脑瘫SPR术后遗留髋内收畸形的个体化手术治疗

目的评价痉挛型脑瘫患者腰骶段选择性脊神经后根切断术（SPR）后遗留髋内收畸形的手术方案选择及临床疗效。方法回顾性分析2008年8月至2012年8月北京中医药大学东直门医院收治的126例脑瘫SPR术后遗留髋内收畸形患者的临床资料,根据肌肉挛缩的范围和畸形程度采取不同的手术方式,包括长收肌、短收肌、股薄肌、髂腰肌、闭孔神经前支切断术等。观察患者术后髋外展角度及畸形矫正情况。结果 126例患者随访14~38个月（平均22个月）。术后髋内收畸形均较术前有明显改善,其中术后髋外展角度≥30°118例、20°~30°8例,缓解率100%（126/126）,满意率93.6%（118/126）。未出现下肢感觉障碍、髋外展或外旋畸形。结论对于脑瘫SPR术后遗留的髋内收畸形,根据个体情况不同,采用肌肉切断松解、闭孔神经前支切断术等个体化治疗方案,可取到满意的临床疗效。

Individualized surgical treatment of cerebral palsy with hip adduction deformity after selective posterior rhizotomy

Objective To evaluate the surgical options and clinical effects of treatment of spastic cerebral palsy with hip adduction deformity after selective posterior rhizotomy （SPR）. Methods From August 2008 to August 2012, 126 patients with hip adduction deformity who had performed SPR for spastic cerebral palsy were treated in Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine. According to the range of muscle contracture and the degree of deformity, different surgical methods were chosen including tenotomy of long adductor muscle, short adductor muscle, gracilis, iliopsoas, as well as transection of anterior branch of obturator nerve etc. Results All cases were followed up with the average time of 22 months （14-38 months）. Postoperative hip adduction deformity improved significantly, among them, the angle of hip abduction more than 30° was in 118 cases, while 20° to 30° in 8 cases, with the rate of remission 100% （126/126）, and the satisfaction rate 93.6% （118/126）. No limb sensory disturbance, hip abduction or external rotation deformity were found after the surgery. Conclusion For cerebral palsy patients with hip adduction deformity after SPR, individualized surgical treatment including muscle tenotomy and transection of anterior branch of obturator nerve could bring into satisfactory clinical efficacy according to different patients＆#＇ individual situations.