Ilizarov技术联合腘绳肌延长矫正脑瘫重度屈膝畸形△

Ilizarov technique combined with hamstring lengthening to correct severe knee flexion deformity due to cerebral palsy

摘要:

[目的]探讨 Ilizarov 技术联合腘绳肌延长治疗痉挛型脑瘫重度屈膝畸形的临床效果。[方法]回顾性分析 2017 年 8 月—2020 年 4 月采用腘绳肌延长和 Ilizarov 技术矫正痉挛型脑瘫重度屈膝畸形 15 例患者的临床资料, 评价临床治疗效果。[结果]所有患者均顺利完成手术，术中无血管、神经损伤。7 例患者同时行髋部及足部畸形矫正术，包括髋内收肌松解、闭孔神经缩窄术、跟腱延长术、腓肠肌腱膜切断术等。所有患者屈膝畸形在术后 28 d 内调整完毕，继续佩戴 Ilizarov 外固定架维持矫正。 佩戴外固定架时间为 36~50 d，平均(41.1±3.5)d。15 例患者随访时间平均为(1.6±0.3)年。术后 3 个月、末次随访时膝关节静态屈曲角度均比术前显著减少(P＜0.05)，被动 ROM、主动 ROM 较术前显著增加(P＜0.05)。GMFCS 分级由术前Ⅳ级提高为末次随访时Ⅲ级，根据 Herzenberg 标准，临床结果优 9 膝、良 21 膝，优良率 100.0%。[结论]应用 Ilizarov 技术联合膝后内侧腘绳肌延长治疗痉挛型脑瘫重度屈膝效果满意。

Abstract:

[Objective] To investigate the clinical outcomes of Ilizarov technique combined with hamstring lengthening for severe knee flexion deformities due to spastic cerebral palsy. [Methods] A retrospective study was done on 15 children who received the Ilizarov tech- nique and hamstring lengthening for bilateral severe knee flexion deformity due to spastic cerebral palsy in our hospital from August 2017 to April 2020 and the clinical consequences were evaluated. [Results] All patients had the surgical managements conducted successfully with- out serious complications such as vascular and nerve injury. Of them, 7 patients had hip and foot deformities corrected simultaneously, in- cluding hip adductor muscle release, obturator nerve constriction, Achilles tendon lengthening and gastrocnemius aponeurotomy. The frame was adjusted only within the first 28 days after operation and was carried up continuely. The duration of wearing the Ilizarov external fixator was 36~50 days, with an average of (41.1±3.5) days. All the patients were followed up for (1.6±0.3) years. The static flexion angle of the knee at 3 months after operation and at the last follow-up was significantly less than that before operation (P＜0.05) , while the passive range of mo- tion (ROM) and active ROM were significantly increased over time (P＜0.05) . The GMFCS was improved from grade Ⅳ preoperatively to grade Ⅲ at latest follow- up. According to Herzenberg's criteria, the clinical results were marked as excellent in 9 knees and good in 21 knees, with an excellent and good rate of 100.0%. [Conclusion] The Ilizarov technique combined with hamstring lengthening is an effective treatment for severe knee flexion deformity in spastic cerebral palsy.