Dabney Kirk W, Miller Freeman, Lipton Glenn E, Letonoff Eric J, McCarthy H Catherine
Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
J Bone Joint Surg Am. 2004 Sep;86-A Suppl 1(Pt 2):156-68. doi: 10.2106/00004623-200409001-00006.
To our knowledge, there have been no previous studies addressing the indications for and the results of treatment of patients with cerebral palsy and concomitant kyphosis or lordosis without scoliosis. The purpose of the present study was to identify the indications for and the results of treatment of patients with cerebral palsy who have a spinal curve deformity solely in the sagittal plane.
We conducted a retrospective review of the data on all patients with cerebral palsy who had a sagittal plane spinal deformity but no coronal plane deformity, had undergone posterior spinal fusion with unit rod instrumentation at our institution, and had been followed for at least two years. Medical records and radiographs were reviewed for symptoms, type and magnitude of deformity, age at surgery, duration of surgery, nutritional status, complications, and concomitant medical problems.
Twenty-four patients--ten boys and fourteen girls--were identified. Eight patients had a hyperlordotic deformity, fourteen had a hyperkyphotic deformity, and two exhibited both. Surgical indications included severe seating problems that could not be rectified with wheelchair modifications (eighteen patients), severe back pain (four patients), superior mesenteric artery syndrome that was refractory to conservative treatment (two patients), and a hyperlordotic deformity with a loss of bowel and bladder control (one patient). It was found that specific technical concerns had to be addressed when the unit rod instrumentation was used. The mean preoperative hyperkyphotic curve of 93.8 degrees was corrected to a mean of 35.8 degrees postoperatively and was a mean of 34.8 degrees at the last visit. The mean preoperative hyperlordotic curve of 91.8 degrees was corrected to a mean of 43.6 degrees postoperatively and was a mean of 48.6 degrees at the last visit. All patients with seating problems and back pain had improvement or resolution of the problem after the surgery. The superior mesenteric artery syndromes, losses of bowel and bladder function, and malnutrition all resolved completely after the surgery.
Patients with cerebral palsy and a severe sagittal plane deformity (> or = 70 degrees ) can be treated successfully with posterior spinal fusion with use of unit rod instrumentation. Indications for treatment include loss of sitting ability or balance, back pain, loss of bowel or bladder function, and superior mesenteric artery syndrome that is unresponsive to medical management.
据我们所知，此前尚无针对脑瘫合并脊柱后凸或前凸而无脊柱侧弯患者的治疗指征及治疗结果的研究。本研究的目的是确定仅在矢状面存在脊柱侧弯畸形的脑瘫患者的治疗指征及治疗结果。
我们对所有患有矢状面脊柱畸形但无冠状面畸形、在本机构接受了单棒器械后路脊柱融合术且随访至少两年的脑瘫患者的数据进行了回顾性分析。查阅病历和X光片，了解症状、畸形类型和严重程度、手术年龄、手术时长、营养状况、并发症及合并的医疗问题。
共确定了24例患者，其中10名男性和14名女性。8例患者有腰椎前凸畸形，14例有胸椎后凸畸形，2例同时存在两种畸形。手术指征包括严重的坐姿问题，经轮椅改装无法纠正（18例患者）、严重背痛（4例患者）、对保守治疗无效的肠系膜上动脉综合征（2例患者）以及伴有肠道和膀胱控制功能丧失的腰椎前凸畸形（1例患者）。发现使用单棒器械时必须解决一些特定的技术问题。术前平均胸椎后凸角度为93.8度，术后平均矫正至35.8度，末次随访时平均为34.8度。术前平均腰椎前凸角度为91.8度，术后平均矫正至43.6度，末次随访时平均为48.6度。所有有坐姿问题和背痛问题的患者术后问题均得到改善或解决。肠系膜上动脉综合征、肠道和膀胱功能丧失以及营养不良在术后均完全得到解决。
脑瘫合并严重矢状面畸形（≥70度）的患者可通过使用单棒器械的后路脊柱融合术成功治疗。治疗指征包括坐位能力或平衡丧失、背痛、肠道或膀胱功能丧失以及对药物治疗无反应的肠系膜上动脉综合征。
