选择性背根切断术对脑瘫患儿脊柱侧弯的影响：一项长期随访研究
The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study.
作者信息
Miller Stacey D, Lewis Emma, Lau Jonathan, Juricic Maria, Nguyen Vuong, Steinbok Paul, Miyanji Firoz, Mulpuri Kishore
机构信息
BC Children's Hospital, Vancouver, BC.
Department of Physical Therapy, University of British Columbia.
出版信息
J Pediatr Orthop. 2025 Mar 1;45(3):158-163. doi: 10.1097/BPO.0000000000002878. Epub 2024 Dec 5.
BACKGROUND
Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.
METHODS
In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.
RESULTS
A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.
CONCLUSIONS
The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.
LEVEL OF EVIDENCE
Level IV.
背景
选择性背根切断术（SDR）常用于降低脑瘫（CP）患儿的痉挛程度。CP患儿脊柱畸形风险增加，且随着年龄增长和粗大运动功能分级系统（GMFCS）水平升高而增加。很少有研究考虑按GMFCS水平划分的SDR术后脊柱畸形风险。本综述的目的是评估CP患儿在SDR术后至少5年时脊柱畸形的发生率和严重程度，包括总体情况以及按GMFCS水平划分的情况。
方法
在这项回顾性研究中，参与者包括2013年1月1日前在一家加拿大儿科医院接受SDR手术的所有患儿。参与者术前必须有脊柱X光片，且SDR术后至少随访5年。收集年龄、GMFCS水平、椎板切除术水平、切断神经根比例和骨科手术史。使用冠状面曲线评估脊柱侧弯，并在SDR术前及术后至少5年或直至脊柱手术时进行测量。如有矢状面X光片，也进行评估。
结果
共纳入107名参与者（男61名，女46名），GMFCS水平为I至V级（分别为2名、25名、22名、45名和13名）。SDR时的平均年龄为4.8岁（标准差1.5），平均随访12.7年（标准差4.9）。SDR术后，57名（53%）参与者出现脊柱侧弯，主弯平均为46度（标准差34.9）。GMFCS II级的参与者中有8名（32%）脊柱侧弯角度>10度，III级中有4名（18%），IV级中有33名（73%），V级中有12名（92%）。GMFCS I至III级的参与者中无人脊柱侧弯角度>40度，IV级和V级分别有35%和67%的参与者脊柱侧弯角度>40度。在接受侧位成像的参与者中，38%有过度后凸，21%有过度前凸，16%有椎体滑脱。
结论
与文献报道的未经手术干预的CP患儿自然病程相比，按GMFCS水平和侧弯严重程度划分，脊柱侧弯发生率是一致的。
证据级别
IV级。
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