脑性瘫痪动物模型的研究进展

脑性瘫痪（脑瘫）是导致儿童严重慢性残疾的重要原因。应用动物模型的目的是在动物身上复制一种或更多的脑瘫特征来进行研究,而这些模型和疾患本身一样是具有异质性的,如损伤发作的时间和机制（中风、感染、先天畸形或窒息）、损伤的靶点（白质或神经元）或功能结果等。该文对不同的脑瘫动物模型作一综述。     

脑性瘫痪动物模型的制作与鉴定研究进展

脑性瘫痪（脑瘫）是导致小儿神经系统伤残的主要疾病。脑瘫发病过程复杂,是多因素综合作用的结果,而目前尚未有获得公认的脑瘫动物模型。该文总结了近期国内外不同脑瘫动物模型：缺血缺氧因素、感染因素、高胆红素因素,并对不同模型之间的有效性进行了比较。其中缺血缺氧因素是目前应用及研究最多的因素,其他两个因素的研究尚处于萌芽阶段,有待于进一步地发展。     

肉毒毒素A注射治疗痉挛性脑性瘫痪的研究进展

肉毒毒素A作为小儿脑性瘫痪的一种新型辅助治疗药物,已越来越多的受到临床医师的关注。结合近几年来对该药不断深入的认识以及临床经验的总结,采用文献回顾的方法对该药的生物学特性、作用机制、临床应用等方面进行综述,以期为该药的合理应用提供帮助。     

生物电刺激治疗痉挛型脑性瘫痪的研究近况

脑性瘫痪(脑瘫)的治疗仍然是医学界的难题.痉挛型脑瘫肢体痉挛的病理机制在于大脑皮质运动区和锥体束损伤后对脊髓牵张反射的抑制障碍,导致肌肉被动牵张时速度依赖性抵抗力增加,肌张力增高致姿势异常、特殊步态,并有高致残率,严重影响了患儿的生活质量.临床上有很多以降低肌张力为主要治疗目的的治疗于段,如药物、康复治疗、理疗、针灸、推拿等,生物电刺激疗法是最近新兴的治疗手段,其疗效及机制尚在探索中,现对生物电刺激治疗痉挛型脑瘫近期研究进行综述.     

脑性瘫痪定义的演变

随着人类医学与文明的发展,在脑性瘫痪(cerebralpalsy,CP)的临床诊治、科学研究、信息交流和社会卫生保障等诸多领域,一个概念明确、广为接纳和标准一致的定义越来越显得重要。例如,目前已明确未成熟脑(immaturebrain)(早产儿)损害与成熟脑(1岁时脑外伤性硬膜外出血)损害无论发病机制、临床表现和综合处置的策略严格意义上是有区别的,对于不同历史时期的病例纳入标准若相差甚远,势必影响同一地区CP流行病学调查结果、潜在影响因素解释和今后策略制定等结论的可信度,更何况国家或地区间的对比;而在同学科不同学者、不同学科间,如若概念认识…     

脑性瘫痪合并癫癎

脑性瘫痪（简称脑瘫）是指发生在产前、围产期由多种原因引起的脑损伤,从而导致的非进行性中枢性运动障碍。严重的脑瘫可以合并癫■,智力迟缓,视力、听力等障碍。随着各项研究的开展,脑瘫合并癫■日益显示出自身的特点。本文将综述脑瘫合并癫■的流行状况、癫■的发作类型、影响因素、起病时间、两者的内在关联及其实验室检查特点,从而指导治疗、评估预后。     

经皮电神经刺激对痉挛型脑性瘫痪患儿运动功能影响的对照研究

目的观察经皮电神经刺激（TENS）结合功能训练对痉挛型脑性瘫痪（脑瘫）患儿运动功能的影响。方法78例脑瘫患儿,年龄36—58个月[（45．6±8．5）个月],通过计算机分层（性别、年龄）后随机分为TENS组（加例）和对照组（38例）。2组患儿均接受功能训练。TENS组使用2台TENS治疗仪（每台2个输出通道）,8个表面电极放在下肢痉挛肌群的两端肌腱和拮抗肌肌腹给予电刺激,每次20min。以上治疗每日1次,每周5次,共治疗30次。之后指导家长实施家庭康复治疗。治疗前,治疗后的6、12、24周随访时进行以下评定：①综合痉挛量表（CSS）,②粗大运动功能量表（GMFM）中的D和E两项,③步行速度。结果两组患儿的CSS评分、GMFM评分及步行速度治疗前差异无统计学意义（P〉0．05）,治疗后6、12、24周组内差异均有统计学意义（P均〈0．05）。2组患儿的CSS评分、GMFM评分及步行速度在治疗后6、12、24周组间差异均有统计学意义（治疗后24周：t值分别为8．96、3．14、2．35,P均〈0．05）。结论与对照组比较,在痉挛型脑瘫患儿的患侧肢体上给予TENS治疗6周,能明显降低息儿下肢痉挛,提高其站立、步行功能和步行速度。     

吡拉西坦治疗脑性瘫痪

脑性瘫痪(CP)是小儿大脑在尚未发育成熟阶段受到各种因素损伤后出现的以中枢性运动障碍和姿势异常为主要临床表现的一组综合征,是儿童时期主要的致残性疾病之一,治疗较为困难[1];我们在综合治疗的基础上,对44例患儿加吡拉西坦静脉滴注,并观察疗效,现报告如下.     

