Schmelzer-Schmied N, Ochs B G, Carstens C, Lill C A
Sektion Kinder-, und Wirbelsäulenchirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg.
Z Orthop Ihre Grenzgeb. 2006 May-Jun;144(3):322-7. doi: 10.1055/s-2006-933442.
Experiences in operation of scoliosis in cerebral palsy are very different. Therefore a therapeutic regiment does not exist. In this study we want to report our experiences.
This retrospective-clinical study (1986-2003) includes 46 patients with cerebral palsy who had been operated for scoliosis. The data focus in particular on the therapeutic strategies and its success and complications. Publications from 1946 to 2003 were reviewed and served for comparison.
28 female and 18 men during one period by median 3.4 years were after-observed. The post office-operationally reached correction of the curvature of all operation procedures was appropriate for median between 51 and 68 % depending upon localization of the curvature. In the last re-examination median a correction loss of 3-25 % existed. A fusion to S1 corrected a thoraco-lumbale or lumbale scoliosis significantly better than a fusion to L5. The posterior and the combined posterior-anterior operation procedure showed comparable correction results. The total complication rate was with 35 %.
Due to good correction successes and smaller complication rate we favor a posterior-anterior operation procedure. A fusion to S1 is indicated with thoraco-lumbale and lumbale fusion. Altogether complication rate was reduced in patients with scoliosis and cerebral palsy after operation at the spinal column in the last years.
脑瘫患者脊柱侧弯的手术经验差异很大。因此不存在一种治疗方案。在本研究中，我们想报告我们的经验。
这项回顾性临床研究（1986 - 2003年）纳入了46例因脊柱侧弯接受手术的脑瘫患者。数据特别关注治疗策略及其成功率和并发症。对1946年至2003年的文献进行了综述并用于比较。
在一段时间内，共观察了28名女性和18名男性，中位随访时间为3.4年。术后所有手术方式对脊柱侧弯的矫正程度，根据侧弯部位不同，中位矫正率在51%至68%之间。在最后一次复查时，中位矫正丢失率为3% - 25%。融合至S1对胸腰段或腰段脊柱侧弯的矫正效果明显优于融合至L5。后路手术和前后联合手术显示出相当的矫正效果。总并发症发生率为35%。
由于矫正效果良好且并发症发生率较低，我们倾向于采用前后联合手术方式。胸腰段和腰段融合时建议融合至S1。近年来，脊柱侧弯合并脑瘫患者术后的总体并发症发生率有所降低。
