痉挛性髋内收内收大肌肌纤维型转化超微损害及临床意义

痉挛性髋内收是脑性瘫痪、颅内感染、脑外伤等脑性疾病常见的后遗症 ,其原发病理损害在中枢神经系统 ,表现在相应的神经中枢所支配的大腿内收肌张力增高和痉挛性瘫痪。近年来 ,逐渐认识到除中枢神经系统病理改变外 ,受累的骨骼肌也有器质性病理改变[1] ,这些改变是影响远期治疗效果的重要因素之一。我们对 16例患脑性疾病痉挛性髋内收患者的内收大肌进行组织化学和超微结构研究 ,探讨这些痉挛性肌纤维的组织化学和肌内能量代谢损害对预后的影响 ,现报道如下。资料和方法一、材料标本取自 16例手术治疗的脑性疾病痉挛性髋内收畸形的内收大肌…     

脑瘫痉挛性马蹄足腓肠肌组织化学和超微结构观察

对２４个脑瘫痉挛性马蹄足经手术治疗后的腓肠肌标本进行肌球蛋白ＡＴＰ酶组化研究和超微结构观察。组织化学的主要改变是Ｉ型肌纤维（慢缩纤维）比例增多和Ｉ型肌纤维的聚集，全部标本均可见到超微结构异常。结果表明，脑瘫痉挛性马蹄足外科手术治疗远期效果不佳，除中枢神经系统失调外，还与腓肠肌肌纤维型转变有关。     

儿童痉挛性脑瘫治疗新进展

儿童痉挛性脑瘫治疗新进展王汉林，梁秋瑾综述１９９１年徐林等［１］在国内报道应用选择性脊神经后根切断术（ｓｅｌｅｃｔｉｖｅｐｅｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙ，ＳＰＲ）治疗痉挛性脑瘫，笔者１９９３年开展该手术取得良好效果，现就国内外ＳＰＲ动态和进展作一介...     

儿童轻度痉挛性脑瘫的治疗

80年代Peacock在美国开展了脊神经根切断术（SPR）手术［1,2］，90年代我国相继也开展了SPR术[3,4]，目前SPR手术已逐渐成为痉挛性脑瘫治疗的主流。如何治疗轻度脑瘫以及它的适应证，国内尚未见统一的认识，我院从1993年起开展SPR手术，已治疗轻度脑瘫32例，现报告如下。材料与     

内侧腘绳肌延长术对痉挛性双侧脑瘫步态的影响

目的通过对随访5年的患儿进行术前和术后临床比较分析,评价内侧腘绳肌延长术对双侧痉挛性脑瘫步态的影响。方法将双侧痉挛性脑瘫患儿分为二组,一组为髂腰肌挛缩组,即内侧腘绳肌延长,股直肌远端转位加腰肌切断术。另一组为髂腰肌无挛缩组,即内侧腘绳肌延长,股直肌远端转位术。利用标准的体检,对二组患儿术前和术后下肢关节活动范围、肌力、腘窝角和Thom-as试验进行检查,并对比分析。结果髂腰肌挛缩组术后伸髋肌肌力与髂腰肌无挛缩组比较明显减弱,分别为(3.8±0.5)和(4.8±0.4)(P=0.006),Thomas试验髋屈曲角度增大,分别为(15.0°±16.8°)和(1.5°±2.4°)(P=0.008),并出现膝反屈趋势。结论表明对屈髖肌挛缩的蹲伏步态患儿,不适宜作腘绳肌延长术。可行腰肌切断术纠正骨盆过度前倾及髋关节屈曲挛缩畸形。无屈髋肌挛缩的蹲伏步态患儿,行内侧腘绳肌延长加股直肌转位术,并可避免单纯腘绳肌延长术带来的僵膝步态。     

痉挛性脑瘫髋关节发育异常的外科治疗

脑性瘫痪简称脑瘫,是目前导致全世界儿童肢体残疾的主要疾病之一.痉挛性脑瘫以锥体系受损为主,继发性肌肉骨骼问题已成为其研究热点,其中髋关节发育不良及髋关节脱位在行走不能及严重型痉挛性脑瘫患儿中发生率越来越高.患儿出生时髋关节一般正常,约2岁左右开始出现股骨头外侧偏移为特征的髋关节发育不良,约4～12岁可发展为髋关节半脱位或脱位,约25％～75％的病例最终进展为影响日常生活的疼痛性、退行性髋关节炎.外科手术治疗配合系统的康复训练,可以改善痉挛性脑瘫儿童的步态和姿势,维持髋关节功能,提高其生活质量和社会参与度.本文就痉挛性脑瘫继发髋关节发育异常的术前评估、外科手术方式的选择、预后等研究进展进行综述.     

