选择性脊神经后根切断术改善脑瘫患者痉挛及粗大运动的临床观察
摘要点击次数: 10   全文下载次数: 0   投稿时间:2019-04-16  修订日期:2019-06-17  
作者Author单位AddressE-Mail
徐杰 xujie 北京中医药大学东直门医院 The Fourth Department of Orthopedics, Dongzhimen Hospital, Beijing University of Traditional Chinese medicine 1158095170@qq.com 
徐林 xulin 北京中医药大学东直门医院  
曾杰 zengjie 北京中医药大学东直门医院  
杨兴奎 yangxingkui 西安中医脑病医院  
李召辉 lizhaohui 西安中医脑病医院  
邵高凯 shaogaokai 西安中医脑病医院  
李筱叶 lixiaoye 北京中医药大学东直门医院  
邓博文 dengbowen 北京中医药大学东直门医院  
穆晓红* muxiaohong 北京中医药大学东直门医院 The Fourth Department of Orthopedics, Dongzhimen Hospital, Beijing University of Traditional Chinese medicine mxh__2004@163.com 
期刊信息:《中国骨伤》年,第卷,第期,第-页
DOI:
基金项目:国家自然科学基金项目(面上项目,重点项目,重大项目)
中文摘要:目的 探究腰骶段选择性脊神经后根切断术(SPR)对脑瘫患者的下肢痉挛状态及粗大运动功能的改善情况。方法 回顾性分析2018年1月至2018年10月分别采用单纯康复治疗和腰骶段SPR术结合康复治疗脑瘫患者各25例,根据是否行SPR腰骶段手术治疗分为A组和B组,A组则采用康复结合腰骶段SPR术治疗,B组采用单纯康复治疗。其中A组25例,男16例,女9例,平均年龄(7.08±3.1)岁;B组25例,男14例,女11例,平均年龄(6.84±3.1)岁。治疗前后对50例患者进行改良的Ashworth(MAS)评级及粗大运动功能评定量表(GMFM-88项)评分。对比治疗前后患者MAS分级及GMFM-88项评分变化以评价两组患者痉挛程度及粗大运动功能改善情况。结果 50例患者均得到随访。A组:入组患者的双侧膝关节及踝关节MAS分级在术后6月均有明显改善(P<0.01),髋关节MAS分级术后6月改善不明显(P>0.05)。入组患者术后6月的GMFM-88项评分较前明显改善,其中D区、E区及总分改善更为明显(P<0.01)。B组:部分患者在开始康复后6个月MAS评级改善明显,部分患者MAS评级改善不明显,双侧髋关节及双侧膝关节康复后MAS评级改善不明显(P>0.05),双踝关节MAS评级较康复前明显改善(P<0.01)。GMFM-88项评分较康复前有明显改善(P<0.05)。组间对照:A组MAS分级和GMFM-88项评分均明显优于B组(P<0.01)。结论 选择性脊神经后根切断术结合康复改善脑瘫患者下肢痉挛状态及粗大运动功能效果明显,能够有效促进脑瘫患儿下肢运动功能重建及恢复,值得进一步推广。
【关键词】选择性脊神经后根切断术  痉挛型脑性瘫痪  痉挛  粗大运动功能
 
Clinical observation of selective posterior rhizotomy for improving paralysis and gross movement in participants with cerebral palsy
ABSTRACT  ABSTRCTS Objective: To investigate the outcomes of lower extremity paralysis and gross motor function in participants with cerebral palsy after selective posterior rhizotomy. Methods: From January 2018 to October 2018,50 patients using pure rehabilitation or lumbosacral SPR combined with rehabilitation treatment were retrospectively reviewed.According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated by rehabilitation combined with SPR, and group B was treated by rehabilitation alone.There were 25 cases in group A, 16 males and 9 females, with an average age of (7.08±3.1) years; 25 cases in group B, 14 males and 11 females, with an average age of (6.84±3.1) years. The modified Ashworth (MAS) rating and gross motor function measure (GMFM-88 ) were applied to 50 patients before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups. Results: All 50 patients were followed up. Group A: The MAS grading of both knees and ankles improved significantly at 6 months after operation (P < 0.01), but the improvement of hip MAS grading was not significant at 6 months after operation (P > 0.05). The GMFM score of the patients in 6 months after operation was significantly improved, especially in area D、E and the total score (P < 0.01). Group B: The MAS rating of some patients in group A decreased in 6 months after rehabilitation, and the muscle tension of some patients did not improve significantly. The MAS rating of bilateral hip and knee joint did not improve significantly after rehabilitation (P > 0.05). The MAS rating of bilateral ankle joint improved significantly (P < 0.01). GMFM-88 scores were significantly improved compared with those before rehabilitation (P < 0.05). Inter-group control: MAS classification and GMFM-88 scores in group A were significantly better than those in group B (P < 0.01). Conclusion:Selective posterior rhizotomy combined with rehabilitation improves the lower extremity paralysis and gross motor function of children, which can effectively promote the reconstruction and recovery of lower limb motor function in patients with cerebral palsy.It is worth further promotion.
KEY WORDS  selective posterior rhizotomy  spastic cerebral palsy  sputum  gross motor function
 
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