CAJ | 학술논문

目的探讨同步多平面手术治疗痉挛性脑瘫手的手术方法和临床疗效.方法回顾性分析2010年1月至2014年6月同步多平面手术治疗获得半年以上随访的25例30肢痉挛性脑瘫手的资料,四肢痉挛型5例,偏瘫痉挛型20例,所有手的畸形均合并下肢痉挛.同步采取的多平面手术方法有肌皮神经、正中神经、尺神经显微神经微缩术,肱骨内上髁屈肌旋前圆肌群松解,腕关节稳定拇指功能重建或伸腕功能加强拇指功能重建及下肢畸形的显微神经微缩术与软组织手术.肌张力按Lazareff分级评定,手功能按脑瘫儿手功能分级系统(MACS)评定,对术后疗效进行统计学分析.结果术后随访6个月至2年,平均1.6年.肌张力恢复有显著差异(z=-5.869,P＜0.01),术前Ⅲ级14例,术后改善有效率为92.86％;术前Ⅳ级11例,术后改善有效率为100％.手功能恢复有显著差异(z=-6.139,P＜0.01),术前Ⅳ级16例,术后改善有效率为93.75％;术前Ⅴ级9例,术后改善有效率为88.89％.结论采用上肢显微神经微缩术配合上肢软组织矫治的同步多平面手术在降低肌张力的同时,一期矫正多关节的畸形,缩短手术疗程,预防痉挛复发,为手功能康复治疗创造条件.对合并下肢畸形也可实施同步手术矫正.术后制定个体化的康复方法,配合合理的支具固定,提高手术疗效.
목적 탐토동보다평면수술치료경련성뇌탄수적수술방법화림상료효.방법 회고성분석2010년1월지2014년6월동보다평면수술치료획득반년이상수방적25례30지경련성뇌탄수적자료,사지경련형5례,편탄경련형20례,소유수적기형균합병하지경련.동보채취적다평면수술방법유기피신경、정중신경、척신경현미신경미축술,굉골내상과굴기선전원기군송해,완관절은정무지공능중건혹신완공능가강무지공능중건급하지기형적현미신경미축술여연조직수술.기장력안Lazareff분급평정,수공능안뇌탄인수공능분급계통(MACS)평정,대술후료효진행통계학분석.결과 술후수방6개월지2년,평균1.6년.기장력회복유현저차이(z=-5.869,P＜0.01),술전Ⅲ급14례,술후개선유효솔위92.86％;술전Ⅳ급11례,술후개선유효솔위100％.수공능회복유현저차이(z=-6.139,P＜0.01),술전Ⅳ급16례,술후개선유효솔위93.75％;술전Ⅴ급9례,술후개선유효솔위88.89％.결론 채용상지현미신경미축술배합상지연조직교치적동보다평면수술재강저기장력적동시,일기교정다관절적기형,축단수술료정,예방경련복발,위수공능강복치료창조조건.대합병하지기형야가실시동보수술교정.술후제정개체화적강복방법,배합합리적지구고정,제고수술료효.
Objective To evaluate the surgical techniques and clinical outcomes of simultaneous multilevel surgery in the treatment of spastic cerebral palsy hand.Methods A retrospective study was conducted to review the clinical data 25 cases of 30 spastic cerebral palsy hands treated with simultaneous multilevel surgery between January 2010 and June 2014 that had more than half a year follow-up.There were 5 cases of quadriplegia spastic hand and 20 cases of hemiplegia spastic hand.All had lower limb spasm as well.The simultaneous multilevel surgery included microsurgical manipulation of the musculocutaneous,median and ulnar nerves,release of the flexor pronator teres muscle group from the medial epicondyle,wrist joint stabilization,reconstruction of thumb or wrist function,correction of lower extremity deformity with microsurgical nerve and soft tissue procedures.Postoperative evaluations included assessment of muscle tension by Lazareff grading and hand function by MACS classification.The results were statistically analyzed.Results Postoperative follow-up ranged from 6 months to 2 years,average being 1.6 years.Muscle tension was significantly decreased (z =-5.869,P ＜ 0.01).Effective tension reduction was achieved in 92.86％ of 14 cases with level Ⅲ spasticity and in 100％ of 11 cases with level Ⅳ spasticity.The hand function improvement was also significant (z =-6.139,P ＜ 0.01).Of 16 cases with level Ⅳ and 9 cases with level Ⅴ classification,the excellent rate was 93.75％ and 88.89％ respectively.Conclusion Simultaneous multilevel surgery combines soft tissue release with multiple joint correction to reduce muscle tension and joint deformity at the same time.It shoaens the surgical treatment duration,prevents recurrence of spasticity and facilitates hand function rehabilitation.This approach can also be used to treat spasticity and deformity of the lower extremity.Individualized rehabilitation regimens combined with proper braces can improve the treatment outcomes.