M'Rabet A, Dubousset J
Service de Chirurgie Orthopédique, Hôpital St-Vincent-de-Paul, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1988;74(7):647-58.
Fifty-five patients with cerebral palsy and spinal deformities were operated on between 1972-1985. 10 had mental retardation related to other etiology than neo-natal encephalopathy where this was found in the remaining 45 patients. 43 curves were paralytic type; 12 were idiopathic type. A non surgical treatment was prescribed to wait for surgery in 32 young children. It was a really followed all along the growth period in only 11 cases. The surgical treatment was often prepared by an halo traction for some days before surgery. The series of patients was divided into two groups: in group I twelve patients were ambulatory, in group II forty three patients were non ambulatory. In the first group, posterior fusion using either Harrington or Luqué or Cotrel-Dubousset instrumentation was done on 10 patients out of 12. In the second group, 21 patients a combined anterior and posterior fusion was done using Dwyer instrumentation anteriorly and Harrington or Cotrel-Dubousset posteriorly. 21 other patients got only the posterior fusion using Luqué or Cotrel-Dubousset instrumentation. Twenty-four out of the 55 had some kind of complications, mainly in the second group (38 p. cent). One death was observed in the immediate postoperative course. The functional results after a follow-up between 2 and 13 years are very encouraging.
1972年至1985年间，对55例患有脑瘫和脊柱畸形的患者进行了手术。其中10例智力发育迟缓与新生儿脑病以外的其他病因有关，其余45例患者存在新生儿脑病。43条曲线为麻痹型；12条为特发型。对32名幼儿采用非手术治疗以等待手术。实际上只有11例在整个生长期得到了持续治疗。手术治疗通常在术前几天采用头环牵引进行准备。患者系列分为两组：第一组12例患者可行走，第二组43例患者不能行走。在第一组中，12例患者中有10例采用哈灵顿、鲁凯或 Cotrel-Dubousset器械进行了后路融合。在第二组中，21例患者采用前路Dwyer器械和后路哈灵顿或Cotrel-Dubousset器械进行了前后联合融合。另外21例患者仅采用鲁凯或Cotrel-Dubousset器械进行了后路融合。55例患者中有24例出现了某种并发症，主要发生在第二组（38%）。术后即刻观察到1例死亡。随访2至13年后的功能结果非常令人鼓舞。
