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目的:探索选择性脊神经后根切断术(selective posterior rhizotomy,SPR)、外周神经缩窄术、下肢矫形术加康复个性化的组合方式对痉挛性脑瘫的疗效,寻找最佳的综合治疗方案。方法:对2007.2到2008.11期间32例痉挛性脑瘫患者,男24例,女8例,平均年龄7.1岁,完成手术加康复的分段梯度疗法,采用自身前后对照研究。进行治疗前、治疗后脑瘫分项功能评分和脑瘫痉挛临床分项评估以及肌力评价及总体疗效评估。结果:梯度疗法治疗后,脑瘫分项中坐姿、躯干活动、蹲立变换分别是94%、91%和91%,均有显著性意义;踝阵挛和Babinski征改善率分别为97.2%和54%。脑瘫分项功能的评分的恢复率均在80%以上。全组疗效优18例(56.3%),良12例(37.5%),可2例(6.2%),优良率93.8%。结论:分度梯度疗法是治疗各种痉挛性脑瘫的有效途径。
Objective: To explore the curative effect of selective posterior rhizotomy (SPR), peripheral nerve narrowing, orthopedic surgery combined with rehabilitation and individualized combination on spastic cerebral palsy and to find out the best comprehensive treatment plan. Methods: From 2007.2 to 2008.11, 32 patients with spastic cerebral palsy, including 24 males and 8 females, with an average age of 7.1 years. They completed surgery plus rehabilitation of segmental gradient therapy and used self-control study. Before treatment, after treatment, cerebral palsy sub-item function score and cerebral palsy clinical sub-item evaluation and evaluation of muscle strength and overall efficacy evaluation. Results: After the gradient therapy, the subtypes of cerebral palsy were 94%, 91% and 91% of sitting posture, trunk activities and squatting changes, respectively, with significant significance; the improvement rates of ankle clonus and Babinski sign were 97.2% and 54 %. Cerebral palsy sub-item features the recovery rate of the scores are above 80%. Efficacy of the whole group was excellent in 18 cases (56.3%), good in 12 cases (37.5%), fair in 2 cases (6.2%), excellent and good rate of 93.8%. Conclusion: Gradient gradient therapy is an effective way to treat all kinds of spastic cerebral palsy.