腰骶段选择性脊神经后根切断术对痉挛型脑性瘫痪患者伴随症状的影响

In1978,Fasanofirstindicatedselectiveposteriorrhizotomybyelectricstimulationonpatientswithspasticcerebralpalsyhadsig-nificanteffects犤1犦.In1991,ourXulinfirstindicatedimprovedselec-tiveposteriorrhizotomybyelectricstimulation,andthenSPRwerewidelyusedinourcountry犤2犦.NowSPRhasbeenaneffectivetreat-menttospasticcerebralpalsy犤3犦.Moreover,partofpatientswhohadSPRhadtheirsymptomsincludingspasticityofupperlimbs,epilepsy,strabismus,sialorrheaanddysarthriaameliorated.Andthiswasalsoreportedbyoverse…     

痉挛型双瘫的临床特征

目的：探讨痉挛型双瘫的临床特征,为脑功能的全面康复提供基础资料。方法：对５０ 例痉挛型双瘫患儿的临床资料进行回顾性分析。结果：５０ 例中３５ 例为早产儿（７０％）,高危因素依次为早产、低体重、缺氧、硬肿症、颅内出血;１５ 例为足月儿（３０％）,高危因素主要为窒息、缺氧缺血性脑病。５０ 例患儿运动神经功能异常,全部表现为骨盆带及下肢痉挛及由此所致的姿势异常,双上肢受累较轻。平均精细运动年龄１８．５ 个月,粗大运动年龄８．７５ 个月（Ｐ＜ ０．０１）。半数患儿同时合并斜视、语言发育迟缓和／ 或运动性构音障碍。结论：痉挛型双瘫的病因,运动神经系统表现具有特征性,对其正确的认识评价有助于康复计划的制订。     

Spasticity in children with cerebral palsy: a retrospective review of the effects of intrathecal baclofen

The administration of baclofen by intrathecal pump is a new technique used to reduce spasticity for individuals with upper motor neuron system injuries. Children with cerebral palsy often have difficulty in mobility because of this form of spasticity. The purpose of this study was to assess the functional outcomes of intrathecal baclofen pump therapy with spasticity in children with cerebral palsy. A retrospective review of medical records for pediatric cerebral palsy patients receiving intrathecal baclofen for intractable spasticity was performed. Of 23 sequential medical records meeting requirements for inclusion in the study, 17 subjects had sufficient recorded data to be included in the study. Data from the medical records included Ashworth scores, therapy complications, and changes in mobility and independence. Although no significant changes in the upper extremities with intrathecal baclofen occurred at one and three months, the trial bolus showed statistically significant changes in mean Ashworth scores. The pre- and posttrial bolus Ashworth scores for the lower extremities showed statistically significant decreases in the posttrial scores and at one and three months when compared with the pretrial scores (p < .001). Complications were resolved with conservative management without long-term sequelae. No infections, respiratory depressions, or deaths occurred as a result of intrathecal baclofen therapy in this study. Although intrathecal baclofen had a significant effect in reducing lower extremity spasticity in children with cerebral palsy, further prospective studies are needed to determine the effects of intrathecal baclofen on such indicators as activities of daily living.     

A型肉毒毒素联合上田法治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效评价

目的 探讨A型肉毒毒素(BTX-A)联合上田法治疗痉挛型脑瘫患儿下肢肌张力障碍的疗效。方法 40例痉挛型下肢瘫脑瘫儿分为治疗组和对照组,治疗组 18例患儿采用 BTX-A肌肉注射联合上田康复手法进行治疗,对照组22例患儿单用上田康复法治疗,2组治疗前、后均用医师等级评价量表法(PRS)及 Ashworth痉挛评分法进行效果评价。结果 治疗组治疗后3 d PRS及Ashworth评分较治疗前有显著差异(P<0.05),治疗后2周治疗组评分较对照组差异有显著性意义(P<0.05)。2组治疗后8周评分差异无显著性意义。结论 BTX-A注射疗法联合上田康复手法能有效地治疗痉挛型脑瘫,起效快,并降低肌张力完全,可缩短康复疗程时间。     