肌电图引导下不同剂量肉毒素治疗痉挛性脑瘫的疗效观察

目的观察肌电图引导下靶肌肉注射不同剂量A型肉毒素(BTX-A)治疗儿童痉挛型脑瘫疗效。方法选择痉挛性脑瘫病例90例,分为3组,肌电图引导下定位,BTX-A痉挛肌肉局部注射,A组3 U/kg,B组4 U/kg,C组5 U/kg。注射后配合康复训练,采用粗大运动评价量表(GMFM)评价患儿功能区的运动功能,采用改良Ashworth痉挛量表评价肌痉挛程度,随访1、2、3个月的疗效。结果各组治疗后GMFM评分增加,Ashworth分级减轻与治疗前比较差异有统计学意义(P均<0.05);但不同剂量BTX-A组在治疗后的GMFM评分、Ashworth分级各组差异无统计学意义(P均>0.05)。结论肌电图定位下BTX-A剂量在3～5 U/kg之间治疗后各项疗效指标改善,不同剂量疗效差异无统计学意义。     

股骨近端外旋截骨矫治脑瘫所致儿童下肢严重内旋畸形

目的：回顾性分析股骨近端外旋截骨矫治儿童痉挛型脑性瘫痪引起的严重下肢内旋畸形,评价其近期临床疗效,探讨该方法的适应证。方法2009年6月至2013年6月,我们共收治17例（26肢）严重下肢内旋畸形的痉挛型脑性瘫痪而能独立行走的儿童,男11例（19肢）,女6例（7肢）;年龄7．5～16岁（平均11．8岁）,行股骨近端外旋（25°～40°,平均32．5°）截骨,结合挛缩肌腱松解手术,5例7髋合并髋关节半脱位的患儿同时行内翻截骨。6周后去除石膏外固定,行功能康复训练。结果17例患儿接受为期6～42个月（平均26个月）随访,经步态观察、肌张力测定,站立位髋关节内旋角度、髋关节旋转角度测量及X线影像学评估,发现所有患儿下肢内旋情况及步态明显改善,关节功能较术前明显好转,影像学检查提示截骨处愈合良好,前倾角减小,髋关节趋于稳定。结论对于严重下肢内旋畸形的较大年龄痉挛型脑瘫患儿,尤其是合并髋关节脱位、半脱位者,采用股骨近端外旋或外旋内翻截骨的方法矫治,可有效矫正痉挛内旋步态,改善肢体力线,近期效果肯定,值得临床选择性应用。     

引导式教育结合Frenkel训练法对脑瘫患儿平衡功能的疗效研究

目的：探索引导式教育结合Frenkel训练法对脑瘫患儿平衡功能的治疗效果。方法：脑性瘫痪患儿115例,随机分为常规组和引导式教育结合Frenkel训练法治疗组,常规组采用常规平衡训练方法,治疗组采用引导式教育结合Frenkel训练法,两组其他康复治疗相同。由专人对患儿的社会适应性行为评定ADL量表和GMFM 运动疗效评定量表中平衡项目量表的平衡功能进行评定。结果：常规组和引导式教育结合Frenkel训练法组治疗后ADL评分和GMFM88平衡评分与治疗前相比有显著变化,评分普遍增高,且引导式教育结合Frenkel训练法组ADL评分和GMFM88平衡评分分别高于常规组,差异均具有显著性(t=3.09,P<0.05; t=2.91,P<0.05)。结论：引导式教育结合Frenkel训练法治疗可更加有效地提高对脑瘫患儿平衡功能障碍的训练效果。［中国当代儿科杂志,2009,11（3）：207-209］     

