Feygin Maximillian S, Larkin Michael, Curry Dan, Rosenfeld Scott B, Schwabe Aloysia, Gadgil Nisha
Neurological Surgery, Baylor College of Medicine, Houston, USA.
Pediatric Neurosurgery, Texas Children's Hospital, Houston, USA.
Cureus. 2024 Nov 21;16(11):e74177. doi: 10.7759/cureus.74177. eCollection 2024 Nov.
Background The management of adductor spasticity and long-term sequelae for cerebral palsy (CP) patients is complex. Hip displacement is a common consequence of CP, and obturator neurectomy (ON) is a potentially underutilized procedure to address the underlying adductor spasticity. The aim of this study is to describe the operational technique of ON and highlight the potential efficacy of ON in reducing spasticity, as well as pain, hip, and functional outcomes in these patients. Methods A total of eight patients from Texas Children's Hospital who underwent ON between 2008 and 2023 were included in this case series. Results ON led to a qualitative decrease in adductor spasticity and had high patient-reported satisfaction. The average length of stay was 1.6 days (range: 1-4 days). Hip outcomes improved in all patients, evidenced by increased hip range of motion, improved mobility/gait, and decreased migration index (MI) in one patient. Conclusions ON is an efficient procedure that has the potential to reduce adductor tone and improve hip outcomes. The operative technique described and the reported patient satisfaction support the integration of ON into the paradigm of adductor spasticity management. Further prospective studies, however, are needed to objectively measure tone and hip outcomes in these patients.
背景 脑瘫（CP）患者内收肌痉挛及长期后遗症的管理较为复杂。髋关节移位是CP的常见后果，闭孔神经切除术（ON）是一种可能未得到充分利用的治疗潜在内收肌痉挛的手术。本研究的目的是描述ON的手术技术，并强调ON在减轻这些患者的痉挛、疼痛、改善髋关节及功能结局方面的潜在疗效。方法 本病例系列纳入了2008年至2023年间在德克萨斯儿童医院接受ON手术的8例患者。结果 ON导致内收肌痉挛在质量上有所减轻，患者报告的满意度较高。平均住院时间为1.6天（范围：1 - 4天）。所有患者的髋关节结局均有改善，表现为髋关节活动范围增加、活动能力/步态改善，1例患者的迁移指数（MI）降低。结论 ON是一种有效的手术，有可能降低内收肌张力并改善髋关节结局。所描述的手术技术及报告的患者满意度支持将ON纳入内收肌痉挛管理模式。然而，需要进一步的前瞻性研究来客观测量这些患者的肌张力和髋关节结局。
