脑瘫患儿合并周围神经病变的回顾性分析

发布时间：2018-06-06 05:23

本文选题：儿童 + 脑性瘫痪　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：总结脑瘫患儿合并周围神经病变的特点,探讨其可能的机制。方法：选择2010年2月-2011年11月期间于重庆医科大学附属儿童医院康复科首次诊断为脑瘫的患儿70例,对其临床表现、周围电生理检测及神经系统影像学结果进行分析。结果： 1、70例患儿中周围神经传导异常的患儿有45例(60.0%),其中仅有9例(12.9%)表现为相应肢体肌张力降低伴腱反射减弱。 2、周围神经传导功能检测以F波或H反射的异常率最高(71.1%)。 3、周围运动神经的肌肉复合动作电位(CMAP)及周围感觉神经的动作电位(SNAP)的异常率(CMAP28.9%,SNAP44.4%)明显高于神经传导速度(MCV、SCV)及反应电位的远端潜伏期(DML)的异常率(MCV6.7%, SCV2.2%, MDML6.7%)。 4、脑白质髓鞘化延迟及脑室旁白质软化与周围神经传导速度降低存在相关性。结论：脑瘫患儿周围神经传导功能检测异常率高,但具备周围神经典型临床表现的患儿比例少,临床容易漏诊或误诊。F波和H反射可能是提示脑瘫患儿周围神经病变最灵敏的指标。周围神经病变的部位在神经的近段,并可能波及脊髓前角细胞。脑瘫患儿周围神经轴索病变较髓鞘病变严重。脑白质髓鞘化延迟或脑室旁白质软化的患儿其周围神经纤维与中枢神经纤维同时存在髓鞘病变现象。
[Abstract]:Objective: to summarize the characteristics of children with cerebral palsy complicated with peripheral neuropathy and to explore its possible mechanism. Methods: from February 2010 to November 2011, 70 children with cerebral palsy were first diagnosed as cerebral palsy in the Department of Rehabilitation, affiliated Children's Hospital of Chongqing Medical University. For its clinical manifestations, Results: (1) among 70 children with abnormal peripheral nerve conduction, 45 cases had abnormal peripheral nerve conduction, among which only 9 cases showed hypotonia of limbs and decreased tendon reflex. In peripheral nerve conduction function detection, the abnormal rate of F-wave or H-reflex was the highest (71.1%). 3. The abnormal rate of muscle compound action potential (CMAPP) of peripheral motor nerve and action potential of peripheral sensory nerve (SNAP) was significantly higher than that of nerve conduction velocity (MCV SCV) and nerve conduction velocity (MCV SCV). The abnormal rate of the distal latency and DMLs of the response potential was higher than that of MCV 6.7g, SCV2.2 and MDML6.70.There was a correlation between delayed myelination of the white matter and leukomalacia in the ventricle and the decrease of the conduction velocity of peripheral nerve. Conclusion: the abnormal rate of peripheral nerve conduction in children with cerebral palsy is higher than that in children with cerebral palsy. However, the proportion of children with typical clinical manifestations of peripheral nerve is small, and the clinical misdiagnosis of .F wave and H reflex may be the most sensitive indicators to suggest peripheral neuropathy in children with cerebral palsy. Peripheral neuropathy is located in the proximal segment of the nerve and may affect the anterior horn cells of the spinal cord. Peripheral nerve axonal lesion was more serious in children with cerebral palsy than that in myelin sheath. In children with delayed myelination or ventricular leukomalacia, myelin lesions were found in both peripheral nerve fibers and central nerve fibers.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.3

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