痉挛型脑性瘫痪患儿下肢H反射变化及其评价肢体痉挛的可靠性

目的探讨痉挛型脑性瘫痪(脑瘫)患儿下肢H反射变化及其评价肢体痉挛的可靠性,探讨痉挛型高肌张力定量评估的客观指标。方法选取本院2010年1月-2011年12月神经康复科收治的50例痉挛型脑瘫患儿为脑瘫组。男33例,女17例。另选取20例健康儿童作为健康对照组。男11例,女9例。应用美国Nicolet公司生产的VikingⅣD型肌电图仪进行H反射测定,对脑瘫组和健康对照组儿童H反射潜伏期、波幅及最大H波与最大M波百分比(Hmax/Mmax,H/M)进行比较。对脑瘫组患儿痉挛侧下肢进行改良综合痉挛量表(CSS)评分,并与H波幅、H/M值进行相关性分析。结果脑瘫组患儿H反射潜伏期为(18.87±2.94)ms,H波幅为(4.21±2.85)μV,H/M值为35.24±16.32;健康对照组儿童H反射潜伏期为(23.20±1.98)ms,H波幅为(2.34±1.53)μV,H/M值为14.23±6.36。脑瘫组患儿H波潜伏期缩短,H波幅增大,H/M值增高,与健康对照组比较差异均有统计学意义(Pa<0.05)。脑瘫组患儿下肢CSS评分为(7.75±2.27)分,与H波幅呈正相关(r=0.562,P<0.05),与H/M值亦呈显著正相关(r=0.904,P<0.01),其线性方程为Y=8.425X-30.021。结论 H反射可作为痉挛型脑瘫患儿痉挛下肢运动神经元兴奋性的量化指标。     

跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效

目的评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效。方法收集1998年5月-2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足。男28例45足,女25例40足;年龄2.5～14.0岁,平均6.8岁。痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足。患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形。合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正。结果患儿均获随访,随访时间0.5～11.2 a,平均2.3 a。1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降。53例85足均获满意疗效,优55足,良30足,优良率达100%。结论跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法。     

Casting Protocols Following BoNT-A Injections to Treat Spastic Hypertonia of the Triceps Surae in Children with Cerebral Palsy and Equinus Gait: A Randomized Controlled Trial

Aim: To study the effects of single versus serial casting post-Botulinum toxin A (BoNT-A) injections on hypoextensibility of triceps surae in children, 2–7 years old, with cerebral palsy and equinus gait. Methods: A randomized, stratified, parallel, two-group trial was conducted at a pediatric health center with assessments at baseline, precast, postcast and, 1-, 2-, and 6-month follow-ups. One week following BoNT-A injections into triceps surae muscle, a single below-knee cast (n = 10) or 3 serial casts (n = 10) were applied for 3 weeks. Primary outcome measure was the Modified Tardieu Scale (MTS), secondary outcome measures were Modified Ashworth Scale (MAS), GAITRite?, Gross Motor Function Measure-66 (GMFM-66), and Pediatric Evaluation of Disability Inventory (PEDI). Results: Significant effects of time, but not group-by-time, were found for MTS R1 (P < 0.001), MTS R2 (P < 0.001), MAS (P = 0.001), GMFM-66 (P = 0.002), and PEDI (P < 0.001–0.009). One participant who received a single cast did not complete the 6-month assessment. Conclusions: Magnitudes of improvements were similar using single or serial casting. If these findings are corroborated in a larger scale study, the recommendation of a single cast may be appropriate due to its greater convenience for families and clinicians.     

Stationary Cycling and Children with Cerebral Palsy: Case Reports for Two Participants

ABSTRACT

These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the cardiorespiratory phase. Average training heart rates were 59% and 35% of maximum heart rate for P1 and P2, respectively. Lower extremity peak knee flexor and extensor moments, gross motor function (Gross Motor Function Measure (GMFM-66)), preferred walking speed (thirty-second walk test), and walking endurance (600-yard walk-run test) were measured pre- and postintervention. Changes in outcome measurements corresponded with differences in exercise intensity. Greater gains in peak knee extensor moments, GMFM-66 scores (+4.2 versus +0.9), 600-yard walk-run test (?29% versus 0%) occurred for P1 versus P2, respectively. Preferred walking speeds did not increase substantially for P1 and decreased for P2.     

