神经干细胞治疗小儿脑性瘫痪的研究进展

背景：神经干细胞移植给小儿脑性瘫痪的治疗带来了可能。 目的：对国内外应用神经干细胞移植治疗的现状及新进展作一综述。 方法：应用计算机检索CNKI和Pubmed数据库中1999-01/2011-04关于神经干细胞移植治疗脑瘫的文章,在标题和摘要中以“脑瘫,神经干细胞,移植”或“cerebral palsy, neural stem cell, transplantation ”为检索词进行检索。选择文章内容与神经干细胞有关者,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到119篇文献,根据纳入标准选择关于神经干细胞移植治疗脑瘫的28篇文献进行综述。 结果与结论：神经干细胞特别是神经营养素3联合神经干细胞移植对小儿脑瘫的功能康复起着促进作用,给小儿脑瘫的今后的治疗指明了方向。      

脐血干细胞联合神经生长因子和物理康复治疗小儿脑性瘫痪

背景：干细胞局部移植可治疗神经系统疾病。 目的：观察脐血干细胞移植联合使用鼠神经生长因子及物理康复治疗小儿脑性瘫痪的临床效果。 方法：将90例小儿脑性瘫痪患儿根据是否接受干细胞治疗分为3组：脐血干细胞治疗组采用脐血干细胞+鼠神经生长因子+物理康复治疗,常规治疗组采用鼠神经生长因子+物理康复治疗,对照组未行有效治疗。 结果与结论：3组患儿入组前粗大运动功能测试量表各能区分值差异无显著性意义(P > 0.05)。治疗后3个月,脐血干细胞治疗组及常规治疗组粗大运动功能测试量表各能区中A、B、D能区分值较治疗前提高(P < 0.05),且脐血干细胞治疗组A、B能区分值均明显高于常规治疗组(P < 0.05),对照组粗大运动功能测试量表各能区分值无变化(P > 0.05)。表明脐血干细胞移植联合使用鼠神经生长因子、物理康复治疗治疗小儿脑瘫疗效优于鼠神经生长因子联合物理康复疗法。     

126例小儿脑性瘫痪病因分析及预防探讨

本文分析了１２６例小儿脑性瘫痪的病因，其中缺氧３８例，早产３３例，母亲因素１３例。患儿本身因素５例，遗传因素２例，原因不明３５例。并指出加强围产期保健，提高产科技术及重视产科与儿科合作是预防性脑性瘫痪的关键。     

小儿脑性瘫痪与先天畸形相关性研究

目的探讨小儿脑性瘫痪与先天畸形发生之间的关系。方法按照1:4比例随机抽取2000年1月～2004年12月200例脑性瘫痪住院患者和800例非脑性瘫痪住院患者进行先天畸形对照研究,分析先天畸形发生率。结果脑性瘫痪儿童先天畸形22例,发生率为110.00‰,非脑性瘫痪儿童先天畸形15例,发生率为18.75‰。结论脑性瘫痪儿童先天畸形发生率明显高于非脑性瘫痪儿童,先天畸形儿童应注意早期排除存在脑性瘫痪的可能。     

38例小儿脑性瘫痪临床分析

脑性瘫痪 (脑瘫 )是小儿时期严重影响身心健康的一种致残性疾病。近年来随着康复医学的不断发展 ,脑瘫的康复效果有所提高。我们于 1996年 6月 - 1999年 6月共收治脑瘫患儿 38例 ,现总结分析如下。临床资料1 一般资料 :本组男 2 4例 ,女 14例 ,城市 3例 ,乡镇 12例 ,农村 2 3例。年龄 :- 6个月 5例 ,- 1岁 7例 ,- 3岁 14例 ,- 7岁 12例。2 发病因素 :母妊娠早期反应重 3例 ,母亲患智力低下1例 ,母既往有流产史 4例 ,母有早产、死胎、死产史各 1例 ,母有妊娠高血压综合征 1例 ,母妊娠期有感染史 5例 (3个月内多次感冒 1例 )。出生时有窒息史…     

40例小儿脑性瘫痪TCD分析

小儿脑性瘫痪（脑瘫Cerebral palsy,CP）是一组包括多种大脑病变所致的自出生后就已存在的非进行性脑损伤,是小儿常见的致残性很高的疾病之一。现将2009．1～2010．6年采用TCD检查的资料数据完整的40例小儿脑性瘫痪病例,进行分析报告如下：     

小儿脑性瘫痪的早期症状研究

目的结合头颅CT检查分析小儿患者出现脑性瘫痪的早期症状,为临床诊治提供资料。方法本组抽取我院于2005年9月~2013年9月收治的脑性瘫痪小儿患者83例,对患者的病例资料作回顾性研究得出如下结论。结果本组83例患者,发现患者的临床症状表现为少量自主运动、运动功能受限、姿势异常、反应缓慢,分析头颅CT检查结果,发现大部分患者出现脑部异常,且颅内细胞受损较为严重。结论加强对脑性瘫痪患者的临床监护,分析患者早期症状,可为临床治疗提供依据。     

