885术次，其中下肢矫形手术为2535术次，上肢矫形手术59术次，颈总动脉外膜交感神经网剥脱切除术269术次，选择性脊神经后根切断术（selective posterior rhizotomy，SPR）22术次。结论早产、难产和窒息为痉挛型CP发生的最常见原因。我国存在大量未能在学龄前实施矫形手术的CP患者，甚至到成年期仍未接受正确的手术治疗，致使下肢畸形发展到严重程度，说明对CP进行综合外科治疗的专科医师十分缺乏。CP是一个综合征，矫形手术主要适用于痉挛型。根据患者的年龄、类型和病情特点，选择相应的手术方法；病情复杂者，优化组合不同的手术方法，术后配合合理的康复，以提高外科治疗效果。

Statistical analysis on surgerical treatment of 1090 cases with cerebral palsy

Objective To explore the cause, age distribution, clinical feature and surgical methods of cerebral palsy （CP） in China, and to provide large sample clinical data for learning the incidence, characteristic of patients. Methods Totally 1090 medical records of CP patients from September 1990 to December 2007 were retrospectively analyzed. And statistical analysis was carried out by SPSS 12. 0 software. Results There were 760 males and 330 females aged from 3 to 41 years old. The ages of 167 cases were between 3 and 5 years old, 356 cases between 6 and 10 years, 304 eases between 11 to 15 years, 218 cases between 16 to 25 years, and, 45 cases above 26 years old. Premature birth, difficult labour and apnoea occupied 52. 9 percent of CP cause, which was obviously higher than other causes. The cause of 174 cases （ 16% ） is still not clear. Spastic type of both lower extremities occupies as many as 41 percent, spastic hemiparalysis occupies 25.5 percent, and spastic type of four limbs occupies 12. 1 percent. There are 20. 09% cases combined with salivation symptom, 4. 59% cases combined with epilepsy. Preoperative function of lower limb ： 53% patients limped, 31.5% patients walked with crutches, and 15.5% patients can not stand and walk. The intelligence of 559 cases （51.2%） was less than normal level, 4. 1% cases maintained severe mental retardation, 53.2% language capability were less than normal. Patients with complete aphasia occupied 2. 8 percent. 1090 cases underwent 2885 surgical operations. Among them there are 2535 operations for deformity of lower limbs, 59 operations for deformity of upper limbs. There are 269 cases who accepted adventitia sympathetic plexus decollement and excision of Arteria carotis communis, 22 cases undergoing selective posterior rhizotomy. Conclusion Premature birth, difficult labour and apnoea are common causes of CP. There are a lot of patients who has not received othorpaedic surgery before school age in China, even some patients in adulthood who have more severe deformities has not been treated with right methods. There are still lack of specialist who can perform comprehensive surgical therapy for CP. CP is an integrated disease. Orthomorphia mainly refer to spastic type. According to age, type and clinical feature, corresponding methods should be chosen. For complex illness, the methods that include optimizing and composing different surgerical methods, matching rational rehabilitation after operation can promote effectiveness of surgery.