本文選題：腦癱 + 偏癱　； 參考：《上海交通大學》2015年博士論文

【摘要】：目的(1)聯(lián)合使用側方錄像和足底印記分析系統(tǒng)評價單側L5神經(jīng)根切斷作為神經(jīng)供體的安全性;(2)通過新生大鼠單側大腦缺血-缺氧和對側下肢制動,構建運動功能障礙和肌張力異常長期明顯的偏癱型腦癱大鼠模型;(3)探討通過患側L5神經(jīng)根切斷和健側L5神經(jīng)根轉(zhuǎn)位,治療痙攣性偏癱型大鼠的可行性;(4)比較腦癱患者痙攣性腓腸肌攣縮松解術式的松解效果。方法(1)成年SD大鼠模擬椎管內(nèi)L5神經(jīng)根切斷,通過側方錄像和足底印記系統(tǒng)對大鼠步態(tài)的時間和空間參數(shù)進行全面分析,評估是否會引起明顯的運動功能障礙;(2)新生SD大鼠單側大腦缺血-缺氧與對側下肢制動分別或聯(lián)合造模,評估和比較大鼠運動功能障礙和肌張力異常情況,以及功能障礙能否長期維持;(3)應用痙攣性偏癱型腦癱大鼠模型,進行單純的患側L5神經(jīng)根切斷,或患側L5神經(jīng)根切斷聯(lián)合健側L5神經(jīng)根的轉(zhuǎn)位手術,評估術后運動功能和肌張力的變化;(4)模擬腓腸肌痙攣性馬蹄足,比較腓腸肌的近端、中段及遠端松解術對固定性畸形的療效和松解后的穩(wěn)定性。結果(1)側方錄像和足底印記系統(tǒng)對大鼠的足底步態(tài)參數(shù)和關節(jié)活動范圍進行全面分析,一側L5神經(jīng)根切斷后產(chǎn)生一過性的功能障礙,損傷后3個月時未見明顯的功能異常;(2)新生SD大鼠單側大腦缺血-缺氧與對側下肢制動雙因素造模后,可以產(chǎn)生長期、明顯的痙攣性偏癱表現(xiàn),如主動活動障礙、肌張力異常增高等,比任一單因素造模癥狀更加明顯;(3)在痙攣性偏癱型腦癱大鼠模型上,單純患側L5神經(jīng)根切斷后肌張力一過性的下降,后又逐漸恢復異常;患側L5神經(jīng)根切斷聯(lián)合健側L5神經(jīng)根轉(zhuǎn)位后,患肢同側運動皮層地圖證實轉(zhuǎn)位神經(jīng)轉(zhuǎn)導通路的形成,運動功能和電生理檢查顯示術后24周時患肢痙攣性、部分步態(tài)參數(shù)均有所改善,但仍存在部分肢體固定畸形;(4)痙攣性腦癱常常存在腓腸肌的固定攣縮,遠端腱膜切斷術松解效果最好,但與肌內(nèi)延長術式相比,松解后內(nèi)在穩(wěn)定性最低。結論(1)大鼠L5神經(jīng)根切斷對后肢運動步態(tài)未見明顯的影響,進一步證實其作為下肢神經(jīng)根供體的安全性。(2)新生大鼠單側大腦缺血-缺氧聯(lián)合對側下肢制動,能夠有效模擬痙攣性偏癱型腦癱患者的發(fā)病機制,存在長期的運動功能障礙和痙攣性肌張力異常;(3)在痙攣性偏癱型腦癱大鼠模型上,健側L5神經(jīng)根轉(zhuǎn)位后患肢痙攣性異常得到緩解,發(fā)現(xiàn)患肢同側大腦運動皮層對患肢有控制作用,患側大鼠運動功能進一步改善,但依然殘留馬蹄足等固定畸形等。(4)對于腦癱常伴的腓腸肌攣縮畸形,肌內(nèi)延長術式松解效果良好,松解術后穩(wěn)定性較高。
[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.
【學位授予單位】：上海交通大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R742.3;R726.5

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