股骨近端外旋截骨矫治脑瘫所致儿童下肢严重内旋畸形

Proximal femur rotary osteotomy for treatment of spastic cerebral palsy in children

目的：回顾性分析股骨近端外旋截骨矫治儿童痉挛型脑性瘫痪引起的严重下肢内旋畸形，评价其近期临床疗效，探讨该方法的适应证。方法2009年6月至2013年6月，我们共收治17例（26肢）严重下肢内旋畸形的痉挛型脑性瘫痪而能独立行走的儿童，男11例（19肢），女6例（7肢）；年龄7．5～16岁（平均11．8岁），行股骨近端外旋（25°～40°，平均32．5°）截骨，结合挛缩肌腱松解手术，5例7髋合并髋关节半脱位的患儿同时行内翻截骨。6周后去除石膏外固定，行功能康复训练。结果17例患儿接受为期6～42个月（平均26个月）随访，经步态观察、肌张力测定，站立位髋关节内旋角度、髋关节旋转角度测量及X线影像学评估，发现所有患儿下肢内旋情况及步态明显改善，关节功能较术前明显好转，影像学检查提示截骨处愈合良好，前倾角减小，髋关节趋于稳定。结论对于严重下肢内旋畸形的较大年龄痉挛型脑瘫患儿，尤其是合并髋关节脱位、半脱位者，采用股骨近端外旋或外旋内翻截骨的方法矫治，可有效矫正痉挛内旋步态，改善肢体力线，近期效果肯定，值得临床选择性应用。

Objetive To evaluate the clinical effect of proximal femur rotary-osteotomy in treatment of spastic cerebral palsy in children. Methods There were 17 cases involving 26 lower limbs,11male （involving 19 lower limbs）and 6 female （involving 7 lower limbs ）,aging from 7.5 to 16 years old,average 11.8 years old.These cases suffered from severe internal rotation deformityof lower limbs,but they all can walk independently.Underwent the following procedures：External rotation osteotomy combined with tenolysis to contractural tendon.The Angle of external rotation was from 25°to 40°,mean 32.5°.Five children also with developmenta1hip dysplasia involving 7 lower limbs who underwent femoral varus osteotomy.These cases were removed the plaster external fixation for active rehabilitation training after six weeks. Results 17 cases with complete follow up data were retrospectively analyzed.The patients were followed up for 6～42 months（mean 26months）after operation.Determination of the gait observation,muscle tension,standing hip internal rotation angle,rotation angle measurement of hip joint,X-ray imaging evaluation,found that spin and gait were improved in all patients.The joint function was significantly improved.Imaging detection show the osteotomy was healed well,anteversion angle decreases,the hip tends to be stable. Conclusion For severe lower extremity internal rotation deformity in spastic cerebral palsy patients with older age,especially with hip jointdislocation or subluxation, the treatment of proximal femoral external rotation or external rotation and varus osteotomy,can effectively correct spastic internal rotation gait,improve limb force line.The recent positive effect,is worthy of clinical application of selective.