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Lumbar structural observation of children with cerebral palsy after selective posterior rhizotomy

By 易斌, 徐林, 洪毅, 俞兴, 王兵, 曹旭 and 汪利合

Abstract

目的观察选择性脊神经后根切断术(SPR)后儿童腰椎椎板再生情况以及术后腰椎稳定性的变化.方法将179例患儿依据年龄和行走能力进行分组,在手术前、后及术后随访时,分别拍摄站立位和平卧位及动力位腰椎正侧位X线片,测量手术前、后腰骶角、侧位腰椎Cobb角、凸顶距、前凸指数、AR/W、RO/W等指标的变化.对比各组之间上述测量值的变化,进行配对t检验.并观察术后切除椎板再生情况.结果 (1)独立行走组手术前、后各项指标差异无显著意义;(2)不能独立行走组患者术后腰骶角、侧位Cobb角差异有显著意义;(3)<10岁组发现脊柱侧弯9例(9.38%,Cobb角18~35度);(4)≥10岁组脊柱侧弯6例(7.23%,Cobb′s角15~25度),腰椎峡部裂或腰椎滑脱5例(6.58%);(5)<10岁组在术后4~6年可见椎板骨性愈合;(6)腰椎稳定评价手术前后无明显差异.结论儿童SPR术后,切除的椎板具有再生能力.SPR手术对腰椎的稳定性近期无明显影响.To investigate the stability of lumbar column after selective posterior rhizotomy and to observe the healing of exscinded laminae.One hundred and seventy nine children with spastic cerebral palsy were divided into four groups (A, B, C, D) according to the age (< 10 years or > or = 10 years) and walking ability (ambulatory or unable to walk) and were operated on by selective posterior rhizotomy (SPR). Lumbar X-ray films, both standing and lying position, and orthotopic and lateral dynamic lumbar films were taken pre- and postoperatively. Lumbosacral angle, Cobb's angle in lateral position, and AO/W, RO/W of dynamic films were recorded and analyzed according to Posner's definition. Regeneration of exscinded laminae was observed.(1) The lumbosacral angle, Cobb's angle, and other indicators in the ambulatory group (A + C) were not significantly varied pre- and postoperatively; (2) The lumbo-sacral angle, Cobb's angle, and other indicators in the groups unable to walk independently (B + D groups) were varied significantly. (3) Nine cases of scoliosis (with the Cobb's angle of 18 degrees-35 degrees) were found in the group of 10 years younger (9.38%); (4) Six cases of spondylolysis (7.23%, with Cobb's angle of 15 degrees-25 degrees) and 5 cases of spondylolisthesis (6.58%) were found in the group of 10 years older. (5) Osteous healing of sectioned laminae was found in the group of age younger than 10 years, especially in the young children. (6) Stability of lumbar vertebrae were not significantly varied pre- and post-operatively among all groups.The exscinded laminae of children after SPR have the healing ability. The stability of lumbar column was not significant varied pre- and postoperatively.PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)016983-9878

Topics: 脑性瘫痪, 神经切断术
Publisher: 中华医学杂志
Year: 2001
DOI identifier: 10.3760/j:issn:0376-2491.2001.16.008
OAI identifier: oai:localhost:20.500.11897/131590
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