选择性脊神经后根切断术治疗痉挛性脑性瘫痪

AIM: To investigate the effects of selective posterior rhizotomy (SPR) to spastic cerebral palsy. METHODS: 55 patients with spastic cerebral palsy who were treated with SPR between April 1999 and January 2002 were followed up and compared their changes of muscle force, muscle tone, the limb function preoperatively and postoperatively.RESULTS: 51 had selective lumbosacral posterior rhizotomy. In 35 cases who could not walk preoperatively, 25 could walk alone. 6 cases improved their gait and walk ability and 4 did not significantly. 20 cases who walked claudicantly preoperatively, can walk nimbly and firmly. Their step width extended and gait improved apparently. 4 cases had selective cervical posterior rhizotomy. They had their spasm of upper limbs relieved, joint function improved, and clawhand disappeared. In this group we didn' t find severe complications. CONCLUSION: Selective posterior rhizotomy has curative effect to spastic cerebral palsy and has no severe complications. Its long-term effects stil     

有限度选择性脊神经后根切断术联合内收肌松解改善下肢痉挛型脑性瘫痪儿童的运动能力

背景选择性脊神经后根切断术(selective posterior rhizotomy,SPR)作为痉挛型脑性瘫痪解除痉挛和改善功能的有效手段已被逐渐公认和推广,但标准的SPR手术后脊柱失稳、肌力减退等并发症已成为人们观注的课题.有限度的选择性脊神经后根切断术(limited selective posterior rhizotomy,LSPR)联合内收肌松解术有效解除下肢痉挛畸形同时,在减少上述并发症方面有良好效果.目的探讨LSPR联合内收肌松解术治疗下肢痉挛型脑性瘫痪对解除下肢痉挛畸形、改善步态、提高患者运动能力的作用.设计以痉挛性脑性瘫痪患儿为研究对象的自身前后对照、随访性观察.单位大连医科大学附属第一医院骨科病房.对象病例来源于2001-01/2002-12吉林大学第一医院骨科病房住院治疗的痉挛性脑性瘫痪患儿.双下肢表现为不同程度的剪刀步态、屈膝及尖足行走.腱反射亢进,踝阵挛阳性18例,Babinski征阳性15例.所有患者躯干与四肢均有较好的运动功能,均能独立行走、下蹲或在单手或双手扶持下行走,无固定的软组织挛缩畸形.干预本组患者均采用选择性L5、S1脊神经后根切断术,同时联合双侧内收肌松解术治疗.术后评定患者下肢肌张力、肌力、膝及跟腱反射、病理症及踝阵挛变化;腰椎、骨盆X射线片及物理检查了解畸形改变;根据手术前后立姿、步姿、下蹲起立等评分,评价运动功能改善情况.随访方法通过查阅原始病历,回院复查及书信联系,填写表格并详细记录,了解手术前后运动功能、肌张力、肌力、膝及跟腱反射、踝阵挛等改变.主要观察指标痉挛性脑性瘫痪患儿有限度的选择性脊神经后根切断术治疗前后痉挛解除和下肢功能评分情况.结果本组30例均获随访,随访时间6个月～3年,平均11个月.所有患者的痉挛程度较术前有明显降低,平均下降2.5级.术后步态明显改善,剪刀步态及尖足消失,屈膝改善,足跟可着地行走.踝阵挛及病理反射消失率100%,12例术前膝腱反射亢进的患者,术后膝反射减弱.术后双下肢无肌力减退及感觉的永久性缺失.术后随访2年以上的9例摄腰椎及骨盆X线片未见畸形出现.同时8例术前有上肢痉挛或流涎、语言障碍的患者术后上述症状也不同程度缓解.患者手术后立姿(4.25±0.91)、步姿(3.92±0.65)、蹲、立姿势变换能力(4.02±0.74)较术前明显改善,差异均有显著性意义(t=2.04～2.98,P＜0.05～0.01).结论LSPR结合内收肌松解术,在减少手术创伤的同时,可有效的解除脑性瘫痪患者下肢痉挛畸形,提高其运动能力.     

