痉挛性脑瘫髋关节发育不良的风险预测与早期干预治疗
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摘要
[目的]探讨痉挛性脑瘫髋关节发育不良的风险预测方法及其相关性,评估对高危患儿实施股骨头骨骺生长控制手术的疗效。[方法] 64例痉挛性脑瘫患儿在采取针对性康复训练前后分别采用粗大运动功能分级(GMFCS)与雷蒙迁移指数(MP)进行动态评估,分析GMFCS分级与MP的相关性。1年后对MP 2级及3级的患者行手术治疗,观察组9例(12髋)接受生长控制手术同期行软组织松解,对照组17例(23髋)接受单纯软组织松解。采用MP、头干角(HSA)进行评估髋发育状态。[结果] GMFCS分级越高,MP越大,两者呈显著正相关(P<0.05),康复治疗后髋关节MP比康复治疗前减少,康复治疗后GMFCS分级比康复治疗前减小,差异有统计学意义(P<0.05),实施手术的患儿术后再随访至少2年,观察组术后MP与HAS较术前显著减小,差异有统计学意义(P<0.05),但对照组术前与术后MP和HAS的差异均无统计学意义(P>0.05)。[结论] GMFCS分级可以很好地预测髋关节发育不良的发生,针对性康复训练能改善髋臼发育,对MP为2级或3级的髋关节采用股骨头骨骺生长控制术可以明显改善髋臼发育。
[Objective] To explore the parameter for prediction of acetabular dysplasia in spastic cerebral palsy and evaluate the clinical outcomes of early intervention. [Methods] A total of 64 children with spastic cerebral palsy were evaluated by using Gross Motor Function Classification System(GMFCS) and Reimer.s migration index(MP) before and after targeted rehabilitation training(TRT) respectively. The correlation between GMFCS and MP was analyzed. The children with MP grade II and III at 1 year after targeted rehabilitation training underwent surgical treatment, including 9 children(12 hips) who received guided growth by transepiphyseal femoral head cannulated screw combined with soft tissue procedure named as the trial group, and17 children(23 hips) who had soft tissue procedure only termed as the control group. The MP and head-shaft angle measured radiographically were used for evaluation of hip development. [Results] The higher the GMFCS was, the greater the MP value was,associated with a significantly positive correlation between them(P<0.05). Both GMFCS and MP significantly improved after the TRT compared with those before the rehabilitation(P<0.05). The patients who received surgical treatment were followed up for another more than 2 years after operation. The trial group had significantly lower GMFCS and HAS at 2 years postoperatively than those before operation(P<0.05). By contrast, the control group had no significant differences regarding to GMFCS and HAS between those before and after operation(P>0.05). [Conclusion] The GMFCS does predict the hip development well. The targeted rehabilitation training improves the hip development, moreover, the guided growth procedure for the children with MP grade II and III after rehabilitation training does considerably improve the hip development.
[Objective] To explore the parameter for prediction of acetabular dysplasia in spastic cerebral palsy and evaluate the clinical outcomes of early intervention. [Methods] A total of 64 children with spastic cerebral palsy were evaluated by using Gross Motor Function Classification System(GMFCS) and Reimer.s migration index(MP) before and after targeted rehabilitation training(TRT) respectively. The correlation between GMFCS and MP was analyzed. The children with MP grade II and III at 1 year after targeted rehabilitation training underwent surgical treatment, including 9 children(12 hips) who received guided growth by transepiphyseal femoral head cannulated screw combined with soft tissue procedure named as the trial group, and17 children(23 hips) who had soft tissue procedure only termed as the control group. The MP and head-shaft angle measured radiographically were used for evaluation of hip development. [Results] The higher the GMFCS was, the greater the MP value was,associated with a significantly positive correlation between them(P<0.05). Both GMFCS and MP significantly improved after the TRT compared with those before the rehabilitation(P<0.05). The patients who received surgical treatment were followed up for another more than 2 years after operation. The trial group had significantly lower GMFCS and HAS at 2 years postoperatively than those before operation(P<0.05). By contrast, the control group had no significant differences regarding to GMFCS and HAS between those before and after operation(P>0.05). [Conclusion] The GMFCS does predict the hip development well. The targeted rehabilitation training improves the hip development, moreover, the guided growth procedure for the children with MP grade II and III after rehabilitation training does considerably improve the hip development.
