正中神经缩窄术结合肌腱转移治疗痉挛性脑瘫手畸形

MEDIAN NERVE CONSTRICTIVE OPERATION COMBINED WITH TENDON TRANSFER TO TREAT BRAIN PARALYSIS CONVULSIVE DEFORMITY OF HAND

目的评价正中神经缩窄术结合肌腱转移治疗痉挛性脑瘫手畸形的疗效。 方法回顾分析2009年8月－2012年4月收治的21例痉挛性脑瘫手畸形患者临床资料。其中男13例，女8例；年龄10～29岁，平均15岁。痉挛性脑瘫原因：早产11例，缺氧窒息7例，脑外伤2例，脑炎后遗症1例。病程2～26年，平均10.6年。21例均有屈腕、屈指及拇内收畸形，12例伴前臂旋前畸形；肌张力以Ashworth评定法分级：Ⅰ级2例，Ⅱ级5例，Ⅲ级8例，Ⅳ级4例，Ⅴ级2例。患者智力均无障碍，术前摄前臂X线片示均无骨质结构改变。术前分析挛缩肌肉及神经支配，显微镜下行正中神经缩窄术结合肌腱转移矫正手畸形。随访时对患者功能活动和畸形改善进行评价。 结果术后患者切口均Ⅰ期愈合，无肌肉萎缩、缺血性痉挛等早期并发症发生。21例均获随访，随访时间1.5～4.5年，平均2.3年。21例患者均无浅感觉减退等手术并发症发生。末次随访时，患者痉挛畸形缓解疗效评定，获优13例，良6例，差2例，优良率90.4%。 结论正中神经缩窄术结合肌腱转移有效解除了痉挛性脑瘫手畸形，预防痉挛复发，达到一期矫形目的，为恢复患者手部功能和提高生活质量提供了有效保证。

Objective To evaluate the effectiveness of the median nerve constrictive operation combined with tendon transfer to treat the brain paralysis convulsive deformity of the hand. Methods The clinical data from 21 cases with brain paralysis convulsive deformity of the hand were analyzed retrospectively between August 2009 and April 2012. Of them, there were 13 males and 8 females with an average age of 15 years （range, 10-29 years）. The causes of the convulsive cerebral palsy included preterm deliveries in 11 cases, hypoxia asphyxia in 7, traumatic brain injury in 2, and encephalitis sequela in 1. The disease duration was 2-26 years （mean, 10.6 years）. All the 21 patients had cock waists, crooking fingers, and contracture of adductors pollicis, 12 had the forearm pronation deformity. According to Ashworth criteria, there were 2 cases at level I, 5 cases at level II, 8 cases at level III, 4 cases at level IV, and 2 cases at level V. All patients had no intelligence disturbances. The forearm X-ray film showed no bone architectural changes before operation. The contraction of muscle and innervation was analyzed before operation. The median nerve constrictive operation combined with tendon transfer was performed. The functional activities and deformity improvement were evaluated during follow-up. Results After operation, all the patients’ incision healed by first intension, without muscle atrophy and ischemic spasm. All the 21 cases were followed up 1.5-4.5 years （mean, 2.3 years）. No superficial sensory loss occurred. The effectiveness was excellent in 13 cases, good in 6 cases, and poor in 2 cases, with an excellent and good rate of 90.4% at last follow-up. Conclusion The median nerve constrictive operation combined with tendon transfer to treat brain paralysis convulsive deformity of the hand can remove and prevent the recurrence of spasm, achieve the orthopedic goals, to assure the restoration of motor function and the improvement of the life quality.