中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (17): 3091-3094.doi: 10.3969/j.issn.1673-8225.2012.17.013

• 骨科植入物 orthopedic implant • 上一篇    下一篇

腰椎椎板原位指骨钢板回植内固定治疗痉挛性脑性瘫痪★

许俊杰，章  凯，王智运，吴增晖，尹庆水   

  1. 解放军广州军区广州总医院骨科医院，广东省广州市  510010
  • 收稿日期:2011-10-01 修回日期:2012-01-20 出版日期:2012-04-22 发布日期:2012-04-22
  • 作者简介:许俊杰★，男，1983年生，广东省揭阳市人，汉族，2007年解放军第二军医大学毕业，硕士，主治医师，主要从事脊柱外科研究。Imagination550@hotmail.com

Application of replantation of lamina and mini-plate fixation in patients with spastic cerebral palsy

Xu Jun-jie, Zhang Kai, Wang Zhi-yun, Wu Zeng-hui, Yin Qing-shui   

  1. Department of Orthopedics, Guangzhou General Hospital of Chinese PLA Guangzhou Military Command, Guangzhou  510010, Guangdong Province, China
  • Received:2011-10-01 Revised:2012-01-20 Online:2012-04-22 Published:2012-04-22
  • About author:Xu Jun-jie★, Master, Attending physician, Department of Orthopedics, Guangzhou General Hospital of Chinese PLA Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China Imagination550@hotmail.com

PDF

277

摘要：

背景：选择性脊神经后根部分切断已广泛应用于痉挛性脑性瘫痪的治疗，以往采用的方法是在脊髓圆锥水平将L1或L1+T12全椎板切除，对解剖结构的破坏较大，远期有导致脊柱畸形的可能。
目的：观察应用选择性脊神经后根部分切断后椎板原位回植指骨钢板内固定治疗痉挛性脑性瘫痪的临床效果。
方法：2008-01/2011-01采用后路选择性脊神经后根部分切断术治疗29例痉挛性脑性瘫痪患者，使用摆锯将相应节段椎板完整截取后再行原位回植，以指骨钢板螺钉进行内固定。观察治疗前后双下肢肌张力变化，通过复查X射线片、CT，观察回植椎板融合情况、椎管形态以及腰椎稳定性等情况。
结果与结论：29例患者均获得随访，治疗后大部分患者双下肢肌张力较治疗前平均降低Ⅱ~Ⅲ级，末次随访时回植椎板均获得骨性融合，未发现明显椎管狭窄、脊柱失稳等相关并发症。提示选择性脊神经后根部分切断治疗痉挛性脑性瘫痪的效果确切，此方案能充分暴露椎管，术后能重建椎管完整性，同时也能有效预防选择性脊神经后根部分切断后瘢痕粘连、脊柱失稳等并发症。
关键词：椎板原位回植；脑性瘫痪；内固定；选择性脊神经后根部分切断；脊柱稳定性
缩略语注释：SPR：selective posterior rhizotomy，选择性脊神经后根部分切断
doi:10.3969/j.issn.1673-8225.2012.17.013

关键词: 椎板原位回植, 脑性瘫痪, 内固定, 选择性脊神经后根部分切断, 脊柱稳定性

Abstract:

BACKGROUND: Selective posterior rhizotomy (SPR) has been widely used in the treatment of spastic cerebral palsy. Traditionally, total resection of lamina of L1 or L1+T12 at the level of conus is the main method to expose the spinal canal. This method has the potential to cause major damage to the normal anatomical structures of the lumbar spine, resulting in deformity of the spine in the long term.
OBJECTIVE: To evaluate the replantation of lamina and mini-plate fixation and its clinical results in patients with spastic cerebral palsy treated with SPR.
METHODS: Twenty-nine cases with spastic cerebral palsy were treated operatively with SPR from January 2008 to January 2011, accomplished with the replantation of lamina on site and mini-plate fixation after the corresponding segments were completely intercepted by the swing saw. Muscular tension of the lower extremities was observed pre- and post-operatively. X-ray films and CT images were used to observe the status of fusion, stability and shape of the vertebral canal.
RESULTS AND CONCLUSION: All the patients were followed-up, the average reduction of Ⅱ-Ⅲ grade of muscular tension was observed in most patients. The replanted lamina got bony fusion without spinal stenosis or spinal instability at the last follow-up. SPR is an effective therapy for spastic cerebral palsy. After widely exposure of the spinal canal, the method of spinal reconstruction can provide good clinical results for patients treated with SPR. It can avoid compression owing to scar and maintain the spinal integrity.

中图分类号: