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SPR加矫正术和康复训练治疗无行走能力的重度脑瘫 |
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李贵涛 宁志杰 黄彦杰 李佩佳 罗永忠 常 辉
摘要 采用脊神经后根选择性切断术(SPR)加矫正和康复训练治疗重度脑瘫19例,随访半年~4.5年,有11例患者(57.9%)获得行走功能。结果:重度脑瘫患者行SPR加矫正和康复训练等综合治疗后仍有相当患者获优良效果。表明重度脑瘫SPR手术后必需辅以恰当的矫正术和复杂持久的康复训练。提示:康复训练是重度脑瘫患者功能改善的根本,而SPR手术只是降低肌张力的关键。SPR手术加矫正术和康复训练相结合为重度脑瘫的治疗提供了一条新途径。 关键词 脑瘫; 外科治疗; 康复训练
Selective Posterior Rhizotomy Combined Corrective Operation and Functional Training for the Treatment of Severely Cerebral Palsy- A Report of 19 Cases
Li Guitao, Ning Zhijie, Huang Yanjie, et al Department of Orthopedics, The 88th Hospital of PLA, Taian 271000
Abstract Nineteen severely spastic paralysis patients without the ability of walk were treated with selective posterior rhizotomy (SPR) combined corrective operation and functional training and followed up from 0.5 to 4.5 years. Eleven cases (57.9%) obtained the ability of walk. The results showed that some patients with severely cerebral palsy obtained satisfactory effects after the comprehensive treatment of SPR combined corrective operation and functional training. It was suggested that the patients treated with SPR needed corrective operation and good functional training yet. The functional training was the most important treatment for severely cerebral palsy to improve the ability of walk. SPR combined corrective operation and functional training was a new mode for the treatment of severely cerebral palsy. Key words cerebral palsy; surgical treatment; rehabilitaion training
脊神经后根选择性切断术(SPR)治疗痉挛性脑瘫是近年来的一项突破性进展。然而对重度的无行走能力的脑瘫患者行SPR争议较多[1]。究其原因,差别主要与病例选择、SPR治疗目的以及SPR术后是否坚持了严格而有效的矫正手术和康复训练有关。自1992年以来我们行SPR治疗93例患者,其中无行走能力的有27例,效果较满意。现将获得随访的19例介绍如下: 1 资料与方法 1.1 临床资料 全组19例,男13例,女6例。年龄最大24岁,最小6岁,平均11.5岁。随访时间最长4.5年,最短半年,平均1.8年。早产3例,难产(包括双胞胎)5例,脑炎或高热抽风3例,脑外伤2例,原因不明6例。术前所有患者均不能行走,其中14例坐不稳,肌张力明显增高。按改良Ashworth分级,肌张力3级2例,4级14例,5级3例。智力轻度低下7例,中度低下5例,重度低下5例,亚白痴2例。家庭背景为干部7例,工人8例,农民4例。有5例曾施行过内收肌、跟腱延长等软组织手术,效果差。 1.2 治疗方法 首先行SPR,术后1个月内辅以矫正手术8例[1] [2] 下一页 上一个医学论文: 波士顿诊断性失语症检查汉语版的信度 下一个医学论文: 现代综合促进技术治疗急性脑卒中
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