小儿脑瘫患者手梯形掌骨关节的屈肌和内收肌痉挛合并掌指关节脱位的手术治疗的初步结果
- 作者: Umnov D.V.1, Umnov V.V.1, Novikov V.A.1, Savina M.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 4 (2020)
- 页面: 417-426
- 栏目: Original Study Article
- ##submission.dateSubmitted##: 25.08.2020
- ##submission.dateAccepted##: 01.12.2020
- ##submission.datePublished##: 09.01.2021
- URL: https://journals.eco-vector.com/turner/article/view/43115
- DOI: https://doi.org/10.17816/PTORS43115
- ID: 43115
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论证:小儿脑瘫患者手第一腕掌关节的屈肌和内收肌痉挛合并掌指关节脱位的手术治疗方法分为以稳定掌骨关节为目的的软组织手术干预和骨科手术。我们开发了一种临时的掌指关节固定术,结合先前使用的扩大第一手指间隙的手术,结合两组手术的积极效果:安装金属结构的关节固定术的稳定性,可以在关节移除后进行足够幅度的活动,以及在稳定的关节背景下进行早期术后康复。
目的:探讨一种新的手术矫治小儿脑瘫患者手梯形掌骨关节的屈肌和内收肌痉挛合并掌指关节脱位的方法。
材料与方法。我们分析了11例患者(n = 11),他们接受了为期一年的用骨板临时关节融合术,并消除了腕掌关节屈肌和内收肌痉挛。对术后6个月、1年、金属结构拆除后平均2个月(1至4个月)的结果进行对比分析。分析了掌指关节被动和主动运动的幅度。采用国际分类系统MACS 2002和Block and Box test对上肢功能能力进行评估。此外,为了研究肌肉的功能状态,主要是确定圆柱形握力的有效性,使用Neurosoft(俄罗斯)的四通道神经肌电描记仪进行了一项调查。
结果。在手术和移除固定结构后一年,腕掌关节被动收缩(32.0°)和伸展(9.5°)的幅度增加,以及主动进行的相同运动(收缩—25.5°和伸展—4.0°)的幅度增加。MACS指标提高了1分。Block and Box test的平均动力学为7个额外的立方体。一年后拆除金属结构,掌指关节平均稳定2个月(最长4个月),屈曲幅度为10-20°。
结果。与关节内固定术相比,发展的掌指关节临时关节外关节固定术不会影响关节内结构,这意味着它比后者有明显的优势。这种手术治疗方法对增加第一腕掌关节主动和被动活动的幅度是有效的。在拆除钢板后,随访期间内,掌指关节平均保持稳定2个月。
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作者简介
Dmitry Umnov
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: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607
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 PetersburgVladimir Novikov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
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 PetersburgMargarita Savina
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: drevma@yandex.ru
ORCID iD: 0000-0001-8225-3885
PhD, Head of the Laboratory of Physiological and Biomechanical Research
俄罗斯联邦, Saint Petersburg参考
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