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目的通过对随访5年的患儿进行术前和术后临床比较分析,评价内侧腘绳肌延长术对双侧痉挛性脑瘫步态的影响。方法将双侧痉挛性脑瘫患儿分为二组,一组为髂腰肌挛缩组,即内侧腘绳肌延长,股直肌远端转位加腰肌切断术。另一组为髂腰肌无挛缩组,即内侧腘绳肌延长,股直肌远端转位术。利用标准的体检,对二组患儿术前和术后下肢关节活动范围、肌力、腘窝角和Thom-as试验进行检查,并对比分析。结果髂腰肌挛缩组术后伸髋肌肌力与髂腰肌无挛缩组比较明显减弱,分别为(3.8±0.5)和(4.8±0.4)(P=0.006),Thomas试验髋屈曲角度增大,分别为(15.0°±16.8°)和(1.5°±2.4°)(P=0.008),并出现膝反屈趋势。结论表明对屈髖肌挛缩的蹲伏步态患儿,不适宜作腘绳肌延长术。可行腰肌切断术纠正骨盆过度前倾及髋关节屈曲挛缩畸形。无屈髋肌挛缩的蹲伏步态患儿,行内侧腘绳肌延长加股直肌转位术,并可避免单纯腘绳肌延长术带来的僵膝步态。
Objective To evaluate the effect of medial hamstring lengthening on the gait of bilateral spastic cerebral palsy by comparing preoperative and postoperative clinical outcomes in children who were followed up for 5 years. Methods The children with bilateral spastic cerebral palsy were divided into two groups. One group was the iliopsoas muscle contracture group, which was the extension of the medial hamstring muscle and distal rectus femoris muscle plus lumbar muscle resection. The other group of iliopsoas without contracture group, that is, the medial hamstring extension, rectus femoris distal transposition. The standard of physical examination, the two groups of children with preoperative and postoperative lower extremity joint motion range, muscle strength, nest angle and Thom-as test were examined and compared. Results The extensor hips muscle strength of the iliopsoas muscle contracture group was significantly weaker than that of the iliopsoas muscle contracture group (3.8 ± 0.5) and (4.8 ± 0.4) respectively (P = 0.006) , Respectively (15.0 ° ± 16.8 °) and (1.5 ° ± 2.4 °) (P = 0.008), with a trend of knee flexion. The conclusion shows that it is not suitable for hamstring gait patients with hip flexor contracture. Possibility of psoas cutting correct pelvic anterior lean and hip flexion contracture deformity. Hyperthyroidism contracture in crouching gait children, the line of the medial hamstring extension plus rectus femoris transposition surgery, and can avoid the simple hamstring gait Gait Gait.