Hoeksma A F, Bos K E, Meester-Delver A
Afd. Revalidatie, Academisch Medisch Centrum, Amsterdam.
Ned Tijdschr Geneeskd. 1995 Aug 12;139(32):1643-8.
To determine the results of surgical correction of spastic paralysis of the hand due to cerebral palsy.
Descriptive.
Academic Medical Centre, Amsterdam, the Netherlands, and rehabilitation centre De Trappenberg.
From 1-1-1990 until 1-6-1994 twenty patients with spastic upper limb in cerebral palsy were operated in our hospital. They were all seen preoperatively by our multidisciplinary team, and selected according to the Zancolli classification. Seventeen operations were aimed at improving hand function, the other three were performed for contractures or for cosmetic/hygienic reasons. Surgery was aimed at correcting the muscular imbalance, by weakening spastic muscles via tenotomy or lengthening and by reinforcing paralysed muscles via tendon transfer or rerouting. Often stabilisation of joints by tenodesis, capsulodesis or arthrodesis was necessary as well.
Eighteen of the twenty patients were (very) happy with the results. In two patients there was no functional gain. Only once was a postoperative complication seen: pseudarthrosis of the first carpometacarpal joint. This was corrected successfully by rearthrodesis. We found we were able to predict the functional outcome fairly accurately.
With accurate patient selection, surgical intervention in patients with cerebral palsy may restore hand function adequately and predictably.
确定脑瘫所致手部痉挛性麻痹的手术矫正结果。
描述性研究。
荷兰阿姆斯特丹学术医疗中心及德特拉彭贝格康复中心。
1990年1月1日至1994年6月1日，我院对20例脑瘫所致上肢痉挛患者进行了手术。他们均在术前由多学科团队进行评估，并根据赞科利分类法进行选择。17例手术旨在改善手部功能，另外3例手术是因挛缩或出于美容/卫生原因进行的。手术旨在通过切断术或延长术削弱痉挛肌肉，并通过肌腱转移或改道加强麻痹肌肉来纠正肌肉失衡。通常还需要通过腱固定术、关节囊固定术或关节固定术来稳定关节。
20例患者中有18例（非常）对结果满意。2例患者没有功能改善。仅出现过1例术后并发症：第一腕掌关节假关节形成。通过再次关节固定术成功矫正。我们发现能够相当准确地预测功能结果。
通过准确的患者选择，对脑瘫患者进行手术干预可充分且可预测地恢复手部功能。
