摘要
[目的]观察腰骶段SPR术对痉挛型脑性瘫痪儿童腰椎稳定性中长期的影响。[方法]回顾分析2003年1月~2010年12月行腰骶段SPR治疗痉挛型脑性瘫痪的22例患儿,依据年龄分为学龄前组和学龄组。比较两组资料,包括影像测量冠状位Cobb角、侧位腰椎Cobb角、骶骨倾斜角、弓顶距、腰椎前凸指数、Posner指数和椎板缺损面积。[结果]两组患者术后随访7~13年,平均(9.91±2.35)年。学龄前组患儿术前有2例L5S1脊柱裂,10例轻度脊柱侧弯,至末次随访时Cobb角度数无显著增加。学龄组患儿术前有8例轻度脊柱侧弯,至末次随访10例轻度脊椎侧弯。末次随访时两组未见腰椎滑脱与腰椎峡部裂。术前与末次随访时比较,学龄前组除骶骨倾斜角有统计学意义(P<0.05),其余各影像学指标均无显著变化(P>0.05);学龄组除冠状位Cobb角、骶骨倾斜角有显著增加(P<0.05),而其余指标无显著改善(P>0.05)。至末次随访时两组Posner腰椎不稳评价指标无显著变化(P>0.05)。两组患者均随术后时间的延长L4/5和L5S1椎板缺损率显著减少(P<0.05)。术后半年学龄前组椎板缺损率显著大于学龄组(P<0.05),而末次随访时学龄前组椎板缺损率显著小于学龄组(P<0.05)。[结论]腰骶段SPR术对腰椎稳定性无明显影响。且行SPR手术的年龄越小,椎板再生更为显著。
[Objective] To observe the long-term effects of lumbosacral selective posterior rhizotomy(SPR) on lumbar stability for spastic cerebral palsy in children. [Methods] A retrospective study was conducted on 22 children who underwent lumbosacral SPR for spastic cerebral palsy from January 2003 to December 2010 in our hospital. Based on the age at operation, 11 children fall into the preschool group, while the remaining 11 children were into the school age group. The clinical documentations, especially radiographic parameters, such as coronal Cobb’s angle, sagittal Cobb’s angle, sacral slope, apical distance, lumbar lordosis index, the Posner index and the area of lamina defect, were compared between different time points and the two groups. [Results] The follow-up period lasted for 7~13 years with an average of(9.91±2.35) years. Although L5 S1 spina bifida in 2 and mild scoliosis in 10 patients were found before operation in the preschool group, no significant variation of Cobb angle in the 10 patients at the latest follow up was noticed. By comparison, mild scoliosis in 8 patients of the school age group were found before operation, which became 10 cases of them at the latest follow-up. However, no spondylolisthesis or spondylolysis was found in anyone of both groups at the latest follow up. Compared the radiographic parameters before operation with those at the latest follow up, no significant changes in anyone of the parameters was proved in the preschool group(P>0.05), except the sacral slope significantly increased(P<0.05),whereas the coronal Cobb’s angle and sacral slope significantly increased at the latest follow up(P<0.05) and the remaining parameters kept unchanged(P>0.05) in school age group. At the latest follow up no significant changes in Posner index were noticed compared with those before operation in both groups(P>0.05). As time went postoperatively, the area of lamina defect at L4 and L5 significantly decreased in both group(P<0.05), which proved significantly greater in the preschool group than the school age group at 6 months postoperatively(P<0.05), while significantly less in the preschool group than the school age group at the latest follow up(P<0.05). [Conclusion] The selective posterior rhizotomy in the lumbosacral segment has no significant influence on the stability of the lumbar spine in long-term. Moreover, the younger children are operated, the better lamina regeneration can be achieved.
作者
邓博文
徐林
李筱叶
徐杰
任敬佩
胡传宇
穆晓红
DENG Bo-wen;XU Lin;LI Xiao-ye;XU Jie;REN Jing-pei;HU Chuan-yu;MU Xiao-hong(The Fourth Department of Orthopaedics,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第21期1959-1964,共6页
Orthopedic Journal of China
关键词
脑性瘫痪
选择性脊神经后根切断术
腰椎稳定性
spastic cerebral palsy
selective posterior rhizotomy
stability of the lumbar spine
作者简介
邓博文,博士研究生在读,研究方向:小儿骨科,(电话)010-84013324,(电子信箱)704405348@qq.com;通信作者:穆晓红,(电话)010-84013324,(电子信箱)mxh_2004@163.com。
