A型肉毒毒素治疗小儿脑性瘫痪下肢肌张力障碍

目的研究A型肉毒毒素(BTX-A)对小儿脑性瘫痪下肢肌张力障碍的治疗效果.方法选择30例痉挛型下肢瘫脑性瘫痪患儿,用国产BTX-A进行下肢痉挛肌肉局部注射,应用PRS方法(Physician Rating Sclae)进行治疗前后的疗效评价.结果29例(96.7%)治疗后较治疗前下肢痉挛明显改善,其PRS指标治疗前后比较差异显著(P＜0.01).治疗中及治疗后无严重不良反应发生.结论BTX-A能缓解脑性瘫痪患儿下肢痉挛的肌肉,改善运动功能.小儿对该药有良好的耐受.该治疗方法是一种安全有效、简便沣易行的治疗小儿脑瘫的方法.     

穴位与肌肉定位水针治疗痉挛型脑瘫的临床观察

目的探讨穴位与肌肉定位水针治疗痉挛型脑瘫的临床疗效。方法将符合诊断标准的60例痉挛型脑瘫患儿随机分为治疗组和对照组,每组各30例。根据患儿病情,制定个体化方案。对照组运用Bobath神经发育疗法、智力训练、肢体功能训练、推拿、电疗、脑细胞活性药物等综合治疗;治疗组在对照组治疗基础上加肌肉功能定位水针注射治疗。2组治疗前后运用小儿智能发育检查表(CDCC)评定表评定临床症状改善情况,并作比较。结果 2组治疗前后主要指标疗效比较,差异有统计学意义(P<0.01);2组治疗后临床疗效比较,差异有统计学意义(P<0.05)。结论位点加穴位水针治疗对痉挛型脑瘫患儿的临床症状有明显改善作用,对小儿早期脑瘫具有较好疗效。     

中药熏蒸对痉挛型脑瘫患儿的疗效观察

目的 评估中药熏蒸对脑瘫患儿的临床疗效.方法 68例脑瘫患儿随机分为2组,对照组采有功能训练、小儿按摩、蜡疗、痉挛肌常规治疗, 观察组除常规治疗外加用中药熏蒸.结果 观察组总有效率(94.1%)明显高于对照组(88.2%), 前者与后者的关节活动度均有明显改善(P＜0.05). 结论 中药熏蒸能有效改善痉挛型脑瘫患儿的运动功能、缓解肌肉痉挛,降低肌张力.     

综合康复治疗脑性瘫痪的疗效观察

目的观察小儿脑瘫的综合康复治疗的疗效。方法对200例脑瘫患儿采用常规功能训练、按摩、中医针灸、穴位注射、引导式教育、水疗、中药熏蒸、高压氧疗、语言训练等综合康复治疗,观察其对不同年龄、不同类型小儿脑瘫的疗效。结果 <6个月组患儿除2例外均有效,6个月~1岁组有效率94.12%,>1~3岁组有效率84.38%,>3岁组有效率58.33%。年龄越小效果越好,脑瘫的类型以痉挛型疗效最好。结论综合康复治疗小儿脑瘫尤其对痉挛型脑瘫疗效明显,且年龄越小,治疗康复效果越好。     

内关穴针刺治疗痉挛性脑瘫患儿的疗效及对血清脑源性神经营养因子的影响

目的探讨内关穴针刺治疗痉挛性脑瘫患儿的疗效及对血清脑源性神经营养因子(BDNF)的影响。方法 2012年3月至2016年3月收治痉挛性脑瘫患儿72例,根据随机信封抽签法分为观察组与对照组,各36例。对照组给予常规治疗,观察组在对照组治疗的基础上给予内关穴针刺治疗,两组治疗观察时间为3个月。结果观察组总有效率(97.2%)明显高于对照组(77.8%;P0.05)。观察组与对照组治疗前适应行为与语言行为评分、血清BDNF水平均无统计学差异(P0.05);治疗后,两组适应行为与语言行为评分、血清BDNF水平较治疗前均明显增高(P0.05),而且观察组治疗后评分、血清BDNF水平均明显高于对照组(P0.05)。结论内关穴针刺治疗痉挛性脑瘫患儿能提高治疗效果,促进智力发育,其机制可能与促进BDNF的表达有关。     

