CAJ | 학술논문

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。
목적：평개경련형뇌탄환자요저단선택성척신경후근절단술（SPR）후유류관내수기형적수술방안선택급림상료효。방법회고성분석2008년8월지2012년8월북경중의약대학동직문의원수치적126례뇌탄SPR술후유류관내수기형환자적림상자료，근거기육련축적범위화기형정도채취불동적수술방식，포괄장수기、단수기、고박기、가요기、폐공신경전지절단술등。관찰환자술후관외전각도급기형교정정황。결과126례환자수방14～38개월（평균22개월）。술후관내수기형균교술전유명현개선，기중술후관외전각도≥30°118례、20°～30°8례，완해솔100%（126/126），만의솔93.6%（118/126）。미출현하지감각장애、관외전혹외선기형。결론대우뇌탄SPR술후유류적관내수기형，근거개체정황불동，채용기육절단송해、폐공신경전지절단술등개체화치료방안，가취도만의적림상료효。
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.