Manske P R
Division of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Hand Clin. 1990 Nov;6(4):697-709.
The care of patients with spastic cerebral palsy requires the dedicated attention of a surgeon who is interested in the upper extremity, in association with therapists and other medical personnel who have a similar interest. The difficult problems of the upper extremity have often been overlooked by concerns related to the other skeletal manifestations in the spine and lower extremities. However, a pessimistic view of surgical results in the upper extremity is unwarranted, as even small gains in severely affected patients often result in an improved life. The surgical concepts related to this complex neurologic problem must be kept rather simple, and include principally the release of spastic deforming muscles, and, secondly, the use of augmentation tendon transfers to maintain an improved functional position. In order to allow the augmentation tendon transfers to function with minimal postoperative muscle re-education, tendon transfers that use muscles that contribute to the deformity are preferred; in the transferred position, these will function to correct the deformity and fire in phase without extensive postoperative training. Such muscle transfers are usually available to correct the more common pattern of spastic deformities. The most important aspect of surgical planning is to determine whether or not the individual is attempting to voluntarily use the upper extremity. In such cases, surgical procedures can reposition the deformed limb and enable the individual to function more effectively. On the other hand, it is most important to realize that an operative procedure will not stimulate an individual to begin to use a previously functionless limb.
痉挛性脑瘫患者的护理需要一位对上肢感兴趣的外科医生与有类似兴趣的治疗师及其他医务人员密切配合。上肢的难题常常被脊柱和下肢的其他骨骼表现所掩盖。然而，对上肢手术结果持悲观态度是没有根据的，因为即使是严重受影响患者的微小改善也常常能提高生活质量。与这个复杂神经问题相关的手术理念必须保持相对简单，主要包括松解痉挛性变形肌肉，其次是使用增强肌腱转移来维持改善后的功能位置。为了使增强肌腱转移在术后肌肉再训练最少的情况下发挥作用，优先选择使用导致畸形的肌肉进行肌腱转移；在转移后的位置，这些肌肉将起到纠正畸形并同步收缩的作用，而无需广泛的术后训练。这样的肌肉转移通常可用于纠正更常见的痉挛性畸形模式。手术规划最重要的方面是确定个体是否试图主动使用上肢。在这种情况下，手术程序可以重新定位畸形肢体，使个体能够更有效地发挥功能。另一方面，必须认识到手术操作不会促使个体开始使用之前无功能的肢体，这一点至关重要。
