SPN配合多平面同步手术治疗痉挛性脑瘫后遗复杂肢体畸形

SPN combined with multilevel synchronous operation for treatment of spastic cerebral palsy with sequelae of complex limb malformation

[目的]探讨选择性周围神经切断术（SPN）配合多平面同步手术治疗痉挛性脑瘫后遗复杂肢体畸形的临床疗效。[方法]回顾分析2010年1月~2013年2月应用SPN配合多平面同步矫形手术策略治疗痉挛性脑瘫后遗复杂肢体畸形患者30例,将其作为观察组,2004年1月~2009年12月单独应用多平面矫形手术的31例患者作为对照组,分别于术前、术后（拆除石膏时）、末次随访（拆除石膏后行康复锻炼2年）应用临床痉挛指数（CSI）与粗大运动功能量表（GMFM）88项评分评估疗效,并将其差异进行统计学分析。[结果]观察组术后及末次随访CSI评分较术前降低,差异有统计学意义（P〈0.05）,且术后与末次随访相比差异无统计学意义（P〉0.05）;对照组术前、术后与末次随访CSI评分相比差异均无统计学意义（P〉0.05）;组间对比两组术前差异无统计学意义（P〉0.05）,术后及末次随访差异均有统计学意义（P〈0.05）。两组术后及末次随访GMFM-88评分均较术前提高,差异有统计学意义（P〈0.05）,观察组末次随访与术后相比差异无统计学意义（P〉0.05）,而对照组末次随访评分较术后降低,差异有统计学意义（P〈0.05）;组间对比两组术前及术后差异无统计学意义（P〉0.05）,末次随访对照组评分明显低于观察组,差异有统计学意义（P〈0.05）。[结论]SPN配合多平面同步矫形手术在对多肢体挛缩固定畸形进行矫正的同时降低其肌张力与痉挛程度,与单独应用矫形手术相比术后近期疗效类似,而中期疗效更优且症状复发风险更小,但需要选择合适的手术人群并制定个体化手术组合方案,同步与分期手术应根据患者情况合理选择。

[Objective] To investigate the efficacy of selective peripheral neurotomy（ SPN） combined with multilevel synchronous operation for treatment of spastic cerebral palsy with sequelae of complex limb malformation. [Methods] Thirty cases of spastic cerebral palsy with sequelae of complex limb malformation were treated by SPN combined with multilevel synchronous orthopedic operation between January 2010 and February 2013,these 30 cases were set as the observation group. Another 31 cases were treated by multilevel synchronous orthopedic operation between January 2004 and December 2009 as the control group.The efficacy was evaluated by clinical spasticity index（ CSI） and 88 grades of the gross motor function measure（ GMFM） before surgery,after surgery（ when removing the gypsum） and during follow- up（ 2- year rehabilitation exercises after the gypsum was removed）. The differences were compared by SPSS 19. 2 statistical analysis software. [Results] In the observation group,postoperative and follow- up CSI scores decreased compared with the preoperative score,the differences were statistically significant（ P 〈0. 05）. The difference of postoperative and follow- up CSI scores was not significant（ P 〉0. 05）. In the control group,the differences of preoperative,postoperative and follow- up CSI scores were not statistically significant（ P 〉0. 05）. There was no significant difference between the two groups in preoperative period（ P〉 0. 05）. However,the differences in postoperative and follow- up period were statistically significant. The GMFM- 88 scores in postoperative and follow-up period of the two groups improved than that before the operation,the differences were statistically significant（ P〈 0. 05）.In follow- up period,the difference of GMFM- 88 scores in observation group was not statistically significant（ P 〉0. 05）.The scores of control group in follow- up period decreased than that in postoperative period, the difference was statistically significant（ P 〈0. 05）. There was no significant difference of the GMFM scores between the two groups before and after surgery（ P 〉0. 05）. The scores of control group were lower than that of observation group in follow- up period,and there was statistically significance between them（ P 〈0. 05）. [Conclusion] SPN combined with multilevel synchronous operation could not only correct the complex limb contracture deformity but also reduce the muscle tension,the short term effect is equivalent compared with single application of orthopedic operation,but the long term effect is better and the risk of recurrence is smaller. It is necessary to choose appropriate operation groups and to make individualized operation combination scheme. Synchronization and staging operation should be selected according to the conditions of patients.