选择性脊神经后根切断术治疗非脑瘫性下肢痉挛性瘫痪的临床疗效

目的探讨选择性脊神经后根切断术(SPR)对非脑瘫性下肢痉挛性瘫痪的疗效。方法选择自2008年10月至2011年6月除外脑瘫所致下肢痉挛型瘫痪36例(其中脑血管意外后遗症8例,脑积水4例,脑脊髓损伤后遗症19例,不明原因5例),行选择性脊神经后根切断术。对术前、术后的下肢肌张力,步态分析及肢体功能的变化进行分析。结果所有患者的均获随诊,时间3～18月,平均5.3±1.8月。术后步态分析及行走能力得到明显改善,差异有统计学意义(P<0.01)。所有患者痉挛改善,肌张力评分由术前3.5±0.2分下降至术后1.5±0.5分,差异有统计学意义(P<0.01),肢体功能均有不同程度改善。结论选择性脊神经后根切断治对非脑瘫性下肢痉挛性瘫痪,可改善痉挛,降低肌张力,改善步态。     

脑病变的部位及大小与Brunnstrom偏瘫恢复阶段及痉挛程度的关系

目的 探讨脑病变的部位及大小与Brunnstrom偏瘫阶段及痉挛程度的关系。方法 36例患者，男26例。女10例；年龄16-70岁；左侧脑病变17例。右侧19例；脑血肿17例。脑梗死及脑皮质软化灶19例。结果 脑皮质受损部位患者呈跳跃式恢复，痉挛主要表现为不能伸腕，指及踝背屈障碍，当上肢伸肌功能恢复后，屈肌痉挛消失；顶叶受损（病变体积为30-50cm^3)患者残留症状为不能并指，分指，对掌运动及踝自主背屈障碍；内囊部分病变患者主要表现为肢体远端痉挛。痉挛期与分离期重叠出现。即出现伸腕，指运动时，屈腕，指肌及屈拇长肌仍有痉挛现象存在；内囊大部分或完全病变患者，痉挛表现在四肢所有关节，运动功能恢复较差。结论 脑病变部位及大小不同，痉挛程度不同，痉挛程度与运动训练疗效关系密切。均有助于判断患者康复后期日常生活活动能力及运动功能恢复状况。     

肌肉功能定位穴位注射治疗脑性瘫痪双上肢障碍临床观察

目的探讨肌肉功能定位穴位注射治疗脑性瘫痪患儿双上肢障碍的疗效。方法对120例痉挛型脑瘫患儿分为两组,各60例,分别采用综合康复加肌肉功能定位穴位注射和综合康复治疗两种方法。疗程结束后按婴幼儿精细运动发育量表和修订的Ashworth痉挛评定量表进行疗效评价。结果注射康复组婴幼儿精细运动发育量表和Ashworth评分优于综合康复组（P<0.05）。结论肌肉功能定位注射可提高脑瘫患儿上肢障碍的疗效。     

脑瘫患儿构音障碍特点与言语治疗

对５６例脑瘫患儿的构音运动和言语特点进行了分析与治疗。结果：４５例和存在运动性构音发生率为８０．４％,其中徐动型、失调型、痉挛型四肢瘫患儿构音障碍发生主高且程度较严重痉挛型双瘫次之。偏瘫型则较少运动异常构音障碍;对其中４５例患儿采用基础性训练、构音器官运动及构音训练后总有效率为９１．０％,提示运动性构音障碍是脑瘫患儿文言语的主要问题,早期正确评价和治疗具有重大意义。     

脑瘫痉挛解除后足畸形的变化

痉挛型脑瘫58例行L_2—S_1节段的选择性脊神经后根切断术,术后患者的下肢痉挛均巳解除.通过术前术后足畸形的对比,发现SPR术能使多数痉挛所致足畸形在术后得以完全矫正,并减轻痉挛与软组织挛缩同时存在的足畸形的严重程度,预防软组织挛缩,避免足畸形加重,而对跟骨畸形影响较小.本组病例中扁平外翻足畸形多见,在治疗中是一个值得重视的问题.     