按摩疗法对痉挛型脑性瘫痪患儿运动功能动态变化的影响

目的探讨按摩疗法对痉挛型脑性瘫痪(CP)患儿运动功能和肌张力动态变化的影响。方法随机选择本院符合痉挛型CP诊断的54例住院患儿(男31例,女23例;平均年龄5.18岁),对其进行24周40 min.d-1的按摩疗法治疗,治疗过程未予药物及其他治疗。分析其运动功能的动态变化。采用SPSS11.01软件进行统计学分析。结果痉挛性CP患儿在24周的按摩过程中,基本粗大运动能力呈逐步提高趋势,治疗前后比较差异有统计学意义(P<0.01);按摩8周时,患儿臂近端的肌张力有轻-中度降低(P<0.05),而在14周时出现明显升高,与治疗8周时比较差异有统计学意义(P<0.05),但在18周时再次下降。同时在上、下肢的远端评价,下肢的近端评价中也出现类似情况;按摩4周时,患儿肌力有轻-中度降低,但按摩10周后均出现明显提高(P<0.05),按摩14周后,患儿颈、上肢近端和下肢近端的肌力也显著提高(P<0.05)。结论按摩疗法治疗可提高痉挛型CP患儿基本粗大运动能力,相应提高其生活能力。     

痉挛型脑性瘫痪儿童磁共振扩散张量成像研究

目的运用磁共振扩散张量成像(DTI)技术,研究痉挛型脑性瘫痪儿童锥体束的扩散特征。方法21例痉挛型脑瘫患儿和21例正常儿童进行DTI检查。采用Functool2和DTIStudio软件处理原始图像。采用脑白质纤维束示踪法显示三维锥体束,分别在大脑脚、内囊及放射冠层面测量患儿和正常儿童锥体束的平行于锥体束方向的扩散率(E0)、垂直于锥体束方向的平均扩散率(λT)、平均扩散系数(D)、部分各向异性值(FA)和相对各向异性值(RA)。用配对t检验统计方法检验脑瘫患儿锥体束与正常锥体束的各项指标差异有无显著性,并比较观察两组儿童的彩色FA图和三维彩色编码张量图。结果患儿组与对照组锥体束在大脑脚平面感兴趣区(ROI)的E0、λT、D、FA及RA值均无显著性差异,在内囊后肢平面两组ROI的E0、λT、D值无明显差异,但患儿组FA、RA值明显低于对照组;在放射冠平面两组ROI的各项测量值均有明显差异,患儿组E0、λT、D显著高于对照组,FA及RA值显著低于对照组。患儿组脑白质彩色FA图上红色及黄色区域较对照组减少。三维彩色编码张量图显示患儿组锥体束内囊后肢及放射冠脑白质颜色较为混杂,边缘不清。结论锥体束扩散率及各向异性指标结合彩色FA图及彩色编码张量图,可对痉挛型脑瘫患儿运动功能障碍做出客观评价。     

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

ABSTRACT

The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0–9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific “dosing” for standing programs to create long-lasting functional effects on gait.     

Changing Pattern of Cerebral Palsy in the Southwest Region of Finland

ABSTRACT. The prevalence of cerebral palsy (CP) increased significantly from 1968–72 to 1978–82 in the region of the University Central Hospital of Turku, Finland, from 1.6/1000 live births during the first five-year period to 2.5/1000 live births during the second. The increase was due to an increase of CP in low birthweight children ( p = 0.0002). The distribution of CP patterns did not change significantly. During the second period the diagnosis was made earlier in all groups (except that of spastic tetraplegia), though it reached statistical significance only in the hemi- and diplegic groups. While the perinatal mortality rate declined greatly during this period (especially in low birthweight groups), the increase in CP prevalence was due to increased survival rather than to a real change in prevalence. As a net gain, the decline resulted in an increased absolute figure in non-CP children, in spite of the rising prevalence of the disease.     

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。     

脑性瘫痪患儿150例血清TORCH抗体检测的意义

目的分析150例脑性瘫痪(脑瘫)患儿的TORCH抗体检测结果,为防治提供依据。方法对150例1个月~3岁脑瘫患儿采用间接酶联免疫吸附方法进行TORCH-IgG检测,1~6个月患儿同时检测TORCH-IgM。分析比较阳性与阴性患儿间的高危因素、脑瘫分型、并发症、头颅CT、脑干听觉诱发电位、眼底检查、脑电图等情况。结果共检测出TORCH-IgG阳性患儿58例(阳性率38.58%);阳性中以巨细胞病毒(CMV)为最常见,其次为弓形体(TOX);母子TORCH阳性符合率达85.71%。高危因素中阳性患儿以窒息、早产、黄疸、低体质量为多见,阴性患儿以窒息、早产、颅内出血为主。脑瘫分型在阳性患儿以痉挛型四肢瘫和偏瘫多见,而阴性患儿以痉挛性双瘫和偏瘫为多见。阳性患儿并发症较阴性患儿多,尤以智力低下为最明显。阳性患儿的头颅CT、脑干听觉诱发电位、眼底检查、脑电图异常率明显较阴性患儿高。结论TORCH感染是婴幼儿脑瘫的重要病因之一,对孕妇、新生儿及婴幼儿常规进行TORCH抗体检测是防治脑瘫发生的重要措施之一。