Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2014 Jan;55(1):191-6. doi: 10.3349/ymj.2014.55.1.191.
Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP.
The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation.
The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs.
ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
髋关节内收肌痉挛对脑瘫（CP）患儿髋关节脱位的发展有很大影响。闭孔神经（ON）阻滞是一种较微创的干预措施，而不是软组织手术，用于减少髋关节内收肌痉挛。本研究旨在探讨 ON 阻滞对低功能痉挛性 CP 患儿髋关节外展的影响。
本研究通过回顾性调查低功能（粗大运动功能分级系统 [GMFCS] 水平 III 至 V）痉挛性脑瘫患儿的临床和放射学随访数据，这些患儿的髋关节半脱位。在髋关节 X 线片上测量迁移百分比（MP），并计算其年变化率。在干预组中，在电刺激引导下用 50%乙醇进行 ON 阻滞。
共收集了 25 名患儿 49 条腿的干预组数据和 23 名患儿 41 条腿的非干预组数据。在干预组中，首次随访时 MP 明显降低，第二次和末次随访时的 MPs 与初始 MP 无显著差异。而在非干预组中，第一次、第二次和末次随访时的 MPs 均明显高于初始 MPs。
对于这些痉挛性 CP 患儿，乙醇 ON 阻滞是一种早期有效的对抗髋关节进行性移位的方法。
