Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Eur Spine J. 2020 Jun;29(6):1416-1423. doi: 10.1007/s00586-019-06235-3. Epub 2019 Dec 3.
The purpose of this study was to determine the incidence of spinal deformities in ambulant adults with cerebral palsy (CP) and spastic diplegia, more than 15 years after orthopaedic interval surgery approach (ISA) treatment, and its relationship to contextual factors, level of pain and physical status.
Spinal X-rays, pain (Oswestry Disability Index (ODI) and location/frequency) questionnaires and physical examination assessing lower extremity muscle strength (Medical Research Council scale), motor control (selectivity scale) and muscle tone (Ashworth score) were conducted in 30 adults with spastic diplegic CP.
Mild scoliosis (curve 12-22°) was determined in eight (28%) participants. Hyperkyphosis (> 50°) was reported in two (7%) and lumbar hyperlordosis (> 60°) in five (17%) participants. Pain was most commonly reported at cervical (n = 19, 63%) and lumbosacral (n = 18, 60%) area, resulting in 'moderate disability' for six (20%) and 'severe disability' for one (3%) participant. Most apparent physical abnormalities determined were hip abduction weakness and increased rectus femoris muscle tone. Regarding correlations, no relations were found for scoliosis curvature, but kyphosis curvature was related to females, ODI scores (lifting and sitting) and increased muscle tone of ankle plantar flexor muscles, lordosis curvature to passive hip extension mobility, and hip flexors and ankle plantar flexors muscle tone.
Adults with spastic diplegic CP who received their first orthopaedic intervention more than 15 years ago (based on ISA) showed similar incidence of spinal deformities as reported in the younger CP population, suggesting stability of spinal curvature into adulthood. These slides can be retrieved under Electronic Supplementary Material.
本研究旨在确定接受骨科间歇性手术（ISA）治疗 15 年以上的痉挛性双瘫脑瘫（CP）患者的脊柱畸形发生率，及其与环境因素、疼痛程度和身体状况的关系。
对 30 例痉挛性双瘫 CP 成人进行脊柱 X 线、疼痛（Oswestry 残疾指数（ODI）和位置/频率）问卷以及下肢肌肉力量（医学研究委员会量表）、运动控制（选择性量表）和肌肉张力（Ashworth 评分）的体格检查。
8 例（28%）患者存在轻度脊柱侧凸（曲线 12-22°）。2 例（7%）存在高胸曲（>50°），5 例（17%）存在腰椎前凸过度（>60°）。疼痛最常见于颈部（n=19，63%）和腰骶部（n=18，60%），导致 6 例（20%）“中度残疾”和 1 例（3%）“重度残疾”。最明显的身体异常是髋关节外展无力和股直肌张力增加。关于相关性，未发现脊柱侧凸曲率的关系，但胸曲曲率与女性、ODI 评分（抬举和坐姿）和踝关节跖屈肌增加的肌肉张力有关，腰椎前凸曲率与被动髋关节伸展活动度有关，髋关节屈肌和踝关节跖屈肌的肌肉张力有关。
接受第一次骨科干预超过 15 年（基于 ISA）的痉挛性双瘫 CP 成人与年轻 CP 人群报告的脊柱畸形发生率相似，这表明脊柱曲率在成年后保持稳定。这些幻灯片可以在电子补充材料中检索到。
