【摘要】：目的：觀察選擇性頸段脊神經(jīng)后根切斷術(shù)治療腦性癱瘓患者上肢痙攣的療效。 方法：2008年5月至2013年6月,20例腦癱上肢痙攣患者接受選擇性頸段脊神經(jīng)后根切斷術(shù)治療,其中男14例,女6例；年齡8～22歲。手術(shù)方式為按一定節(jié)段,以一定比例將神經(jīng)刺激儀刺激后閾值低的神經(jīng)后根小束切斷。術(shù)后第一天(無(wú)明顯并發(fā)癥者)即開(kāi)始上肢的關(guān)節(jié)活動(dòng)、肌力訓(xùn)練,術(shù)后2周拆線并行系統(tǒng)的康復(fù)訓(xùn)練,上肢以作業(yè)療法(OT)訓(xùn)練為主。手術(shù)前后分別對(duì)肌張力、粗大運(yùn)動(dòng)功能(GMFM-88)、精細(xì)運(yùn)動(dòng)能力(FMFM)、功能獨(dú)立性(FIM)進(jìn)行評(píng)分 結(jié)果：20例均獲得術(shù)后6個(gè)月復(fù)診,術(shù)前、術(shù)后兩周及術(shù)后6個(gè)月的肌張力評(píng)分分別為4.20±0.41,1.50±0.60,1.60±0.59,術(shù)前、術(shù)后6個(gè)月GMFM-88評(píng)分分別為128.25±24.42,171.75±20.85；術(shù)前、術(shù)后6個(gè)月的FMFM評(píng)分分別為58.15±9.95,84.80±14.29；術(shù)前及術(shù)后6個(gè)月FIM評(píng)分分別為61.35±16.82,77.45±15.41；術(shù)后6個(gè)月患者的肌張力、粗大運(yùn)動(dòng)功能、精細(xì)運(yùn)動(dòng)能力和日常生活功能獨(dú)立性均有改善(P0.01) 結(jié)論：選擇性頸段脊神經(jīng)后根切斷術(shù)能降低患者的肌張力、緩解痙攣,能提高患者的運(yùn)動(dòng)功能和日常生活能力,治療腦癱上肢痙攣的短期療效肯定,遠(yuǎn)期療效需進(jìn)一步觀察。
[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 鹵0.41 鹵1.50 鹵0.601.60 鹵0.59 at two weeks after operation and six months after operation, and the GMFM-88 score was 128.25 鹵24.42171.75 鹵20.85 at 6 months before and 6 months after operation, and the FMFM score was 58.15 鹵9.95 鹵84.80 鹵14.29 before and 6 months after operation, respectively, and the FIM score was 61.35 鹵16.82 鹵77.45 鹵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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.3

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