电邮这篇文章 暂时性关节外固定术治疗小儿脑瘫腕关节屈肌挛缩症的效果
- 作者: Novikov V.A.1, Umnov V.V.1, Umnov D.V.1
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隶属关系:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- 期: 卷 8, 编号 3 (2020)
- 页面: 281-292
- 栏目: Original Study Article
- URL: https://medbiosci.ru/turner/article/view/34151
- DOI: https://doi.org/10.17816/PTORS34151
- ID: 34151
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详细
论证：桡腕关节屈肌挛缩的外科治疗方法分为软组织干预（延长或移植肌腱）和稳定桡腕关节的骨手术。考虑到两种方法的优点，我们开发了一种桡腕关节临时融合术：安装金属结构的关节固定术的稳定性和拆除金属结构后桡腕关节活动的可能性。
本研究的目的是比较一种治疗脑性瘫痪儿童桡腕关节屈肌挛缩症的新手术方法的有效性，包括临时的关节外固定术和移植的手部屈肌到伸肌根据格林。
材料与方法。该研究对两组患者的治疗进行了比较分析。第一组的患者（13例）接受尺侧腕屈肌腱（m. flexor carpi ulnaris）移植到桡侧腕短伸肌/长肌腱的治疗（m. extensor carpi radialis brevis/longus）（格林手术）。第二组（13例）的患者接受了用骨板暂时进行桡腕关节固定术，
为期一年。分析第一组和第二组在关节固定术和骨板拆除1年后和肌肉移植1年后的治疗结果。第二组患者在拆除金属结构后接受14天的康复疗程，然后评估治疗效果。采用国际分类系统MACS（2002）
和积木盒障碍测试评估箱（Block and Box test）评估桡腕关节主动和被动运动的振幅以及上肢的功能能力。
结果。第一组患者被动活动度增加（+9.7°）。两组患者的主动运动幅度均明显增加（第一组为31.9°，
第二组为45.7°）。两组中用于评估手部状况的MACS上肢功能指标几乎相同。在第一组患者中，治疗后积木盒障碍测试评估箱的平均动态是增加了8个立方体，而在第二组患者中仅增加了1.6个立方体。
结论。作为矫正桡腕关节屈肌挛缩的一种方法，格林手术与临时关节固定术相比效果较差，但格林手术后的功能指标较高。手术治疗方法的选择基于以下几点：在高功能前景的情况下，进行格林手术，在矫正严重挛缩且功能前景可疑的情况下，可以进行临时关节固定术。
作者简介
Vladimir Novikov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
编辑信件的主要联系方式.
Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
MD, PhD, Research Associate of the Department of Infantile Cerebral Palsy
俄罗斯联邦, Saint PetersburgValery Umnov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
MD, PhD, D.Sc., leading researcher of the Department of Infantile Cerebral Palsy
俄罗斯联邦, Saint PetersburgDmitry Umnov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607
MD, PhD, Research Associate of the Department of Infantile Cerebral Palsy
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