Sahu Ramji Lal
SMS & RI Sharda University, Uttar Pradesh, India.
JNMA J Nepal Med Assoc. 2014 Jan-Mar;52(193):702-6.
Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anaesthesia.
From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females) were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anaesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children.
Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (P = 0.01).The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%.
Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis.
髋部内收肌痉挛是痉挛型脑瘫患者功能活动和康复的主要障碍。本研究旨在评估全身麻醉下经皮内收肌松解术的效果。
2005年7月至2010年7月，从门诊招募了32例患有脑瘫儿童髋部内收肌挛缩的患者（男19例，女13例），共64个髋部。所有儿童均在全身麻醉下接受手术。所有儿童均随访24个月。临床结果通过影像学评估，包括测量CE角、AC指数和股骨头覆盖率，并根据儿童的活动水平进行评估。
32例儿童中，28例显示出明显且即时的改善。随访时，我们的患儿功能均未变差。CE角和股骨头覆盖率无明显变化。AC指数显著改善（P = 0.01）。12.5%的儿童结果为优，50%为良，25%为中，12.5%为差。
双侧微创内收肌松解术对于非手术治疗无效的内收肌挛缩患儿可能是一种有效的治疗方法，早期内收肌松解可预防半脱位，并可能避免未来对股骨近端和骨盆进行骨性手术的需要。
