摘要
目的观察有限度的脊神经后根切断术联合有限度软组织松解术治疗对痉挛性脑性瘫痪患儿运动功能的影响。方法①收集1996-10/2004-01在吉林大学第一医院骨科施行选择性脊神经后根切断术联合有限度软组织松解术治疗的脑性瘫痪患儿438例,男298例,女150例。监护人对治疗方案及观察目的知情同意。②351例为有限度的脊神经后根切断术及有限度软组织松解术一次完成,87例术前不能独立行走,先行有限度软组织松解术,进行功能锻炼,待可行走后再行脊神经后根切断术。③根据运动功能评分(立姿可以稳定自行站立,足跟着地,膝关节伸直计5分,扶持亦不能站立或直跪竖立计1分。步姿能自己稳定上下楼梯,独立行走,步态稳定计5分;扶持亦不可行走,抬腿困难计1分。下蹲起立可自行蹲下起立,不用扶持及帮助计5分;扶物亦不能站立计1分)评定患儿手术前后的运动功能变化。对438例患儿术后运动功能进行9年随访。④计数资料和计量资料差异比较分别采用χ2检验和t检验。结果脑性瘫痪患儿438例均进入结果分析。438例患儿术后能生活自理、功能改善、独立行走的占99.3%。家长反映无明显好转者3例。畸形改变完全消失32.1%,程度减轻82.2%,程度不变0.68%。术后计分明显高于术前(立姿4.32,3.12分,步姿3.62,2.42分,蹲立变换3.82,2.32分,χ2=11.3201,P<0.01)。结论选择性脊神经后根切断术联合有限度软组织松解术可改善脑性瘫痪患者站立和行走时的交叉和尖足畸形,改善患者行走步态,提高患者的运动功能,尤其是改善独立行走能力。
AIM： To Observe the therapy （LSPR） with limited selective soft of limited selective posterior rhizotomy tissue release （LSTR） on the motor function of children atients with spastic cerebral palsy. METHODS： （1） 438 children patients with spastic cerebral palsy, who were treated with SPR associating with selective soft tissues release at Department of Orthopaedics, First Hospital, Jilin University from October 1996 to January 2004, were selected, including 298 males and 150 females. Their guardians all agreed them to join the experiment. （2）351 patients were treated with LSPR and LSTR once. Eighty-seven patients who could not walk independently were treated with LSTR firstly to conduct functional exercise, and then given LSPR after walking. （3） The change of motor function before and after operation of the children patients was evaluated with motor function assessment （Standing position： Self-standing stabilizing, heel touching the ground, knee joint straightening as 5 points; upholding but cannot stand or kneeling straightly as 1 point. Walking position： stair activity stabilizing by oneself, walking independently, stable gait as 5 points; upholding but cannot walking, leg-raising difficulty as 1 point. Squatting and standing up： squatting and standing up by oneself without upholding and helping as 5 points; upholding but cannot standing as 1 point）. Nine-year follow up was performed in the motor function of 438 children patients after operation. （4） Digital data and measurement data were analyzed with X^2 test and t-test, respectively. RESULTS： 438 children patients with spastic cerebral palsy were all involved in the result analysis. In the 438 patients, the rate of better quality of life, functional improvement and working independently were 99.3 percent, and 3 patients could not be improved reflected by the parents. Alteration of deformation： The rate of deformity full peter was 32.1 percent, the rate of deformity being improved was 82.2 percent, and the rate of deformity being no change was 0.68 percent. The score were significantly higher after operation than that before operation （standing position： 4.32, 3.12 points,walking position 3.62, 2.42 points,squating and standing 3.82, 2.32 points,x^2= 1.320 1, P 〈 0.01 ）. CONCLUSION： LSPR with LSTR can ameliorate the standing with crossing and foot deformity when walking of patients with cerebral palsy, improve walking gait, enhance motor function, and espeeially ameliorate the ability of independent ambulation.
出处
《中国临床康复》
CAS
CSCD
北大核心
2005年第47期105-107,共3页
Chinese Journal of Clinical Rehabilitation
