脊神经后根切断术对痉挛型脑瘫髋关节发育的影响

Effect of selective posterior rhizotomy on hip development in children with spastic cerebral palsy

摘要:

［目的］ 探究腰骶段选择性脊神经后根切断术 （selective posterior rhizotomy, SPR） 对痉挛型脑瘫髋关节发育的影响。 ［方法］回顾性分析 2017 年 2 月—2020 年 2 月本科行 SPR 的痉挛型脑瘫 50 例患儿（共 100 髋）的临床资料，根据年龄分为学龄前组与学龄组。比较两组临床与影像学结果。［结果］两组均顺利完成手术，无严重并发症。学龄前组手术时间与术中出血量均显著少于学龄组 （P<0.05）。两组均获随访 2~3 年，平均 （2.52±0.43） 年，与术前相比，末次随访时两组粗大运动功能评定 （Gross Motor Function Measure, GMFM）88 项 E 区评分均显著提高（P<0.05），髋屈-伸 ROM 和髋内收-外展 ROM，Ashworth 髋肌张力和 MRC 髋肌力评级均显著改善（P<0.05）；但相应时间点两组间上述临床指标差异均无统计学意义（P>0.05）。影像学方面， 与术前相比，末次随访时两组髋臼指数（acetabular index, AI）和颈干角（neck shaft angle, NSA）均无显著变化（P>0.05）；学龄前组中心边缘角（center-edge angle, CE）显著增大（P<0.05），而学龄组 CE 无变化（P>0.05）；两组股骨头偏移百分比（migration percentage, MP） 均显著减小 （P<0.05）。术前学龄前组 AI、MP 和 NSA 均显著大于学龄组 （P<0.05），CE 显著小于学龄组 （P< 0.05）。末次随访时两组间比较，学龄前组 AI 和 NSA 仍显著大于学龄组 （P<0.05），但两组间 MP 差异已无统计学意义 （P> 0.05），学龄前组 CE 仍显著小于学龄组（P<0.05）。［结论］腰骶段 SPR 术可以改善痉挛型脑瘫患儿髋关节发育。

Abstract:

[Objective] To explore the effect of selective posterior rhizotomy (SPR) on the hip development in children with spastic ce- rebral palsy. [Methods] A retrospective study was performed on 50 children (100 hips) who underwent SPR for spastic cerebral palsy in our department from February 2017 to February 2020. The patients were divided into preschool group and school age group according to the age at operation. The clinical and imaging results of the two groups were compared. [Results] All children in both groups had operation per- formed successfully without serious complications. The preschool group consumed significantly less operative time with significantly less in- traoperative blood loss than the school age group (P＜0.05) . The children were followed up from 2 to 3 years, with an average of (2.52±0.43) years. The score of Gross Motor Function Measure (GMFM) 88-E, hip flexor-extension and adduction-abduction ROMs, as well as Ash- worth muscle tone scales and MRC scale for hip muscle strength significantly improved at the latest follow-up compared with those preoper- atively in both groups (P＜0.05) . However, there were no statistically significant differences in the abovementioned clinical items between the two groups at any corresponding time points (P＞0.05) . Radiographically, compared with those preoperatively the acetabular index (AI) and neck shaft angle (NSA) had not significantly changed in both groups at the latest follow-up (P＜0.05) ; the center-edge (CE) angle in the preschool group increased significantly (P＜0.05) , whereas which remained unchanged in school-age group (P＜0.05) ; the migration per- centage (MP) of femoral head significantly decreased in both groups at the latest follow up (P＜0.05) . Comparison between the two groups before operation showed that the AI, MP and NSA of preschool group were significantly higher (P＜0.05) , and the CE angle significantly low- er than those of school-age group (P＜0.05) . Despite of the facts that the preschool group still had significantly greater AI and NSA, where- as significantly less CE angle than the school-age group (P＜0.05) , there was no significant difference in MP between the two groups at the latest follow up (P＞0.05) . [Conclusion] Lumbosacral SPR can improve the development of hip joint in children with spastic cerebral palsy.