右美托咪定用于小儿脑瘫选择性脊神经后根切断术麻醉的研究

目的观察右美托咪定用于4,JL脑瘫选择性脊神经后根切断术麻醉的效果。方法选择30例行选择性脊神经后根切断术的患儿,随机分为右美托咪定组和对照组,每组15例,右美托咪定组于术中按0．2μg·kg^-1·h^-1持续泵人右美托咪定。两组术中麻醉维持按瑞芬太尼0．1～0．3μg·kg^-1·min^-1、丙泊酚2—6mg·kg^-1·h^-1持续泵人。记录两组不同时段SBP、HR、BIS、PETcO：,记录术中电刺激进行肌电（EMG）监测时患儿体动发生例数、术后躁动例数。结果右美托咪定组EMG监测时HR低于对照组,术中EMG监测时体动例数（0）及术后躁动例数（6．7％）少于对照组（13．3％,13．3％）。结论右美托咪定用于小儿脑瘫选择性脊神经后根切断术的麻醉维持,可使患儿术中生命体征更平稳,减少术后躁动发生。     

Utility of brainstem auditory evoked potentials in children with spastic cerebral palsy

In a retrospective study of 75 children with spastic cerebral palsy (CP), brainstem auditory evoked potentials (BAEP) were recorded and subsequently correlated with birthweight, gestational age, aetiology and type of CP, neuroradiological findings, additional impairments and disabilities (including the inability to walk independently). Seventeen patients (22.7%) had abnormal BAEP recordings. Thirteen of these 17 patients (76.5%) had spastic tetraplegia, 16 patients (94.1%) were full-term infants, 12 patients (70.6%) had myoskeletal problems, 9 (52.9%) had epilepsy, 16 (94.1%) had visual impairment, 13 patients (76.5%) were unable to walk independently, while all 17 patients (100%) had speech impairment and mental retardation. The aetiology of CP was prenatal in 2 of these 17 patients (11.8%) and perinatal in 15 patients (88.2%). Thirteen patients (76.5%) had cortical atrophy determined by either computed tomography or magnetic resonance imaging, two patients (11.8%) had an infarct picture and two patients (11.8%) had maldevelopment of the central nervous system. There was a definite statistically significant association between abnormal BAEP recordings and full-term delivery, perinatal aetiology of CP, spastic tetraplegia, speech, visual and myoskeletal impairments, epilepsy, mental retardation, inability to walk independently and cortical atrophy on neuroimaging (p < 0.001). We conclude that abnormal BAEP recordings in children with spastic CP are indicative of poor prognosis and associated with a "multihandicap state". BAEP testing should be incorporated into the diagnostic plan of all children with spastic CP newly referred to neurodevelopmental centres.     

CPIPS: musculoskeletal and hip surveillance for children with cerebral palsy

CPIPS (Cerebral Palsy Integrated Pathway Scotland) provides access for all children with cerebral palsy (CP) aged between 2 and 16 years in Scotland for a standardized musculoskeletal examination of the spine and lower limbs by paediatric physiotherapists. Children with more severe CP are at risk of developing a displaced hip joint which can become painful and interfere with seating and daily activities. Therefore all children also receive regular X-rays of their hips based on their age and severity of CP. CPIPS has been universally accepted and approved by the children, parents, carers and clinicians alike. It provides useful data on epidemiology, hip subluxation, physiotherapy participation and orthotic use as well as much more. It is already producing a significant improvement in hip displacement rates in Scotland. CPIPS has also greatly improved communication between community based care and hospital services. It is now fully embedded in the day to day care of these vulnerable children in Scotland and is now deemed essential in improving and maintaining their musculoskeletal health.     

Effects of forward tilted seating and foot-support on postural adjustments in children with spastic cerebral palsy: An EMG-study

ObjectiveTo evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching.DesignObservational study repeated-measures design; step two of two-step-project.SettingLaboratory unit within University Hospital and two special education schools.Participants19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6–12 years old). Participants were able to take part for one one-hour session.InterventionReaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order.Outcome measuresSimultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability.ResultsOnly foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01).ConclusionIn terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity.     

