内侧腘绳肌延长术对痉挛性双侧脑瘫步态的影响  

The effects of medial hamstring lengthening on gait in patients with diplegic cerebral palsy

作　　者：徐宏文[1] 马瑞雪[2] 吉士俊[3] 

机构地区：[1]广州市儿童医院骨科,510120 [2]上海复旦大学附属儿科医院骨科 [3]沈阳中国医科大学附属第二医院小儿骨科

出　　处：《中华小儿外科杂志》2006年第4期200-203,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的通过对随访5年的患儿进行术前和术后临床比较分析,评价内侧腘绳肌延长术对双侧痉挛性脑瘫步态的影响。方法将双侧痉挛性脑瘫患儿分为二组,一组为髂腰肌挛缩组,即内侧腘绳肌延长,股直肌远端转位加腰肌切断术。另一组为髂腰肌无挛缩组,即内侧腘绳肌延长,股直肌远端转位术。利用标准的体检,对二组患儿术前和术后下肢关节活动范围、肌力、腘窝角和Thom-as试验进行检查,并对比分析。结果髂腰肌挛缩组术后伸髋肌肌力与髂腰肌无挛缩组比较明显减弱,分别为(3.8±0.5)和(4.8±0.4)(P=0.006),Thomas试验髋屈曲角度增大,分别为(15.0°±16.8°)和(1.5°±2.4°)(P=0.008),并出现膝反屈趋势。结论表明对屈髖肌挛缩的蹲伏步态患儿,不适宜作腘绳肌延长术。可行腰肌切断术纠正骨盆过度前倾及髋关节屈曲挛缩畸形。无屈髋肌挛缩的蹲伏步态患儿,行内侧腘绳肌延长加股直肌转位术,并可避免单纯腘绳肌延长术带来的僵膝步态。Objective To evaluate the effects of medial hamstring lengthening on gait in patients with diplegic cerebral palsy. Methods All patients were divided into two groups： one group underwent medial hamstring lengthening and distal rectus femoris transfer, and the other group underwent intramuscular psaos lengthening as well. The motion analysis data from the clinical history, physical examination, diagnostic imaging, and quantitative gait analysis were analyzed before and after operation in these patients. Results Patients who underwent psaos lengthening showed reduced hip extensor strength （3. 8 ± 0. 5 vs 4. 8 ± 0. 4, P = 0. 006）, increased Thomas-test （15.0° ± 16. 8°vs 1.5°± 2.4°, P = 0. 008）, and a tendency of genu recurvatum compared with those without psaos lengthening. Conclusions The results underline the importance of medial hamstring for hip and knee motion in the sag- ittal plane during walking. In addition, it is not enough to use the popliteal angle to evaluate the hip flexor tightness in patients with cerebral palsy.

关 键 词：内侧腘绳肌延长术 脑性瘫痪 痉挛性双侧脑瘫 步态 

分 类 号：R726.8[医药卫生—儿科]