偏瘫型脑瘫痉挛性下肢畸形治疗的实验研究

发布时间：2018-05-19 03:08

本文选题：脑瘫 + 偏瘫　；参考：《上海交通大学》2015年博士论文

【摘要】：目的(1)联合使用侧方录像和足底印记分析系统评价单侧L5神经根切断作为神经供体的安全性;(2)通过新生大鼠单侧大脑缺血-缺氧和对侧下肢制动,构建运动功能障碍和肌张力异常长期明显的偏瘫型脑瘫大鼠模型;(3)探讨通过患侧L5神经根切断和健侧L5神经根转位,治疗痉挛性偏瘫型大鼠的可行性;(4)比较脑瘫患者痉挛性腓肠肌挛缩松解术式的松解效果。方法(1)成年SD大鼠模拟椎管内L5神经根切断,通过侧方录像和足底印记系统对大鼠步态的时间和空间参数进行全面分析,评估是否会引起明显的运动功能障碍;(2)新生SD大鼠单侧大脑缺血-缺氧与对侧下肢制动分别或联合造模,评估和比较大鼠运动功能障碍和肌张力异常情况,以及功能障碍能否长期维持;(3)应用痉挛性偏瘫型脑瘫大鼠模型,进行单纯的患侧L5神经根切断,或患侧L5神经根切断联合健侧L5神经根的转位手术,评估术后运动功能和肌张力的变化;(4)模拟腓肠肌痉挛性马蹄足,比较腓肠肌的近端、中段及远端松解术对固定性畸形的疗效和松解后的稳定性。结果(1)侧方录像和足底印记系统对大鼠的足底步态参数和关节活动范围进行全面分析,一侧L5神经根切断后产生一过性的功能障碍,损伤后3个月时未见明显的功能异常;(2)新生SD大鼠单侧大脑缺血-缺氧与对侧下肢制动双因素造模后,可以产生长期、明显的痉挛性偏瘫表现,如主动活动障碍、肌张力异常增高等,比任一单因素造模症状更加明显;(3)在痉挛性偏瘫型脑瘫大鼠模型上,单纯患侧L5神经根切断后肌张力一过性的下降,后又逐渐恢复异常;患侧L5神经根切断联合健侧L5神经根转位后,患肢同侧运动皮层地图证实转位神经转导通路的形成,运动功能和电生理检查显示术后24周时患肢痉挛性、部分步态参数均有所改善,但仍存在部分肢体固定畸形;(4)痉挛性脑瘫常常存在腓肠肌的固定挛缩,远端腱膜切断术松解效果最好,但与肌内延长术式相比,松解后内在稳定性最低。结论(1)大鼠L5神经根切断对后肢运动步态未见明显的影响,进一步证实其作为下肢神经根供体的安全性。(2)新生大鼠单侧大脑缺血-缺氧联合对侧下肢制动,能够有效模拟痉挛性偏瘫型脑瘫患者的发病机制,存在长期的运动功能障碍和痉挛性肌张力异常;(3)在痉挛性偏瘫型脑瘫大鼠模型上,健侧L5神经根转位后患肢痉挛性异常得到缓解,发现患肢同侧大脑运动皮层对患肢有控制作用,患侧大鼠运动功能进一步改善,但依然残留马蹄足等固定畸形等。(4)对于脑瘫常伴的腓肠肌挛缩畸形,肌内延长术式松解效果良好,松解术后稳定性较高。
[Abstract]:Objective 1) to evaluate the safety of unilateral L5 nerve root transection as nerve donor using lateral video recording and plantar imprinting analysis system. To establish a model of hemiplegic cerebral palsy rats with abnormal motor function and muscular dystonia for a long period of time, we explored the transposition of L5 nerve root in the affected side and the transposition of the normal L5 nerve root in the affected side. The feasibility of treatment of spastic hemiplegic rats (4) the effect of spastic gastrocnemius contracture release was compared in patients with cerebral palsy. Methods 1) L5 nerve root transection was simulated in adult SD rats. Time and space parameters of rat gait were analyzed by lateral video recording and plantar imprinting system. To assess whether or not it would cause significant motor dysfunction) the neonatal SD rats were modeled separately or in combination with contralateral lower extremity immobilization with ischemia and hypoxia to assess and compare the motor dysfunction and muscular tension abnormalities in rats. The model of cerebral palsy rats with spastic hemiplegia was used to perform the transposition of L5 nerve root of the affected side, or the transposition of the L5 nerve root of the affected side combined with the normal L5 nerve root. To evaluate the changes of motor function and muscle tension after operation) to simulate the spastic foot of gastrocnemius and to compare the efficacy and stability of proximal, middle and distal decompression of gastrocnemius in the treatment of fixed deformities. Results 1) the lateral video recording and plantar imprinting system were used to analyze the gait parameters and the range of joint movement in rats. The unilateral L5 nerve root was cut off to produce transient dysfunction. 3 months after injury, no obvious functional abnormalities were found in neonatal SD rats. After modeling the two factors of cerebral ischemia and hypoxia and contralateral lower limb immobilization in neonatal SD rats, long-term and obvious symptoms of spastic hemiplegia, such as disturbance of active activity, were observed. The muscular tension was abnormally increased, which was more obvious than that of any single factor model. (3) on the model of spastic hemiplegic cerebral palsy, the myotonia of the affected side was temporarily decreased after L5 nerve root was transected, and then recovered gradually. The ipsilateral motor cortex map of the affected limb confirmed the formation of transposition nerve transduction pathway, motor function and electrophysiological examination showed spasticity at 24 weeks after the transposition of the affected L5 nerve root and the transposition of the contralateral L5 nerve root. Partial gait parameters were improved, but there were still some limb fixed deformities. 4) Fixed-contracture of gastrocnemius muscle was often found in spastic cerebral palsy. Distal aponeurotomy had the best release effect, but compared with intramuscular lengthening. The internal stability is the lowest after release. Conclusion (1) there is no significant effect of L5 nerve root transection on the motor gait of hind limb, and the safety of L5 nerve root donor is further confirmed. 2) the unilateral cerebral ischemia / hypoxia combined with contralateral lower limb immobilization is confirmed in neonatal rats. It can effectively simulate the pathogenesis of spastic hemiplegic cerebral palsy, and has long-term motor dysfunction and spastic dystonia in the rat model of spastic hemiplegia. The contralateral L5 nerve root transposition alleviated the spastic abnormality of the affected limb. It was found that the ipsilateral motor cortex of the affected limb could control the affected limb, and the motor function of the affected side of the rat was further improved. However, the residual equal-fixation deformity of horseshoe foot etc. 4) for gastrocnemius contracture deformity often accompanied by cerebral palsy, the effect of intramuscular lengthening release is good, and the stability is high after decompression.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R742.3;R726.5

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