微创半腱肌股薄肌交叉缝合治疗小儿脑瘫膝关节屈曲畸形临床疗效及对膝关节功能的影响

Clinical efficacy of minimally invasive treatment of knee flexion deformity in children with cerebral palsy and its effect on knee joint function

目的观察微创半腱肌、股薄肌交叉缝合治疗小儿脑瘫后遗症膝关节屈曲畸形的临床疗效及对膝关节功能的影响。方法将70例小儿脑瘫后遗症所致膝关节屈曲畸形患者按照随机数字量表分为治疗组(35例)和对照组(35例)。治疗组35例行后方半腱肌、股薄肌交叉缝合,半膜肌腱性成分行"Z"形切断术。对照组行Ilizarov外固定架治疗。均术后3个月统计临床疗效,并观察2组治疗前后徒手肌力检查(manual muscle testing,MMT)、主动关节活动度(active range of motion,AROM)和Muller膝关节稳定性;术后6个月观察复发率。结果治疗组优良率为94.29%,对照组优良率为80.00%,治疗组优良率高于对照组(P<0.05)。2组治疗后AROM、MMT和Muller膝关节稳定性评分均改善(P<0.05)。治疗组治疗后AROM、MMT和Muller膝关节稳定性评分改善均优于对照组(P<0.05)。治疗组复发率为2.86%,对照组复发率为17.14%,治疗组复发率低于对照组,差异有统计学意义(P<0.05)。结论微创半腱肌股薄肌交叉缝合治疗小儿脑瘫后遗症膝关节屈曲畸形疗效确切,改善膝关节功能有明显优势,并减少复发。

Objective To observe the clinical efficacy of the treatment of knee flexion deformity in children with cerebral palsy using cross suture of the semitendinosus and gracilis and the influence on knee joint function. Methods Seventy patients with knee flexion deformity caused by cerebral palsy were equally divided into two groups according to random number scale. The treatment group was treated with the suture of the posterior semitendinosus and gracilis muscle, and the ＆quot;Z＆quot; shape of the semitendinosus tendon was cut off. The control group was treated with the Ilizarov external fixator. The clinical efficacy of the treatment was evaluated in both groups 3 months after surgery. The preoperative and postoperative active range of motion （AROM）, manual muscle test （MMT） and Muller stability of the knee joint were observed in both groups. The recurrence rate of the two groups was observed at the end of 6 months.Results The excellent and good rate was 94.29% in the treatment group compared with 80% in the control group. The difference between the two groups was statistically significant （P〈0.05）. The clinical efficacy of the treatment group was better than that of the control group. AROM, MMT and Muller knee stability score were significantly improved （P〈0.05） in both groups after treatment. The difference in AROM, MMT and Muller knee stability score between the two groups was statistically significant （P〈0.05）. AROM, MMT and Muller knee stability score improved more significantly in the treatment group than in the control group. The recurrence rate of the treatment group was 2.86%, butwas 17.14% in the control group. The difference between the two groups was statistically significant （P〈0.05）.Conclusion It is effective to treat knee flexion deformity in children with cerebral palsy withminimally invasive semitendinosus tendon suture.