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[目的]2004年以来对重症脑瘫痉挛性双侧瘫治疗方法进行改进,探索提高其治疗效果的方法。[方法]23例重症脑瘫痉挛性双侧瘫。男14例,女9例;年龄3～12岁,平均5.7岁;主要症状:不能独自站立和行走,双下肢肌紧张,家长扶持站立,双下肢呈剪刀步态,双髋、膝关节屈曲,踝关节跖屈,双足马蹄内翻畸形,足尖着地行走。体格检查:双髂腰肌、内收肌、腘绳肌、小腿三头肌、胫前肌、胫后肌、长屈肌、趾长屈肌部分或多数不同程度肌张力增高。依Ashworth分级,为3～4级。治疗方法:对动态性肌痉挛,采用肌内肌腱切断或肌筋膜切断;对静态性肌痉挛行肌腱滑动延长,胫前肌腱劈开外侧1/2移位。然后用自制外固定器矫形固定,保持膝关节伸直,双踝、足中立位,双下肢外展30°,6周后去除外固定康复训练。[结果]本组病例随访1～3年,平均2.2年。优良21例,有效2例。[结论]严重脑瘫痉挛性双侧瘫,一期多关节软组织松解,肌力平衡,外固定矫形,术后配合家庭长期康复训练,是一种有效的治疗方法。
[Objective] To improve the treatment of spastic bipolar paralysis of severe cerebral palsy since 2004, and to explore ways to improve its curative effect. [Methods] Twenty-three cases of severe cerebral palsy with spastic bipolar disorder. 14 males and 9 females; aged 3 to 12 years old, an average of 5.7 years old; main symptoms: can not stand and walk alone, muscle weakness in both lower extremities, parents support standing, scissors gait in both lower extremities, double hip, knee flexion, Ankle plantar flexion, horseshoe crabs varus deformity, toe walking. Physical examination: double iliopsoas, adductor, hamstring, triceps, calf anterior tibialis, posterior tibialis muscle, long flexor, long flexor flexor muscle part or most of the degree of muscle tension increased. Graded by Ashworth, grade 3 to 4. Treatment: dynamic muscle spasm, the use of intramuscular tendon or myofascial cut off; static muscle spasm tendon slide extension, the anterior tibialis tendon cleft lateral 1/2 shift. Then use homemade external fixator orthopedic fixation, keep the knee straight, ankle, foot neutral position, lower extremities outreach 30 °, 6 weeks after the removal of external fixation rehabilitation training. [Results] This group of patients were followed up for 1 to 3 years, an average of 2.2 years. Excellent in 21 cases, effective in 2 cases. [Conclusion] Severe cerebral palsy is a kind of effective treatment method for spastic bipolar paralysis, primary polyarticular soft tissue loosening, balance of muscle strength, external fixation and orthopedics combined with long-term family rehabilitation training.