小针刀治疗痉挛型脑瘫疗效观察

目的 观察小针刀疗法降低痉挛型脑瘫患者肌张力的疗效。方法 105例痉挛型脑瘫患者随机分为A组（小针刀组35例）、B组（运动疗法组34例）和C组（小针刀加运动疗法36例）共3组。治疗前和治疗后1月时分别用改良的Ashworth肌张力评定量表进行评定。结果 A组有23例有效（65．71%），B组10例有效（29．41%）．C组有效28例（77．78％）。B组有效率明显低于A组（P=0．00313）和C组（P=0．00227）。结论 小针刀疗法在改善痉挛型脑瘫患者的肌张力方面明显优于运动疗法。     

按摩结合手术矫形治疗儿童重症痉挛型脑瘫

为探讨中医按摩结合手术矫形治疗儿童重症痉挛型脑瘫的方法。对８３例重症痉挛型脑瘫患儿随机分为Ａ组和Ｂ组。Ａ组采用术前下肢按摩、手术矫形和术后功能锻炼等;Ｂ组则单纯下肢手术矫形。结果：Ａ组治疗３￣６月后患儿双下肢内收肌、屈膝肌和小腿三头肌的肌力与治疗前比较,差异有显著性,Ｐ〈０．００１。Ａ组优,良,改善率分别为４０．０％,４８．０％,,１２．０％;Ｂ组分别为２２．４％、５３．５％、２４．１％。２组优良     

Improvement of sleep apnea in a patient with cerebral palsy.

Intrathecal baclofen (ITB) can reduce spasticity in adults and children with cerebral palsy. Benefits of ITB therapy include improved Ashworth scores, activities of daily living, and mobility. The impact of ITB therapy on sleep apnea in patients with cerebral palsy has not been reported. This case report describes a 29-yr-old female with mixed spastic athetoid quadriparetic cerebral palsy with dystonia, gross motor function IV, who had sleep apnea, requiring nightly continuous positive airway pressure. She received ITB with the goal to improve her wheelchair positioning and decrease her excessive movements. After the initiation of the ITB, reduction of her spasticity and dystonia was noted, as well as improvement of her sleep apnea. This case suggests that ITB therapy may improve respiratory function through reduction of respiratory muscle spasticity.     

肌内效贴联合运动控制训练对脑瘫患儿运动功能影响的研究

目的:观察肌内效贴联合运动控制训练对痉挛型脑瘫双下肢痉挛及粗大运动功能的影响。方法:收集痉挛型脑瘫患儿58例,随机分为观察组和对照组各29例。对照组进行常规康复功能训练,观察组在对照组治疗基础上加用肌内效贴及运动控制治疗。2组患儿均于治疗前和治疗3个月后,采用踝关节被动活动范围(PROM)、改良Ashworth痉挛分级量表(MAS)、粗大运动功能量表(GMFM)中的D区、E区进行测定。结果:治疗后,2组患儿PROM角度、GMFM(D、E区)得分均较组内治疗前明显提高(P0.05),MAS评分明显降低(P0.05),观察组各项评分较对照组改善更为显著(P0.05)。结论:肌内效贴配合运动控制训练能有效缓解痉挛型脑瘫下肢痉挛并提高粗大运动功能。     

推拿养肝柔筋法对脑瘫患儿斜视的疗效观察

目的观察推拿养肝柔筋法治疗脑瘫患儿斜视的疗效。方法 60例伴有斜视的脑瘫患儿分为治疗组 (3 0例 )和对照组(3 0例 ) ,前者采用推拿养肝柔筋法治疗 ,后者不做治疗 ,同时 ,3 0例非脑瘫斜视患儿作为观察组 ,治疗手法同治疗组 ,比较疗效。结果治疗组痊愈 6例、好转 16例、无效 8例 ;对照组 :临床痊愈 1例、好转 2例、无效 2 7例 ;非脑瘫观察组痊愈 1例、好转 10例、无效19例 ;脑瘫治疗组与对照组有非常显著性差异 (P <0 .0 1) ,与非脑瘫观察组有显著性差异 (P <0 .0 5 )。结论养肝柔筋法对脑瘫斜视是一种有效可行的治疗方法 ,其远期疗效有待进一步观察。     

