第三腓骨肌紧缩术治疗痉挛型脑性瘫痪患儿足内翻及背伸障碍的效果

Effect of third fibular muscle constriction surgery on foot varus and dorsal extension disorder in children with spastic cerebral palsy

目的观察第三腓骨肌紧缩术治疗痉挛型脑性瘫痪患儿足内翻及背伸障碍的临床效果。方法对我科2016年1月至2017年12月收治的21例痉挛型脑性瘫痪足内翻及背伸障碍患儿应用第三腓骨肌紧缩术并跟腱延长术治疗,分析患儿治疗效果。结果 21例患儿中,15例(71.4%)足部畸形矫正程度及患儿满意程度评价结果为优,6例(28.6%)结果为良。术后21例患儿(100.0%)的踝关节背曲度扩大15°~60°,平均扩大30°;21例患儿中,足内翻明显改善15例(71.4%),改善6例(28.6%);患儿术后足底位置正常(足底完全着地)15例(28.6%),基本正常(足底基本稳定,与地面夹角<10°)6例(28.6%);21例患儿术后Dimeglio评分均下降5~10分,平均下降8分;所有患儿随访6~12个月,术后下肢未出现感觉障碍。结论第三腓骨肌紧缩术治疗痉挛型脑性瘫痪患儿足内翻及背伸障碍的效果理想,值得临床推广与应用。

Objective To observe the clinical effect of third fibular muscle constriction surgery on foot varus and dorsal extension disorder in children with spastic cerebral palsy. Methods From January 2016 to December 2017, 21 cases of spastic cerebral palsy children with foot varus and dorsal extension disorders admitted in our department were treated with the third fibula muscle constriction surgery and achilles tendon lengthening. The treatment effects in children were analyzed. Results Among 21 cases, 15 cases (71.4%) had excellent results of foot deformity correction and satisfaction of children, while 6 cases (28.6%) had good results. Postoperative ankle dorsal curvature of 21 children (100.0%) expanded by 15°-60°, with an average expansion of 30°. In 21 children, foot varus significantly improved in 15 cases (71.4%) and improved in 6 cases (28.6%). The postoperative position of plantar was normal (completely landed on ) in 15 cases (71.4%) and basically normal (basically stable, with an angle of <10° to the ground) in 6 cases (28.6%). Postoperative Dimeglio score decreased by 5-10 points in 21 children, with an average of 8 points. All the children were followed up for 6-12 months. There was no sensory disturbance of lower limb after operation. Conclusion The third fibular muscle constriction surgery on foot varus and dorsal extension disorder in children with spastic cerebral palsy has ideal effect, which is worthy of clinical popularization and application.