一期手术治疗重度痉挛性脑瘫双下肢多关节畸形  

One-stage surgical treatment for severe spastic cerebral paralysis with multiple joint deformity in both lower extremities

作　　者：罗军忠[1] 王汉林[1] 李亚洲[1] 徐培 

机构地区：[1]河北医科大学第三医院小儿骨科,石家庄市050051 [2]河北省霸州市第二医院

出　　处：《河北医药》2009年第10期1184-1186,共3页Hebei Medical Journal

基　　金：河北省科技支撑计划项目(编号:072761498)

摘　　要：目的对重度痉挛性脑瘫双下肢多关节畸形治疗方法进行改进,并探讨其治疗效果。方法重度痉挛性脑瘫患儿30例,均表现为双下肢多关节畸形,不能独自站立和行走,双侧髂腰肌、髋内收肌、腘绳肌、小腿三头肌、胫前肌、胫后肌、拇长屈肌、趾长屈肌大多有不同程度肌张力增高。依Ashworth分级,为3～4级。治疗方法:一期行双下肢多关节软组织松解,对动力肌痉挛,采用肌内肌腱切断或肌筋膜切断;对静态性肌痉挛(挛缩)行肌腱滑动延长,胫前肌腱劈开,外侧1/2移位。然后用自制可调外固定器固定,保持双下肢外展45°,膝关节伸直,踝、足中立位,术后6周去除外固定器行康复训练。结果本组病例随访1～3年,平均2.5年。优良26例,有效4例。结论重度痉挛性脑瘫双下肢多关节畸形,一期行多关节软组织松解,平衡肌力,矫整畸形,术后配合康复训练,是一种有效的治疗方法。Objective To improve the therapy for severe spastic cerebral paralysis with multiple joint deformity in both lower extremities, and to investigate the therapeutic effect. Methods 30 patients with severe spastic cerebral paralysis were operated. The patients＇ main symptoms were multiple joint deformity in both lower extremities,who were unable to stand and walk independently. There was hypermyotonia in iliopsoas, adductor musculus, hamstrings, triceps surae, anterior and posterior tibial muscle, flexor pollicis longus and flexor digitorum longns. The muscle tone was 3 - 4 grade according to Ashworth criterion. Therapy： one-stage surgical treatment to make multi-joint soft tissue solution, the intramuscular tenotomy,fascial division or sliding elongation were performed to lengthen the tendon of joint flexion contracture, and the lateral half of anterior tibial muscle tendon was transferred laterally to balance the muscle force in the feet. Finally, both lower extremities were fixed by a new designed external frame to strengthen the articular genu, keep both ankles and feet in neutral position, both lower extremities abducting 45°, and to correct all joint deformities. Family rehabilitation programs started after the external frame was removed 6 weeks after operation. Results All the patients were followed up for 1 - 3 years, average 2.5 years. The excellent cases were 26, and acceptable eases were 4. Conclusion For the severe spastic cerebral paralysis with multiple joint deformity of both .lower extremities in children, the effective therapies are reasonable release of the tight tendons of the multi-joint flexion contraeture, balance of muscle force at the foot, correction of all deformities and fixation of the lower extremities with the new external frame, and long term of family rehabilitation after the surgical treatment.

关 键 词：痉挛性脑瘫 关节畸形 治疗方法 外固定 

分 类 号：R742.3[医药卫生—神经病学与精神病学]