脑瘫髋关节的定期监控和及时手术预防疼痛性髋脱位  

The hip in cerebral palsy:surveillance and timely surgical intervention can prevent painful hip dislocation

作　　者：刘海清[1] David P.Roye Jr. 李旭[1] Liu Haiqing;David P.Roye Jr.;Li Xu(Santou university Guangzhou Huaxin Orthopaedic Hospital,Guangzhou 510630,China)

机构地区：[1]汕头大学广州华新骨科医院,广州510630

出　　处：《中华骨科杂志》2023年第9期605-612,共8页Chinese Journal of Orthopaedics

摘　　要：脑瘫是最常见的发病于儿童期而机体功能受损影响终身的神经肌肉系统疾患,新生儿发病率约为1/500,目前全世界约有1700万脑瘫患者。脑瘫并不特指某个具体疾病,而是指发育中的胎儿或婴幼儿遭受非进展性脑损伤引发运动发育和姿势控制的永久性异常而导致机体活动受限的一组临床症候群。脑瘫可引发诸多肢体畸形,其中髋关节移位是常见的畸形之一,发生比例仅次于马蹄足。本文回顾文献并总结归纳脑瘫髋关节移位的病理生理机制、临床症状、与大运动功能分级的关系及骨科相关治疗。脑瘫髋关节移位主要是由于早期缺乏正常应力刺激及髋关节周围持续的不对称性肌力牵拉所致。髋关节移位早期常无症状,但若不及时治疗会逐渐出现髋关节半脱位或脱位,导致髋关节疼痛和活动受限,从而影响患者活动能力和增加日常护理难度。脑瘫髋移位与大运动功能分级密切相关,大运动分级越高髋移位风险越大,而通过髋关节监控可明显减少髋关节脱位的发生率。因此,建立规范的脑瘫髋关节监控流程、及时干预、防止髋脱位和疼痛的出现是国内外学者的共识。目前脑瘫髋关节移位的手术治疗主要分为三类:预防性手术、重建性手术和姑息性手术。Cerebral palsy is the most common childhood-onset neuromuscular disorder creating lifelong physical disabilities.It affects about 1 in 500 neonates with an estimated worldwide prevalence of 17 million.Cerebral palsy is not a specific disease,but a spectrum of clinical symptoms of permanent abnormalities of the development of movement and posture caused by non-progressive disturbances in a developing fetal or infant brain.Various musculoskeletal disorders are caused by cerebral palsy,hip displacement is one of the most common deformities,second only to equinus deformities of the foot and ankle.Based on the review of previous literatures,this paper summarized the pathophysiology,clinical symptoms,relationship with the gross motor functionclassification and orthopedic treatment of hip displacement in cerebral palsy.Hip displacement in cerebral palsy is mainly caused by the lack of normal stress stimulation in the early childhood and the continuous asymmetric muscle tone and muscle strength around the hip joint.Early hip displacement in cerebral palsy is usually asymptomatic,but without timely intervention hip subluxation/dislocation will cause hip pain and hip motion limitation and thus influence the patient's activity ability and increase the difficulty of daily caring.Hip displacement in cerebral palsy is closely related to the gross motor functionclassification,and the higher the classification of gross motor,the greater the risk of displacement,and hip monitoring can significantly reduce the incidence of hip dislocation.Therefore,a consensus has been reached that a standardized hip surveillance programs and timely intervention are important to prevent the occurrence of hip dislocation and pain.The surgical strategies for hip displacement in CP can be divided into three types:preventive surgery,reconstructive surgery and salvage surgery.

关 键 词：脑性瘫痪 髋关节 关节脱位 早期医疗干预 

分 类 号：R651.11[医药卫生—外科学]