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[目的]探讨采用脊柱钉棒内固定系统在青少年痉挛性脑瘫患者腰骶段选择性脊神经后根切断术(selective posterior rhizotomy,SPR)中重建腰骶关节稳定性的可行性,为青少年痉挛性脑瘫的治疗寻找一种安全、稳定、有效的方法。[方法]自2007年6月~2012年1月,对42例下肢痉挛性脑瘫患者进行腰骶段SPR手术治疗,其中男24例,女18例;年龄14~22岁,平均16岁。在三维导航引导下,采用脊柱钉棒内固定系统,行腰骶段SPR手术中按常规方法置入椎弓根螺钉系统,横突间植骨融合。[结果]手术时间120~170 min,平均150 min;术中出血量400~1 000 ml,平均700 ml。术中和术后均未发生神经、脊髓损伤。术后出现低颅压反应5例,经补液、抬高床尾等措施后缓解。随访6个月~3年,采用自身前后对比,术后下肢痉挛解除良好,肌张力明显降低,肌力恢复良好,均早期恢复正常负重和行走。无1例出现断钉、断棒,其中1例3年后出现螺钉松动,及时取出内固定。X线片检查未发现钉孔扩大、腰椎下移(L5下沉)等现象。[结论](1)脊柱钉棒内固定系统在青少年痉挛性脑瘫患者腰骶段SPR手术中可重建腰骶关节稳定性;(2)该手术方法简便、创伤小、并发症少,固定牢固;(3)SPR+内固定术是治疗青少年痉挛性脑瘫的有效方法。
[Objective] To explore the feasibility of reconstructing the lumbosacral joint stability in selective posterior rhizotomy (SPR) of spastic cerebral palsy patients by means of spinal rod-and-rod fixation system, and to evaluate the feasibility of adolescent spastic cerebral palsy The treatment of looking for a safe, stable and effective method. [Methods] From June 2007 to January 2012, 42 patients with spastic cerebral palsy of lower extremities underwent lumbosacral SPR. There were 24 males and 18 females, aged from 14 to 22 years with an average of 16 years. Guided by three-dimensional navigation, using spine rod fixation system, the lumbosacral SPR surgery by pedicle screw system according to conventional methods, the inter-lateral fusion of bone graft. [Results] The operation time ranged from 120 to 170 minutes, with an average of 150 minutes. The intraoperative blood loss ranged from 400 to 1 000 ml with an average of 700 ml. No intraoperative and postoperative neurological and spinal cord injury. Postoperative low intracranial pressure response in 5 cases, after rehydration, raising the bed tail and other measures to ease. Followed up for 6 months to 3 years, using their own before and after contrast, postoperative spasm of lower extremity was relieved, muscle tension was significantly reduced, muscle strength recovered well, both early return to normal weight and walking. No cases of broken nails, broken rods, of which 1 case 3 years after the screw loose, remove the internal fixation. X-ray examination found no nail hole expansion, lumbar shift (L5 sink) and so on. [Conclusion] (1) The stability of the lumbosacral joint can be reconstructed in lumbosacral SPR in adolescents with spastic cerebral palsy. (2) The method is simple, less traumatic and has fewer complications and firm fixation. (3) SPR + internal fixation is an effective method to treat spastic cerebral palsy in adolescents.