局部注射疗法对脑瘫患儿下肢痉挛状态的疗效观察

目的　探讨局部注射疗法治疗痉挛型脑性瘫痪的临床疗效。方法　将 96例下肢痉挛型脑性瘫痪患儿随机分为两组。A组 :药物局部注射 (治疗组 ) 5 4例 ,隔天 1次 ,10次为一疗程 ;B组 :上田敏法 (对照组 ) 42例 ,1次 /d ,2 0d为一疗程。结果　治疗前后两组疗效比较有显著性差异 ,治疗组疗效显著高于对照组。结论　局部注射疗法使局部组织新陈代谢活跃 ,再生过程加强 ,肌肉软化松解 ,从而达到降低肌张力的目的 ,为下肢痉挛型脑瘫患儿又开辟了一条新的治疗途径     

痉挛性脑性瘫痪患儿智力水平对康复治疗效果的影响

目的了解痉挛性脑性瘫痪患儿的智力水平对康复治疗效果的影响。方法选取2009-06~2010-06在郑州市儿童医院儿童康复科住院的112例婴幼儿痉挛性脑性瘫痪患儿作为研究对象,采用婴幼儿智能发育量表(CDCC)评定患儿的智力水平,观察并比较不同智力水平脑瘫患儿的康复疗效。结果智力水平中等者12例均治疗有效,中下水平者有效率95.83%,边缘状态有效率77.50%,低下水平有效率58.33%,四个不同智力水平组疗效比较,差异有统计学意义(P<0.05)。结论婴幼儿痉挛性脑性瘫痪患儿智力水平影响康复治疗的效果,智力水平越高,治疗效果越好。     

平足穴 承山穴药物注射治疗痉挛型脑性瘫痪患儿尖足的疗效观察

目的观察平足穴与承山穴药物注射治疗痉挛型脑性瘫痪患儿尖足的疗效。方法 120例痉挛型脑瘫尖足患儿随机分为治疗组60例和对照组60例,2组均予以综合康复训练,治疗组加用平足穴与承山穴药物治疗,2组均治疗3个月。采用改良的Ashworth痉挛评定量表评定腓肠肌的肌张力及结合足背屈角测量综合判断其临床疗效。结果治疗组尖足的改善情况明显优于对照组,差异有统计学意义(P0.05)。结论平足穴与承山穴药物注射治疗能有效改善痉挛型脑瘫患儿尖足的状况,具有临床推广价值。     

痉挛性脑瘫患儿脑脊液胆碱酯酶的研究

目的 研究痉挛性脑性瘫痪(CP)患儿肌痉挛形成机制及选择性脊神经后根切断术(SPR)治疗机制。方法 采用改良的Ellman法测定45例痉挛性脑瘫患儿。30例非神经系统疾病儿童及18例SPR术后脑瘫患儿脑脊液中乙酰胆碱酯酶(AchE)和丁酰胆碱酯酶(BchE)的水平。结果 SPR术前脑瘫组脑脊液AchE明显低于对照组，且与病情程度相关，BchE和对照组无显著差异；SPR术后脑瘫患者脑脊液AchE比术前明显升高，BchE与术前无显著差别。结论 痉挛性脑瘫患儿胆碱能神经元功能降低可能在痉挛性脑瘫肌痉挛及智力障碍的形成中起重要作用，SPR术后胆碱能神经元功能增强与肌痉挛解除和全身症状改善有关。     

穴位注射对痉挛型脑瘫患儿肌张力及智力影响临床分析

目的观察穴位注射对痉挛型脑瘫患儿肌张力及智力的影响。方法痉挛型脑瘫患儿70例随机分为治疗组和对照组各35例。治疗组用穴位注射和功能训练,对照组单用功能训练。结果治疗组总有效率为94.3%,对照组为71.4%,治疗组疗效明显优于对照组(P0.05)。在改善肌张力及智力方面,治疗组也明显优于对照组(P0.05)。结论穴位注射能够明显降低痉挛型脑瘫患儿的肌张、提高智力,与对照组比较疗效明显。     

