SPR配合矫形及康复治疗下肢痉挛性脑瘫的临床研究
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摘要
目的:观察伴有下肢畸形的痉挛性脑性瘫痪者行选择性脊神经后根切断术(selective posterior rhizolomy,SPR)+腘绳肌前置术并配合康复训练的疗效分析,探索治疗痉挛性脑瘫的有效途径,及分析矫形手术在该治疗体系中的必要性。
方法:采用的随机方法选择下肢痉挛型脑瘫患儿60例,其中男33例,女27例,年龄3-16岁,分成观察组:SPR手术配合康复治疗组(A)30例,SPR手术+腘绳肌前置配合康复治疗组(B)30例,平均随访1年～1.5年。采用刘小林等的脑瘫疗效评估标准,比较两组患者治疗后脑瘫分项功能及其下肢运动功能。
结果:SPR手术配合康复治疗组(A)与SPR手术+腘绳肌前置配合康复治疗组(B)治疗后在脑瘫分项功能评分方面有显著性差异(P＜0.05),有统计学意义,临床疗效有明显差异(P＜0.05),并且在kernig症阳性治愈情况、膝关节活动等方面有显著性差异(P＜0.05),具有统计学意义。在临床疗效有显著性差异(P＜0.05)有统计学意义。
结论:选择性脊神经后根切断结合腘绳肌前置术及功能康复训练能明显改善膝关节功能,是治疗伴有下肢畸形的痉挛性脑瘫的有效途径。
Objective: To study an effective therapy for spastic cerebral palsy(CP) with deformity of lower extremities by analyzing the efficacy of treatrnenl of selective posterior rhizolomy(SPR) , composite hamstring fore-lying and systematic Functional rehabilitation training in spastic CP patients accompanied with deformed lower extremities , and to analyze the essentiality of orthomorphia .
Method : 60 cases of Child Spastic Cerebral Palsy accompanied with deformed lower extremities(33 males and27 Females, aged 3 to 16 years old) are randomly divided into two groups, with 30 cases in the groups(A) treated by the therapy of selective posterior rhizolomy(SPR) combined with systematic Functional rehabilitation training, while 30 cases in the groups(B) treated by the therapy of selective posterior rhizolomy(SPR) combined with hamstring fore-lying and systematic Functional rehabilitation training , They were averagely followed-up for with 1 years to 1. 5 years. The scores of respective functlions of CP and the evaluation of respective clinical spasm of CP were compared between two groups after these treatment with the criterion of evaluation for efficacy of CP which was composed by Liu XL. et al and the founction of lower extremities.
Rusults: the group A, compared with the group B has remarkable difference on the evaluation of respective clinical spasm of CP (P<0.05).There has statistical significance. And the group A compared with the group B has remarkable difference on the respective of ameliorating rate of kernig'symptom and the motion of articular genu (P<0.05). There has statistical significance.
Conclusion: SPR combined with hamstring fore-lying and systematic Functional rehabilitation training can improve articular genu' founction. It is a effective therapy for the spastic CP patients with deformity of lower extremities.
方法:采用的随机方法选择下肢痉挛型脑瘫患儿60例,其中男33例,女27例,年龄3-16岁,分成观察组:SPR手术配合康复治疗组(A)30例,SPR手术+腘绳肌前置配合康复治疗组(B)30例,平均随访1年～1.5年。采用刘小林等的脑瘫疗效评估标准,比较两组患者治疗后脑瘫分项功能及其下肢运动功能。
结果:SPR手术配合康复治疗组(A)与SPR手术+腘绳肌前置配合康复治疗组(B)治疗后在脑瘫分项功能评分方面有显著性差异(P＜0.05),有统计学意义,临床疗效有明显差异(P＜0.05),并且在kernig症阳性治愈情况、膝关节活动等方面有显著性差异(P＜0.05),具有统计学意义。在临床疗效有显著性差异(P＜0.05)有统计学意义。
结论:选择性脊神经后根切断结合腘绳肌前置术及功能康复训练能明显改善膝关节功能,是治疗伴有下肢畸形的痉挛性脑瘫的有效途径。
Objective: To study an effective therapy for spastic cerebral palsy(CP) with deformity of lower extremities by analyzing the efficacy of treatrnenl of selective posterior rhizolomy(SPR) , composite hamstring fore-lying and systematic Functional rehabilitation training in spastic CP patients accompanied with deformed lower extremities , and to analyze the essentiality of orthomorphia .
Method : 60 cases of Child Spastic Cerebral Palsy accompanied with deformed lower extremities(33 males and27 Females, aged 3 to 16 years old) are randomly divided into two groups, with 30 cases in the groups(A) treated by the therapy of selective posterior rhizolomy(SPR) combined with systematic Functional rehabilitation training, while 30 cases in the groups(B) treated by the therapy of selective posterior rhizolomy(SPR) combined with hamstring fore-lying and systematic Functional rehabilitation training , They were averagely followed-up for with 1 years to 1. 5 years. The scores of respective functlions of CP and the evaluation of respective clinical spasm of CP were compared between two groups after these treatment with the criterion of evaluation for efficacy of CP which was composed by Liu XL. et al and the founction of lower extremities.
Rusults: the group A, compared with the group B has remarkable difference on the evaluation of respective clinical spasm of CP (P<0.05).There has statistical significance. And the group A compared with the group B has remarkable difference on the respective of ameliorating rate of kernig'symptom and the motion of articular genu (P<0.05). There has statistical significance.
Conclusion: SPR combined with hamstring fore-lying and systematic Functional rehabilitation training can improve articular genu' founction. It is a effective therapy for the spastic CP patients with deformity of lower extremities.
引文
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[5]王盈盈,周延安,黄永莲等,小儿脑瘫社区预防干预探讨[J],中国初级保健,2004,8(9);81-82。
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[9]7.林庆,李松,刘建蒙等.我国六省(区)小儿脑瘫患病率及临床类型的调查分析[J],中华儿科杂志,2001,39(10):613-615.
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