Zorer Gazi, Doğrul Cemal, Albayrak Mehmet, Bagatur A Erdem
Department of Orthopedics and Traumatology (1. Ortopedi ve Travmatoloji Kliniği), SSK Istanbul Training Hospital, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2004;38(5):317-25.
We evaluated the results of single-stage multilevel muscle-tendon surgery performed for the treatment of contractures in the lower extremities of patients with spastic cerebral palsy.
The study included 23 patients (11 girls, 12 boys; mean age 6 years 3 months; range 4 to 17 years) with spastic cerebral palsy, who underwent single-stage multilevel muscle-tendon surgery for the treatment of contractures in the lower extremities secondary to spasticity. Quadriplegia, diplegia, and hemiplegia were present in five, 14, and four patients, respectively. Preoperatively, 13 patients could walk, while 10 patients lacked ambulation even with support. Evaluations were based on pre- and postoperative (mean 4 years 9 months; range 1 to 8 years) physical examination findings and on the Gross Motor Function Classification System (GMFCS) scores. The patients' mean age at the last follow-up was 11.5 years (range 9 to 19 years).
The range of motion of all the operated joints improved postoperatively, resulting in significant improvements in posture, sitting, gait, and hygiene of the patients. Of ten patients who could not walk, five could ambulate with the use of a walker or crutches postoperatively. The mean pre- and postoperative GMFCS scores were 3.045 and 1.864, respectively (p<0.001). All the patients showed an improvement of at least one GMFCS level.
Surgery for spastic cerebral palsy can be most beneficial only when all contractures of the hip, knee, and ankle have been corrected. Symmetrical and multilevel operations should be performed when necessary, for single-stage and symmetrical multilevel muscle-tendon surgical applications have definite advantages over staged interventions.
我们评估了为治疗痉挛性脑瘫患者下肢挛缩而进行的单阶段多级肌腱手术的结果。
该研究纳入了23例痉挛性脑瘫患者（11名女孩，12名男孩；平均年龄6岁3个月；范围4至17岁），他们接受了单阶段多级肌腱手术以治疗因痉挛引起的下肢挛缩。分别有5例、14例和4例患者存在四肢瘫、双瘫和偏瘫。术前，13例患者能够行走，而10例患者即使在有人扶持的情况下也无法行走。评估基于术前和术后（平均4年9个月；范围1至8年）的体格检查结果以及粗大运动功能分级系统（GMFCS）评分。患者最后一次随访时的平均年龄为11.5岁（范围9至19岁）。
所有手术关节的活动范围术后均有改善，患者的姿势、坐姿、步态和卫生状况有显著改善。在10例无法行走的患者中，5例术后可使用助行器或拐杖行走。术前和术后GMFCS评分的平均值分别为3.045和1.864（p<0.001）。所有患者的GMFCS水平至少提高了一级。
只有当髋、膝和踝关节的所有挛缩均得到纠正时，痉挛性脑瘫手术才可能最为有益。必要时应进行对称的多级手术，因为单阶段对称多级肌腱手术应用比分期干预具有明显优势。