A comparative magnetic resonance imaging study of the corpus callosum in neurologically normal children and children with spastic diplegia

To determine the extent of brain damage in children with spastic diplegia, we analyzed the true midsagittal magnetic resonance imaging findings for the corpus callosum in 43 children with spastic diplegia and in 69 neurologically normal children. In the normal children, the thicknesses of the genu, midbody, splenium and the entire corpus callosum were found to increase with age, while the ratios of the thickness of the splenium and of the midbody to the length were constant, regardless of age. Both ratios were significantly reduced in diplegic children and the ratio for the splenium was highly correlated with the extent of motor impairment. Assessment of the morphometric changes in the corpus callosum using magnetic resonance imaging may contribute to the determination of the extent of brain damage in diplegic children.     

全身振动训练对痉挛型脑瘫患儿20例步行速度及粗大运动功能影响研究

目的 探究全身振动训练对痉挛型脑瘫患儿步行及粗大运动能力的影响.方法 选取2019年1月至2019年12月在上海市第一人民医院康复医学科门诊行康复治疗的痉挛型脑瘫患儿40例,随机(抛硬币法)分为试验组(全身振动训练结合常规康复治疗)20例,对照组(常规康复训练)20例.分别于干预前、干预12周后评估粗大运动功能评定(G...     

感觉统合训练对痉挛型脑瘫患儿步态影响的临床研究

目的观察感觉统合训练对痉挛型脑性瘫痪(简称脑瘫)患儿步态的影响,为脑瘫患儿提供更合理、有效的康复治疗方法。方法痉挛型脑瘫患儿64例,按性别、年龄、身高、体质量、临床分型及其移动能力进行配对分组。观察组和对照组各32例(双瘫22例,偏瘫10例)。观察组接受运动疗法、按摩、理疗等常规康复训练的同时配合每日1次共30 min的专业感觉统合训练,对照组只接受常规的康复训练,3个月为1个疗程。康复治疗前后采用足印法对所有受试对象进行步态分析。结果 (1)两组双瘫患儿两侧步行足长、步速较治疗前增大,步宽较治疗前减小,差异均有统计学意义(P<0.05,0.01);观察组两侧步行足长、步速较对照组增大,步宽较对照组减小,差异均有统计学意义(P<0.01);两侧站立足长在治疗前后比较和组间比较差异均无统计学意义(P>0.05)。(2)两组偏瘫患儿治疗后患侧步行足长较治疗前增大,观察组偏瘫患儿步宽较治疗前减少,差异均有统计学意义(P<0.05,0.01);观察组治疗后患侧步行足长、步速较对照组增大、步宽较对照组减少,差异有统计学意义(P<0.01);两组步速、对照组步宽较治疗前差异均无统计学意义(P>0.05),两侧站立足长、健...     

虚拟现实训练对痉挛型双瘫脑瘫患儿肢体运动功能的影响

目的 观察虚拟现实（VR）训练对痉挛型双瘫脑瘫患儿上肢精细运动和下肢粗大运动的影响。方法 选取痉挛型双瘫脑瘫患儿35 例,随机分为VR 训练组（n=19）和常规训练组（n=16）,常规训练组给予3 个月的常规运动疗法和作业疗法训练;VR 训练组给予3 个月的VR 训练和作业疗法训练。采用Peabody 运动发育量表的抓握、视觉-运动整合分测试对患儿治疗前后精细运动进行评价,采用88 项粗大运动功能量表（GMFM-88）的D 区及E 区、改良Ashworth 量表（MAS）、Berg 平衡量表（BBS）对患儿治疗前后粗大运动进行评价。结果 治疗前两组患儿抓握、视觉-运动整合、精细运动发育商、GMFM-88 之D 区、E 区评分、MAS评分、BBS 评分无明显差异（P > 0.05）;治疗后,VR 训练组抓握、视觉-运动整合、精细运动发育商、GMFM-88D 区评分、E 区评分、BBS 评分、MAS 评分较常规训练组明显改善（P 结论 VR 训练可有效提高痉挛型双瘫脑瘫患儿上肢精细运动功能和下肢粗大运动功能。