脑瘫的临床与头颅CT表现

目的 探讨小儿脑性瘫痪临床症状与头颅CT形态学改变的关系。方法 对86例小儿脑瘫患者行颅脑CT检查,并对结果进行分析。结果 86例患儿中,CT表现异常者66例,异常率76．7％,其中脑萎缩最常见,占59．1％,并且,年龄越小,CT异常率越高。病因中,有窒息史者CT异常率最高。临床类型中,痉挛型的CT异常率最高。结论 头颅CT形态学检查对小儿脑性瘫痪的病因学诊断有参考价值。     

针刺配合Bobath法治疗痉挛型脑性瘫痪的临床观察

目的观察针刺配合Bobath法治疗痉挛型脑性瘫痪的康复效果。方法30例脑瘫患儿为针刺组,使用针刺配合Bobath法治疗。30例脑瘫患儿为运动组,采用Bobath法治疗。比较两组患儿的康复效果。结果针刺组总有效率为93%,运动组总有效率80%;两组患儿治疗后粗大运动功能测定（GMFM）评分较治疗前均有提高（P＜0.05）,针刺组评分高于运动组（P＜0.05）;两组治疗后痉挛改善针刺组总有效率76.7%,运动组总有效率50%。结论针刺配合Bobath法治疗痉挛型脑性瘫痪较单一Bobath法治疗有更好疗效。     

Immediate effects of short period lower limb ergometer exercise in adolescent and young adult patients with cerebral palsy and spastic diplegia

[Purpose] To determine the effects of lower limb ergometer exercise on the spasticity and joint range of motion of the lower extremity and gait function in patients with cerebral palsy and spastic paralysis. [Participants and Methods] This study included 8 participants with cerebral palsy and spastic paralysis (GMFCS levels I to IV) who received care at the outpatient clinic. After a 5-min rest, the lower limb ergometer exercises were performed for 10 min. We measured the participants’ arterial blood pressure, pulse rate, passive range of knee joint extension, muscle tone using the Modified Ashworth scale (MAS) and Modified Tardieu scale (MTS), and 10-m walk test (10MWT). Measurements were collected three times (at baseline before exercise, immediately at the end of exercise, and 5 min after exercise during recovery). [Results] The 10-min lower limb ergometer exercise significantly improved the knee joint extension, MAS and MTS scores, and reduced lower extremity spasticity. Furthermore, it significantly increased the range of knee joint extension and decreased the 10MWT score. [Conclusion] The results showed that the 10-minute lower limb ergometer exercise is beneficial in reducing the spasticity of the lower limb muscles and in increasing the range of motion of knee extension in paraplegic patients with cerebral palsy, suggesting that its implementation in young children could prevent spasticity and enhance motor function.Key words: Spasticity, Rehabilitation, Muscle tone     

Change of dynamic gastrocnemius and soleus muscle length after block of spastic calf muscle in cerebral palsy

OBJECTIVE: The purpose of this study was to evaluate the efficacy of gastrocnemius and soleus muscle length measured by gait analysis for characterizing the spastic calf muscles in ambulant cerebral palsy. METHODS: A total of 20 limbs in the 16 children with diplegic or hemiplegic cerebral palsy showing spasticity of the calf muscle were analyzed by three-dimensional gait analysis before and after botulinum toxin injection. RESULTS; The mean maximal ankle dorsiflexion angle, the minimal knee flexion angle in stance, and the dynamic gastrocnemius and soleus muscle lengths increased after the block. Paradoxically the dynamic gastrocnemius muscle lengths decreased in the eight patients after the block, all of whom had a common characteristic of the genu recurvatum. In contrast, dynamic soleus length, knee angle, and ankle angle improved after the injection. CONCLUSION: Gastrocnemius length and soleus length are useful variables to evaluate the antispastic effect of botulinum toxin in patients with cerebral palsy. When the genu recurvatum is present, the soleus muscle length is more informative than gastrocnemius length.