脑瘫患者股骨髁上截骨术后的神经并发症

Neurological complications after supracondylar femoral osteotomy in cerebral palsy.

作者信息

İnan Muharrem, Sarikaya İlker Abdullah, Yildirim Enis, Güven Mehmet Fatih

机构信息

*Department of Orthopedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul †Department of Orthopedics and Traumatology, Muş State Hospital, Muş ‡Department of Orthopedics and Traumatology, Şirnak State Hospital, Şirnak, Turkey.

出版信息

J Pediatr Orthop. 2015 Apr-May;35(3):290-5. doi: 10.1097/BPO.0000000000000264.

DOI:10.1097/BPO.0000000000000264

PMID:25075896

Abstract

BACKGROUND

Knee flexion contracture in children with cerebral palsy (CP) is very common and functional impairment leads to a crouch gait. Correction of the knee flexion contracture and improvement of the gait pattern by supracondylar femoral extension osteotomy seems to be a more effective method than distal hamstring procedures in long-standing severe crouch. Only a small number of publications reported the neurological complications of this surgical technique. This study was planned to identify the risk factors leading to neurological complications after supracondylar femoral extension osteotomy in patients with CP.

METHODS

Supracondylar femoral osteotomies performed for a primary diagnosis of CP with rigid knee flexion deformity of 10 to 30 degrees were included in the study. Supracondylar femoral extension osteotomy was performed in 28 patients (total: 48 cases). Neurological complication was not detected in 43 cases (group 1) and detected in 5 cases (group 2). Previous surgical operation, concomitant operations on the same extremity, application of a brace or long leg cast after operation, preoperative and postoperative popliteal angle, amount of correction, radiologic correction, tourniquet time, level of malnutrition, and emotional state were reviewed.

RESULTS

There were 18 boys and 10 girls. The mean age was 12±4 years in group 1 and 13±1 years in group 2. Except 6 patients, all patients had concomitant operations (38 cases in group 1 and 4 cases in group 2). Postoperatively, long leg cast was used in 38 cases and brace in 10 cases. In group 1 mean correction was 23±3.8 degrees and in group 2 it was 19±5.7 degrees.

CONCLUSIONS

Correlation was not found between the incidence of neurological complications and amount of correction and deformity. After supracondylar femoral extension osteotomy, all patients must be suspected of neurological complication, and measures taken to alleviate the stretch at once if nerve palsy is diagnosed.

LEVEL OF EVIDENCE

Level IV.

摘要

背景

脑性瘫痪（CP）患儿的膝关节屈曲挛缩非常常见，功能障碍会导致蹲伏步态。对于长期严重蹲伏的情况，股骨髁上延长截骨术矫正膝关节屈曲挛缩并改善步态模式似乎比腘绳肌远端手术更有效。仅有少数出版物报道了这种手术技术的神经并发症。本研究旨在确定CP患者股骨髁上延长截骨术后导致神经并发症的危险因素。

方法

本研究纳入了因原发性CP诊断而进行股骨髁上截骨术且膝关节屈曲畸形僵硬在10至30度的患者。28例患者（共48例）接受了股骨髁上延长截骨术。43例（第1组）未检测到神经并发症，5例（第2组）检测到神经并发症。回顾了既往手术操作、同一肢体的同期手术、术后使用支具或长腿石膏、术前和术后腘窝角、矫正量、影像学矫正、止血带时间、营养不良程度和情绪状态。