A型肉毒毒素治疗口下颌肌张力障碍

目的观察A型肉毒毒素治疗口下颌肌张力障碍(OMD)患者的临床效果。方法对19例口下颌肌张力障碍患者进行临床分析,依据患者临床特点,将A型肉毒毒素注射到患者一侧或双侧咀嚼肌、颞肌及翼外肌,并根据肌肉收缩力量大小、肌肉体积及患者体重调整剂量。结果 68.4%的患者功能改善评分≥3分,疗效平均维持8～12周(有效范围2～28周)。4例患者注射后有轻度咀嚼无力,2～3周恢复。1例混合型患者注射后出现轻度鼻音,持续13天后症状消失。所有患者未出现其它严重副作用。结论 A型肉毒毒素对于口下颌肌张力障碍的治疗是有效、安全的。熟悉本病的临床特点及分型,选择正确的靶肌肉及注射适宜剂量的肉毒毒素是治疗本病的关键。     

Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up using gross motor function measure

One of the main goals when treating spasticity is to relieve pain and improve function. Intramuscular injection of botulinum toxin type A (BTX-A) has gained widespread acceptance in the treatment of spastic cerebral palsy. Several studies have clearly shown the short-term functional benefit of BTX-A treatment. Information is limited, however, on the efficacy of medium and long-term regimens, using repeated injection of BTX-A. The aim of the present open-label, prospective study was to evaluate functional outcome in children with spastic cerebral palsy after 1 year of treatment with BTX-A, using the Gross Motor Function Measure (GMFM) as a validated outcome measure. Patients ( n =25, age 1.5–15.5 years) were treated with BTX-A for adductor spasm ( n =12) or pes equinus ( n =13). The local effect was evaluated using passive range of motion and modified Ashworth Scale. Apart from a significant improvement in joint mobility and reduction of spasticity compared to pretreatment values ( P  < 0.01), we demonstrated a significant improvement of gross motor function after 12 months of treatment, with a median gain of 6% in total and goal scores ( P  < 0.001). An increase in GMFM scores was particularly evident in younger and moderately impaired children (Gross Motor Function Classification System level III). Whether the observed improvement in gross motor function in children with cerebral palsy is specifically related to therapy with BTX-A or represents at least in part the natural course of motor development still needs clarification.     

A comparison of spastic diplegic and tetraplegic cerebral palsy

The aim of this study was to compare spastic diplegic and tetraplegic cerebral palsy. Thirty-eight children had spastic diplegic cerebral palsy and 48 spastic tetraplegic cerebral palsy. Risk factors of cerebral palsy, seizures, severity of cerebral palsy, electroencephalogram, and magnetic resonance imaging findings were analyzed. Gestational history, low birth weight, and perinatal pathologies were present in similar percentages in both groups. Lower values of the Apgar score were recorded more often in the tetraplegic cerebral palsy group than the diplegic group. The children with spastic diplegia were classified more frequently into levels I and II of the Gross Motor Function Classification System, but patients with spastic tetraplegia were classified more frequently into levels IV and V. Similarly, mental retardation was observed more frequently in the patients with spastic tetraplegia. In magnetic resonance imaging, periventricular leukomalacia was detected in a higher proportion of children with spastic diplegia than in patients with tetraplegia. Cerebral atrophy occurred more frequently in the tetraplegic group compared with diplegic patients. Twenty-four (50.0%) children with spastic tetraplegia had epilepsy compared with six children with spastic diplegia. The incidence of intractable epilepsy was higher in the tetraplegic patients than in the children with spastic diplegia.     

Assessment of surface electromyographic clinical analysis of selective femoral neurotomy on cerebral palsy with stiff knee

