选择性限制性脊神经后根切断术后脑瘫患儿腰椎稳定性的变化

Lumbar stability observation of children with cerebral palsy after limited selective posterior rhizotomy

目的观察痉挛型脑瘫患儿选择性限制性脊神经后根切断术(limitedselectiveposteriorrhizotomy,LSPR)后,腰椎稳定性、切除椎板再生及脊柱生长发育情况。方法将125例痉挛型脑瘫患儿根据年龄(<8岁、≥8岁)及手术方式(软组织矫形手术、LSPR手术、软组织矫形+LSPR手术)分组。在手术前、后及随访时,分别摄站立位及动力位腰椎正侧位X线片,测量手术前、后腰骶角、L5S1矢状位椎体位移率等指标。分析比较各组之间及手术前、后各项指标的差异。观察术后切除椎板再生及脊柱生长发育情况。结果(1)软组织矫形手术组手术前、后各项指标差异无统计学意义;(2)LSPR组及软组织矫形+LSPR手术组手术前、后各项指标差异显著;(3)行LSPR手术的<8岁组手术前后各项指标差异有统计学意义,≥8岁组手术前后仅L5S1矢状位椎体位移率差异显著;(4)LSPR术后发现L5S1Ⅰ度滑脱3例(3.90%),脊柱侧凸4例(5.19%,Cobb角15°～34°),腰椎前凸3例(3.90%);(5)LSPR术后见切除椎板部分再生。结论LSPR手术对脑瘫患儿腰椎稳定性有一定影响,但不是惟一的因素。儿童LSPR术后,切除的椎板有再生能力。Lumbar stabilityobservationofchildrenwith cerebralpalsyafterlimitedselectiveposteriorrhizoto-my YANG Chao,WANG Qiu-gen,ZHANG Qiu-lin,etal.

Objective To investigate the stability of lumbar column after limited selective posterior rhizotomy(LSPR) and observe the healing of exscinded laminae and the deformation of lumbar column. Methods One hundred and twenty five children with spastic cerebral palsy were divided into six groups(A, B, C, D, E, F)according to the age(< 8 years, ≥8 years) and operation method(soft tissue orthopaedic operation, LSPR, soft tissue orthopaedic operation with LSPR). Lumbar X-ray films, standing position,and orthotopic and lateral dynamic lumbar films were taken pre-and postoperatively. Lumbosacral angle and L5S1 centrum displacement percent(CDP) on dynamic films were recorded and analyzed according to Posner definition. Regeneration of exscinded laminae and deformation of lumbar column were observed. Results (1) The lumbarsacral angle and L5S1 CDP were not significantly varied pre- and postoperatively in the soft tissue orthopaedic operation group(A+B); (2) These two indicators were significantly varied pre- and postoperatively in the LSPR group(C+D) and soft tissue orthopaedic operation with LSPR group(E+F); (3) Both indicators were significantly varied pre- and postoperatively in < 8 years groups(C+E) operated on by LSPR, and L5S1 CDP was significantly varied pre- and postoperatively in ≥8 years group(D+F); (4) Three cases of L5S1 Ⅰdegree spondylolisthesis (3.90%), four cases of scoliosis with the Cobb angle of 15°-34°(5.19%) and three cases of lordosis(3.90%) were found in all group operated on by LSPR postoperatively; (5) Osteous healing of sectioned laminae was found after LSPR. Conclusion LSPR influences the stability of lumbar column on children with spastic cerebral palsy, but it's not the only factor. The exscinded laminae of children after LSPR have the healing ability.