祖国医学气功治疗小儿脑性瘫痪

小儿脑性瘫痪是儿科的常见疾病．也是难治之症，近年来各地采用各种方法治疗小儿脑性瘫痪都收到不同程度的效果，尤其采用气功治疗具有无痛苦、疗效明显等优点、越丧越受到广大患者的关注，但对于其作用原理的研究则很少步见有报道，影响其发展。如此，我院自1992年开始采用少林内劲一指禅功法治疗小儿脑性瘫痪13例，并且对其作用机理进行了初步探讨，取得了一定效果，现总结分析如下。     

脐血干细胞移植与神经生长因子联合治疗小儿脑性瘫痪的安全性分析

背景：脐血干细胞移植联合神经生长因子治疗小儿脑性瘫痪是临床研究热点。 目的：分析脐血干细胞移植联合神经生长因子治疗小儿脑性瘫痪疗效及安全性。 方法：选取天津红桥医院儿科2011年11月至2013年2月收治的脑性瘫痪患儿80例,按治疗方法分别分为试验组(n=40)和对照组(n=40),分别接受脐血干细胞移植与神经生长因子联合治疗和单独神经生长因子治疗。 结果与结论：与治疗前相比,2组患儿治疗后脑性瘫痪综合功能评定表及粗大运动功能测量量表分值均有所提高(P < 0.05),且白细胞计数、中性粒细胞分数、总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶明显升高(P < 0.05),且试验组患儿的治疗效果优于对照组(P < 0.05)。所有患儿未见严重不良反应。说明脐血干细胞移植联合神经生长因子治疗小儿重症脑性瘫痪疗效显著,安全性高。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

气功治疗小儿脑性瘫痪的临床研究

气功治疗小儿脑性瘫痪的临床研究上海医科大学儿科医院（２０００３２）施炳培，卜怀娣，孙家娥上海交通大学人体科学研究室陈守勤，王忠良，沈汉昌小儿脑性瘫痪是儿科的常见疾病，是以大脑发育不全、智力低下、四肢运动障碍为主症，其生长发育明显落后于正常同龄儿童，在...     

注射用鼠神经生长因子联合利培酮治疗儿童孤独症的 临床疗效分析

目的 探讨注射用鼠神经生长因子联合利培酮治疗儿童孤独症的临床疗效。方法 选取我院小儿神经专科收治的65例儿童孤独症患儿,随机分为两组,对照组31例患儿单用利培酮治疗,治疗组34例患儿予注射用鼠神经生长因子联合利培酮治疗。所有患儿均在治疗前和治疗后3个月进行ABC量表、CARS量表评定,对比两组患儿量表评分情况及临床有效率。结果 治疗后,治疗组ABC量表中感觉能力、交往能力、运动能力、语言能力及自我照顾5项评分均优于对照组（P＜0.05）;对照组和治疗组CARS量表总分均比治疗前降低（P＜0.05）,治疗组与对照组相比,CARS量表总分降低更明显（P＜0.05）。治疗组临床有效率为94.11%,高于对照组的77.42%,差异具有统计学意义（P＜0.05）。结论 注射用鼠神经生长因子联合利培酮较利培酮单药治疗儿童孤独症疗效更佳,不良反应少。     

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

Assessed pain, anxiety, physical functioning, and cooperativenessin 32 childrenn with spastic cerebral palsy. This is the firststudy to assess children throughout rehabilitation followingselective posterior rhizotomy. Results of the ObservationalScale of Behavioral Distress and observer Likert ratings confirmedthe hypothesis that children's pain and anxiety decrease overtime. Children's physical functioning and cooperativeness improveover time. No significant correlation was found between painand changes in physical functioning. Cognitive impairment, parentalinvolvement, and children's pain behaviors explained 77% and56% of the variance in two forms of cooperativeness. Researchand clinical implications are discussed, and special considerationsregarding pain assessment and management in this populationare addressed     

Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

Purpose

The purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot.

Materials and Methods

Children in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments were performed before the intervention and 1 month after the intervention.

Results

After the intervention, there were significant improvements in tone, dynamic spasticity, and passive range of motion (ROM) in both groups. However, the changes were greater in group A than in group B. Dimension D (standing) in Gross Motor Function Measure (GMFM)-66 was significantly improved in group A but not in group B. On the other hand, there were no significant changes in di-mension E (walking, running, jumping) in GMFM-66 in either group.

Conclusion

The results of our study suggest that a serial casting application after BTX-A injection can enhance the benefits of BTX-A injection in children with cerebral palsy.     