This study aimed to explore the role of surface electromyography (sEMG) on the changes of myoelectric activities of quadriceps femoris and the assessment of its clinical effect before and after selective femoral neurotomy on spastic cerebral palsy with stiff knee. Selective femoral neurotomy was carried out in 15 patients on 26 sides. The electromyography of quadriceps femoris was recorded before and after the operation. Passive and voluntary movements were performed during recording. The root mean square (RMS) and integrated electromyography (iEMG) was calculated by time domain analysis. Meanwhile, the range of the patients' knee joint motion (ROM) was measured by a joint goniometer. The RMS and iEMG of the quadriceps femoris during passive movement was significantly decreased post-operation when compared to those pre-operation (both P<0.05, n=26). Meanwhile, the RMS and iEMG of the quadriceps femoris during voluntary movement post-operation was significantly reduced than those pre-operation (both P<0.05, n=26). Additionally, total excursion on the sagittal plane and the peak knee flexion in the swing phase were significantly raised post-operation than those pre-operation (both P<0.05, n=26). The spasms in the quadriceps femoris in spastic cerebral palsy patients with stiff knee was clearly improved, and the ROM of the knee was significantly enhanced after the selective femoral neurotomy. Importantly, surface EMG can objectively evaluate the clinical therapeutic effect of spastic cerebral palsy stiff knee as a noninvasive detection method.     

选择性周围神经部分切断术治疗脑瘫性肢体痉挛

目的观察选择性周围神经部分切断术治疗痉挛性脑瘫的效果。方法采用显微神经外科手术治疗的68例痉挛型脑瘫病例,根据患者肢体痉挛的不同情况采用相应的选择性周围神经部分切断术,包括胫神经、坐骨神经和正中神经,其中选择性胫神经切断术36侧,选择性正中神经切断术28侧,选择性坐骨神经切断术28侧,共计92侧。结果全部患者经3-15个月的随访,术后即刻肢体痉挛状态缓解率为97.8%(90/92),随访期间为94.6%(87/92),随访期间运动功能改善率为76.5%(52/68),术后肢体痉挛状态不同程度复发5侧(5.4%)。结论选择性周围神经部分切断术对降低痉挛性脑瘫患者肌张力、纠正痉挛性畸形近期疗效满意,手术创伤小,治疗效果能够被医患双方同时认可。     

Inhibitory and excitatory amino acids in the cerebrospinal fluid of children with two types of cerebral palsy*

BACKGROUND： Under normal conditions, excitatory amino acids are dynamically balanced with inhibitory amino acids. Excitatory amino acids have been implicated in perinatal brain injury. OBJECTIVE： To investigate differences in the levels of the excitatory amino acids glutamic acid and aspartic acid, and the inhibitory amino acid gamma-aminobutyric acid （GABA） in the cerebrospinal fluid （CSF） of children with spastic cerebral palsy or athetotic cerebral palsy. DESIGN, TIME AND SETTING： Case-control exploratory observation of neurotransmitter in patients. The experiment was performed in the Pediatrics Department of the Second Affiliated Hospital of Changsha Medical College, the Cerebral Palsy Center of Xiangtan Affiliated Hospital of South China University and the Pediatrics Department of Xiangya Hospital, between February 2006 and May 2007. PARTICIPANTS： We selected 27 children with cerebral palsy, including 13 with spastic cerebral palsy and 14 with athetotic cerebral palsy. We selected 10 patients who were not affected by any neurological disease as controls. METHODS： Two mL blood-free CSF was harvested between the third and fourth lumbar vertebrae of each patient after anesthesia, and stored at -70℃. One mL CSF was mixed with 10 mg sulfosalicylic acid and placed in ice-bath for 10 minutes, then centrifuged 2 000 g for 10 minutes. The supernatant was collected for amino acid quantitation. MAIN OUTCOME MEASURES： The concentrations of glutamic acid, aspartic acid and GABA in the CSF were determined by high-performance liquid chromatography and fluorometric method. The correlation of glutamic acid, aspartic acid and GABA levels with muscular tension in children with cerebral palsy was analyzed using linear dependence. RESULTS： The concentration of GABA was significantly lower in both spastic cerebral palsy and athetotic cerebral palsy patients than in the control group （P 〈 0.01）. Glutamic acid and aspartic acid were significantly higher in both cerebral palsy groups than in the control     

Spastic cerebral palsy: clinical magnetic resonance imaging correlation of 129 children

