腰方肌腰髂肋肌痉挛型脑瘫的手术治疗.docVIP

作者简介： 作者简介：张雪非（1946-），主任医师，研究方向：矫形外科，（电话）0539-8769163 *通讯作者：（电子信箱）musi_36@ 张雪非,李存玉,任中杰*,王金余,马扩助,甄玉来,王方玉 （临沂经济技术开发区人民医院骨科，临沂 276023） 摘要[目的] 探讨手术治疗腰方肌腰髂肋肌痉挛型脑瘫的方法和临床疗效。[方法] 29例腰方肌腰髂肋肌痉挛型脑瘫，男19例，女10例;年龄5岁至33岁，平均年龄13.7岁。肌张力按Ashworth评级法评定腰方肌腰髂肋肌，肌张力1级25例， 2级4例。踝阵挛按Clonus评级法评定。双下肢痉挛性瘫痪23例，下肢肌张力4级1例，3级4例，2级14例，1级4例；踝阵挛4级2例，2级4例，1级5例，0级12例。单下肢痉挛性瘫痪3例，下肢肌张力均1级，踝阵挛均 0级。同侧上下肢痉挛性瘫痪2例，下肢肌张力2级1例，1级1例，踝阵挛2级1例，1级1例。单一腰方肌腰髂肋肌痉挛1例，肌张力1级，踝阵挛0级。临床定性分析：髂肋间距短缩、脊柱侧凸29例；骨盆倾斜29例；坐位双膝前方不平齐16例；双侧髋关节屈曲19例，单侧髋屈曲8例，髋关节半脱位2例，髋关节脱位1例；双侧膝屈曲16例，单侧膝屈曲3例；双侧足下垂7例，单侧足下垂5例，马蹄内翻足12例；行走时划圈步态11例；剪式步态行走16例。手术方法：先行痉挛的腰方肌腰髂肋肌松解手术，手术后下肢踝套牵引。二侧髂肋间距相等时，二次手术矫正所有肢体畸形。手术后按软组织或骨性手术需要固定肢体并实施康复训练计划。[结果] 所有病例均获随访，时间1年5个月至7年1个月，平均4.2年。腰方肌腰髂肋肌痉挛消失，两侧髂肋间距相等，骨盆倾斜消失。脊柱、双下肢异常姿态和运动功能障碍情况随手术后康复训练得以纠正。[结论] 可靠的临床定性分析、合理的手术治疗和系统的手术后矫姿与功能康复训练，是腰方肌腰髂肋肌痉挛型脑瘫手术矫形良好疗效的保证。 【关键词】痉挛; 腰方肌; 腰髂肋肌; 手术治疗; 脑瘫 Surgical?treatment of?the spastic quadratus?lumborum?and iliocostalis ?lumborum in?cerebral palsy//ZHANG Xue-fei ，LI Cun-yu，REN Zhong-jie，et al.Department of orthopatdics，People’s hospital of Linyi Economic Technological Development Area，Linyi 276023，China Abstract?[Objective] To investigate the?surgical methods and clinical?efficacy of ?the spastic quadratus?lumborum?and iliocostalis ?lumborum in?cerebral palsy.? [Methods] ?Since April 2004,29 cases with spastic quadratus?lumborum?and iliocostalis ?lumborum were operated,?19 males and 10 females, with the average of?13.7 years old(range, 5-33?years). According to? Ashworth’s standard,the?muscular tension of?quadratus?lumborum?and iliocostalis lumborum was evaluated, 25 cases were in degree I，4 cases were in degreeⅡ.?According to?Clonu’s? standard, the ankle?clonus?was evaluated. There were 23 cases ?with spastic diplegia,3 cases with spastic monoplegia, 2 cases with spastic hemiplegia and 1case with spastic quadratus lumborum?and iliocostalis ?lumborum merely.About the muscular tension of lower extremity,1 case was in degree Ⅳ,4cases were in degree Ⅲ,15 cases were in degr