选择性颈段脊神经后跟切断术治疗脑瘫上肢痉挛的临床观察

发布时间：2018-07-31 11:40

【摘要】：目的：观察选择性颈段脊神经后根切断术治疗脑性瘫痪患者上肢痉挛的疗效。方法：2008年5月至2013年6月,20例脑瘫上肢痉挛患者接受选择性颈段脊神经后根切断术治疗,其中男14例,女6例；年龄8～22岁。手术方式为按一定节段,以一定比例将神经刺激仪刺激后阈值低的神经后根小束切断。术后第一天(无明显并发症者)即开始上肢的关节活动、肌力训练,术后2周拆线并行系统的康复训练,上肢以作业疗法(OT)训练为主。手术前后分别对肌张力、粗大运动功能(GMFM-88)、精细运动能力(FMFM)、功能独立性(FIM)进行评分结果：20例均获得术后6个月复诊,术前、术后两周及术后6个月的肌张力评分分别为4.20±0.41,1.50±0.60,1.60±0.59,术前、术后6个月GMFM-88评分分别为128.25±24.42,171.75±20.85；术前、术后6个月的FMFM评分分别为58.15±9.95,84.80±14.29；术前及术后6个月FIM评分分别为61.35±16.82,77.45±15.41；术后6个月患者的肌张力、粗大运动功能、精细运动能力和日常生活功能独立性均有改善(P0.01) 结论：选择性颈段脊神经后根切断术能降低患者的肌张力、缓解痉挛,能提高患者的运动功能和日常生活能力,治疗脑瘫上肢痉挛的短期疗效肯定,远期疗效需进一步观察。
[Abstract]:Objective: to observe the effect of selective posterior rhizotomy of cervical spinal nerve on upper limb spasm in patients with cerebral palsy. Methods: from May 2008 to June 2013, 20 patients with upper limb spasm of cerebral palsy were treated with selective posterior rhizotomy of cervical spinal nerve, including 14 males and 6 females, aged 822 years. The method of operation was to cut the nerve posterior root bundles with low threshold after stimulation with a certain proportion according to a certain segment. On the first day of operation (without obvious complications), the joint movement and muscle strength training of the upper extremities were started, and the rehabilitation training was performed 2 weeks after the operation. The main training of the upper extremities was the (OT) training of occupational therapy. Muscle tension, gross motor function (GMFM-88), fine motor ability (FMFM),) functional independence (FIM) were evaluated before and after operation. The results showed that 20 cases were re-diagnosed 6 months after operation. The muscular tension score was 4.20 卤0.41 卤1.50 卤0.601.60 卤0.59 at two weeks after operation and six months after operation, and the GMFM-88 score was 128.25 卤24.42171.75 卤20.85 at 6 months before and 6 months after operation, and the FMFM score was 58.15 卤9.95 卤84.80 卤14.29 before and 6 months after operation, respectively, and the FIM score was 61.35 卤16.82 卤77.45 卤15.41 before and 6 months after operation. 6 months after operation, muscle tension, coarse motor function, fine motor ability and independence of daily living function were all improved (P0.01). Conclusion: selective posterior rhizotomy of cervical spinal nerve can reduce muscle tension and relieve spasm. It can improve the motor function and daily life ability of the patients, and the short-term curative effect of treating cerebral palsy upper limb spasm is certain, and the long-term effect needs further observation.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.3

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