A prospective study was undertaken of 129 children with spastic cerebral palsy to clarify the relationship between magnetic resonance imaging (MRI) findings and clinical features of cerebral palsy. Low birth weight, asphyxia, prematurity, seizures, mental development, Gross Motor Function Classification System, and MRI findings were analyzed. Significant abnormalities relevant to the cerebral palsy were evident on imaging in 123 (95.3%). A similar percentage of MRI abnormalities were detected in the groups, 45 (100%) in patients with tetraplegic cerebral palsy, 37 (92.5%) in children with diplegic cerebral palsy, and 42 (95.4%) with hemiplegic cerebral palsy. Periventricular leukomalacia was detected more frequently in the children with spastic diplegia than in the patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more frequently in children with spastic hemiplegia. Congenital brain anomalies were found in a higher proportion in tetraplegic children. Significant correlations between the MRI findings and Gross Motor Function Classification System in the diplegic and tetraplegic patients were found. No correlations between the MRI results and risk factors for cerebral palsy in the tetraplegic patients were noted. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the initiation of appropriate therapy     

辅加单侧脊神经S2后根选择性切断治疗脑瘫踝痉挛的疗效观察

目的评价脊神经S2后根选择性切断术治疗脑瘫踝痉挛疗效。方法25例痉挛性脑瘫患者均为双下肢受累,对踝痉挛较重的一侧下肢采用L2~S2SPR术,对另一侧踝痉挛相对较轻者采用L2~S1SPR术。术中将各后根分为3~5个小束,采用同心圆电极进行刺激,通过肉眼观察及肌电图记录显示肌肉收缩情况,将肌肉收缩范围明显异常的小束切断。踝痉挛情况按照Ashworth法进行评估,随访16.3±4.9个月,观察疗效并比较两侧肢体踝痉挛改善情况。结果S2后根的切断率为32%。病人术后踝痉挛均明显缓解,行走功能改善,无括约肌功能障碍。手术范围包括S2后根时,该侧踝痉挛改善更佳。结论对踝痉挛严重的脑瘫患者,采用选择性脊神经后根切断术治疗时,手术范围应包括S2后根。     

Magnetic resonance imaging in children with bilateral spastic forms of cerebral palsy

We analyzed the relationship between magnetic resonance image findings in children with bilateral spastic cerebral palsy and its stages of severity in term and preterm children. Magnetic resonance image findings of 102 children (66 male and 36 female) with bilateral spastic cerebral palsy (median age, 2.5 years; range, 3 months to 15 years) were reevaluated. The study group consisted of children with confirmed perinatal asphyxia. Hypoxic-ischemic events were diagnosed in 64% of the children. Significant abnormalities relevant to cerebral palsy were evident on imaging in 85/102 (83%) children (in 77% of term and 93% of preterm children). Enlargement of the ventricles alone (48%) or accompanied by periventricular white-matter damage (25%) was the most frequent finding in term and preterm children, but was more highly expressed in preterm children (P < 0.05). White-matter damage was more often found in preterm children (P < 0.05). Enlargement of the lateral ventricles and periventricular leukomalacia may be attributable to ischemic damage to the neonatal brain. Significant correlations were found between magnetic resonance image findings and severity of cerebral palsy (P < 0.05). Detection of brain abnormalities in children with cerebral palsy may prove useful in prognoses as well as in medical consultations and management.     

Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

This study compared the efficacy of Adeli suit treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). Twenty-four children with CP, Levels II to IV according to the Gross Motor Function Classification System (GMFCS), were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12; eight males, four females; mean age 8.3 y [SD 2.0]), six children had spastic/ataxic diplegia, one triplegia and five spastic/mixed quadriplegia. In the NDT group (n=12; nine males, three females; mean age 8.1 y [SD 2.2]), five children had spastic diplegia and seven had spastic/mixed quadriplegia. Both groups were treated for 4 weeks (2 hours daily, 5 days per week, 20 sessions). To compare treatments, the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EIHB) during stair-climbing were measured at baseline, immediately after 1 month of treatment, and 10 months after baseline. The small but significant time effects for GMFM-66 and EIHB that were noted after 1 month of both intensive physiotherapy courses were greater than expected from natural maturation of children with CP at this age. Improvements in motor skills and their retention 9 months after treatment were not significantly different between the two treatment modes. Post hoc analysis indicated a greater increase in EIHB after 1 month (p=0.16) and 10 months (p=0.004) in AST than that in NDT, predominantly in the children with higher motor function (GMFCS Levels II and III). The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function.