穴位贴敷及穴位注射联合低频脉冲治疗肺癌患者化疗所致呕吐的临床观察

目的 观察涌泉穴穴位贴敷及足三里穴位注射联合内关穴低频脉冲治疗肺癌患者含顺铂方案化疗所致呕吐的有效性和安全性。方法 选择我院肿瘤科2017年1月~2019年1月的含有顺铂方案化疗的肺癌住院患者64例,随机分为治疗组和对照组,每组32例。对照组常规予以托烷司琼、地塞米松、甲氧氯普胺片止吐治疗方案;治疗组在对照组基础上,予以涌泉穴中药贴敷,足三里穴位注射,内关穴低频脉冲治疗。比较两组化疗后呕吐的次数、程度,进食量、体重、KPS评分、血液指标的变化,呕吐的有效控制率及不良反应。结果 治疗组重度呕吐的发生率（15.63%）低于对照组（40.63%）,差异有统计学意义（P＜0.05）。治疗组呕吐的有效控制率（87.50%）高于对照组（65.63%）,差异有统计学意义（P＜0.05）。治疗后治疗组进食量、KPS评分、血液指标的变化优于对照组,差异有统计学意义（P＜0.05）;治疗后两组患者体重变化比较,差异无统计学意义（P＞0.05）;两组不良反应均较轻,发生率比较,差异无统计学意义（P＞0.05）。结论 双侧涌泉穴中药贴敷,双侧足三里穴位注射,同时联合内关穴低频脉冲治疗肺癌患者含顺铂方案化疗所致的呕吐,其疗效确切,止吐效果明显,有助于改善患者的生活质量,保证化疗周期的完成,且该方法无明显不良反应,简便易行,值得临床应用。     

A Population-Based Analysis of Behavior Problems in Children with Cerebral Palsy

Used the National Health Interview Survey, Child Health Supplementfor 1981 and 1988, to analyze parent-reported behavior problemsof children, ages 4–17 years, with cerebral palsy (n =47), with mental retardation (n = 50), with other chronic conditions(n = 6,038), and with no known health problem (n = 5,930), usingthe Behavior Problem Index (developed by Zill & Peterson).Behaviors with scores greater than the 90th percentile of theentire sample were considered problem behaviors. Parent-reportedbehavior problems were 5 times more likely in children withcerebral palsy (25.5%) compared with children having no knownhealth problem (5.4%). The adjusted odds ratio for behaviorproblems of children with cerebral palsy without mental retardationwas 4.9 and of children with mental retardation without cerebralpalsy was 7.9. Specific behaviors that were most problematicfor children with cerebral palsy were identified as dependency,headstrong, and hyperactive.     

The Effect of Obturator Nerve Block on Hip Lateralization in Low Functioning Children with Spastic Cerebral Palsy

Purpose

Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP.

Materials and Methods

The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation.

Results

The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs.

Conclusion

ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.     

痉挛型脑瘫儿童步态运动学特征

目的基于步态分析方法研究痉挛型脑瘫儿童行走的运动学特征。方法应用便携式步态分析仪对16例痉挛型脑瘫儿童和16例健康儿童平地常速来回行走的步态进行测试,比较痉挛型脑瘫儿童患侧与健侧、痉挛型脑瘫儿童与健康儿童的步态差异。结果与健侧相比,痉挛型脑瘫儿童患侧单步时间、摆动时间和跖骨离地期显著长于健侧(P 0. 05),患侧步频、步速、支撑相末期显著低于健侧(P 0. 05)。痉挛型脑瘫儿童患侧步态周期时间、单步时间、站立时间、摆动时间、站立相所占百分比、支撑相中期、摆动前期和跖骨离地期相比于正常儿童均显著增加(P 0. 05)。痉挛型脑瘫儿童跨步长、步速、步频、支撑相末期相比于正常儿童均显著降低(P 0. 05),拔腿强度也降低(P=0. 05)。结论痉挛型脑瘫儿童行走时稳定性降低,其患侧单步时间、摆动时间、跖骨离地期和拔腿强度或许可以作为敏感指标应用于临床评估,指导脑瘫儿童的康复治疗。     

Multilevel Botulinum Toxin Type A as a Treatment for Spasticity in Children with Cerebral Palsy: A Retrospective Study

INTRODUCTION:

Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients.

OBJECTIVE:

The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients.

METHODS:

Data from 71 cerebral palsy patients (64% male, 36% female, mean age 6.7 ±3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM–88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months.

RESULTS:

We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments.

CONCLUSION:

We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy.     

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

Purpose

This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP).

Materials and Methods

Thirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection.

Results

The mean age of the subjects was 5.8 (±1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position.

Conclusion

Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.     

穴位注射配合自血疗法治疗慢性风疹59例

目的：研究穴位注射配合自血疗法在临床上治疗慢性风疹的疗效。方法对符合标准的59例患者采用本法治疗,共计3个疗程后观察疗效。结果痊愈28例、显效16例、有效10例,无效5例,总有效率达91.5豫。结论穴位注射配合自血疗法治疗慢性风疹,临床有效率较高,且无任何毒副作用,值得在临床推广。