引文
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[6]钱旭光,林青梅,刘振寰.粗大运动功能分级系统对脑瘫患儿粗大运动功能发育预测作用的研究[J/CD].中华临床医师杂志(电子版),2009,3(2):314-318.
[7]朱庆,韩庆.脑性瘫痪并髋关节发育异常83例分析[J].农垦医学,2012,34(4):317-319.
[8]Scrutton D,Baird G,Smeeton N.Hip dysplasia in bilateral cerebral palsy:incidence and natural history in children aged 18months to 5 years[J].Dev Med Child Neurol,2001,43:586-600.
[9]Flynn JM.Miller F.Management of hip disorder in patients with cerebral palsy[J].J Am Acad Orthop Surg,2002,10(2):198-209.
[10]Hermanson M,H?gglund G,Riad J,et al.Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy[J].Acta Orthop,2015,86(2):229-232.
[11]孙祥水,周颖,楼跃.痉挛性脑瘫髋关节发育异常的外科治疗[J].中华小儿外科杂志,2016,37(8):629-632.
[12]Presedo A,Oh CW,Dabney KW,et a1.Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy[J].J Bone Joint Surg Am,2005,87(4):832-841.
[13]李智勇,朱家恺,刘小林,等.脑瘫髋发育畸形及选择性脊神经后根切断术对脑瘫髋关节的影响[J].中山大学学报(医学科学版),2014,25(2):177-179.
[14]Chang CH,Chi CH,Lee ZL.Progressive coxa vara by eccentric growth tethering in immature pigs[J].J Pediatr Orthop B.2006,15(4):302-306.
[15]Lee WC,Kao HK,Yang WE,et al.Guided growth of the proximal femur for hip displacement in children with cerebral palsy[J].JPediatr Orthop,2016,36(5):511-515.
[2]Reimers J.The stability of the hip in children:a radiological study of results of muscle surgery in cerebral palsy[J].Acta Orthop Scand Suppl,1980,184(1):1-100.
[3]Lin JP.Deep brain stimulation neuromodulation in childhood dystonias[C].International Conference on Cerebral Palsy and other Childhoodonset Disabilities.Stockholm,Sweden.2016:18.
[4]Howard CB,McKibbin B,Williams LA,et al.Factors affecting the incidence of hip dislocation in cerebral palsy[J].J Bone Joint Surg Br,1992,67(2):530-532.
[5]Lundy DW,Ganey TM,Ogden JA,et al.Pathologic morphology of the dislocated proximal femur in children with cerebral palsy[J].JPediatr Orthop,1998,18(4):528-534.
[6]钱旭光,林青梅,刘振寰.粗大运动功能分级系统对脑瘫患儿粗大运动功能发育预测作用的研究[J/CD].中华临床医师杂志(电子版),2009,3(2):314-318.
[7]朱庆,韩庆.脑性瘫痪并髋关节发育异常83例分析[J].农垦医学,2012,34(4):317-319.
[8]Scrutton D,Baird G,Smeeton N.Hip dysplasia in bilateral cerebral palsy:incidence and natural history in children aged 18months to 5 years[J].Dev Med Child Neurol,2001,43:586-600.
[9]Flynn JM.Miller F.Management of hip disorder in patients with cerebral palsy[J].J Am Acad Orthop Surg,2002,10(2):198-209.
[10]Hermanson M,H?gglund G,Riad J,et al.Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy[J].Acta Orthop,2015,86(2):229-232.
[11]孙祥水,周颖,楼跃.痉挛性脑瘫髋关节发育异常的外科治疗[J].中华小儿外科杂志,2016,37(8):629-632.
[12]Presedo A,Oh CW,Dabney KW,et a1.Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy[J].J Bone Joint Surg Am,2005,87(4):832-841.
[13]李智勇,朱家恺,刘小林,等.脑瘫髋发育畸形及选择性脊神经后根切断术对脑瘫髋关节的影响[J].中山大学学报(医学科学版),2014,25(2):177-179.
[14]Chang CH,Chi CH,Lee ZL.Progressive coxa vara by eccentric growth tethering in immature pigs[J].J Pediatr Orthop B.2006,15(4):302-306.
[15]Lee WC,Kao HK,Yang WE,et al.Guided growth of the proximal femur for hip displacement in children with cerebral palsy[J].JPediatr Orthop,2016,36(5):511-515.