腰骶段SPR术对痉挛型脑瘫患儿腰椎稳定性影响的中长期观察
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北京中医药大学东直门医院

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A mid-term and long-term observation of the effect of SPR in lumbosacral segment on lumbar stability of children with spastic cerebral palsy
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Dongzhimen Hospital,Beijing University of Chinese Medicine

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    摘要:

    [目的] 观察腰骶段SPR术对痉挛型脑性瘫痪儿童腰椎稳定性中长期的影响。[方法] 将符合纳排标准的22例患儿,依据年龄分为A、B两组,分别在术前、术后半年和术后末次随访时拍摄站立位的腰椎X线平片,测量手术前、后以及末次随访时的冠状位Cobb角、侧位腰椎Cobb角、骶骨倾斜角、弓顶距、腰椎前凸指数、AO/W与RO/W(Posner指数)等指标,采用面积统计方法测量术后椎板再生情况以及生活问卷调查。运用SPSS 25.0统计分析软件将上述测量值进行组内、组间对比。[结果] (1)术后末次随访发现 22例患儿中有7例(31.8%)出现腰部疼痛;3例(13.6%)出现髋部疼痛;2例(9.0%)出现膝关节疼痛;1例(4.5%)1年1次以上出现膝关节疼痛。(2)A组术前和术后末次随访对比,各项指标差异无显著意义;B组除冠状位Cobb角与骶骨倾斜角有统计学差异。(3)A、B两组Posner腰椎不稳评价指标术前、术后末次随访对比无显著差异。(4)A、B两组组间对比椎板缺损率有显著差异,B组平均椎板缺损率大于A组。(5)A组患儿术前有2例L5、S1脊柱裂,10例轻度脊柱侧弯,术后Cobb角度数无显著增加;B组患儿术前有6例轻度脊柱侧弯,术后末次随访10例轻度脊椎侧弯。(6)两组均无腰椎滑脱与腰椎峡部裂。[结论] 通过对痉挛型脑瘫患儿中远期随访,发现腰骶段SPR术对腰椎稳定性无明显影响。且行SPR手术的年龄越小,椎板再生更为显著。

    Abstract:

    [Objective] To observe the effects of postoperative lumbosacral SPR for children with spastic cerebral palsy and long-term stability of the lunbar spine. [Methods] According to their age, 22 children with spastic cerebral palsy who were included in the standard were divided into group A and group B. The lumbar vertebrae positive side, left-right oblique position and dynamic position plain film were taken in 22 children before operation, half a year after operation and at the last follow-up after operation. Then we would measure changes in coronal Cobb angle, lateral lumbar Cobb angle, sacral slope, apical distance, lumbar lordosis index and the Posner index before and after surgery and at the final follow-up. At the same time, the Area Statistics Method was used to measure postoperative laminar regeneration and the life questionnaire survey was conducted. All collected measurements would take statistics to perform in-group and inter-group comparisons. [Results] (1) At the last follow-up, 7 of 22 cases (31.8%) had occasional lumbar pain, 3 cases (13.6%) had occasionally hip pain, 2 cases (9.0%) had occasional knee pain and 1 case (4.5%) occurred knee pain more than once a year. (2) There was no significant difference in the indexes between the preoperative and postoperative follow-up of group A. In group B, there was no significant difference between preoperative and final follow-up except the Coronal Cobb Angle and sacral slope. (3) There was no significant difference in the evaluation of the lumbar instability of the Posner A and B groups before and after the surgery. (4) Only comparative laminectomy defect rates were significantly different betweem group A and B. The average rate of lamina defect in group B was higher than that in group A. (5) Although there were 2 cases of L5, S1 spina bifida and 10 cases of mild scoliosis before operation in group A, there was no significant increase in Cobb angle after operation. In group B, 6 cases had mild scoliosis before operation and 10 cases had mild scoliosis after the last follow-up. (6) There was no lumbar spondylolisthesis or lumbar spondylolysis in both groups. [Conclusion] The selective spinal rhizotomy in the lumbosacral segment had no significant influence on the stability of the lumbar spine in the mid to long-term. Moreover, the younger children got operated, the better effective improvement in the lamina regeneration.

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  • 收稿日期:2019-07-04
  • 最后修改日期:2019-07-22
  • 录用日期:2019-08-13
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