Cervical perivascular sympathectomy for the treatment of athetoid cerebral palsy / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively review the results of cervical perivascular sympathectomy (CPVS) in treating athetoid cerebral palsy and discuss the possible mechanism of the surgery.</p><p><b>METHODS</b>From 1998 to 2006,560 patients with athetoid cerebral palsy were treated with cervical perivascular sympathectomy and all had periodical follow-up at 1 week, 6 months and 1 year postoperatively. Among the 560 patients,there were 391 boys and 169 girls. The age at operation was from 3 to 25 years old with an average of 10.7 years.</p><p><b>RESULTS</b>At 1 year follow-up postoperatively, among the 560 cases, athetoid movement of the neck and head improved in 308 patients (55%), the movement of the hand and fingers improved in 403 patients (72%), standing and gait improved in 229 patients (41%), muscle tone reduced in 185 patients (33%), salvation reduction appeared in 252 patients (45%), eyeball movement improved in 174 patients (31%), speaking improved in 251 patients (45%); 310 patients (55%) agreed that the operation had curative effect for the patients. Short-term follow up results was better than long-term follow up results.</p><p><b>CONCLUSION</b>Primary results showed that CPVS had a curative effect on athetoid cerebral palsy, especially in improving athetoid movement of the neck and head, hand and fingers, standing and gait, speaking ability, eye-ball movement and so on. The possible mechanism of the CPVS in the treatment of athetoid cerebral palsy might be reducing the excitability of sympathetic nerve, improving microcirculation of the brain and eventually activating potential neurons. Long-term follow up is necessary.</p>

Application of intraoperative electrophysiological monitoring in lumbosacral selective posterior rhizotomy for spastic cerebral palsy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical application of intraoperative electrophysiological monitoring in lumbosacral selective posterior rhizotomy for spastic cerebral palsy.</p><p><b>METHODS</b>Total 372 dorsal roots of 89 patients underwent selective posterior rhizotomy at a single medical center. The dorsal roots from L3 to S1 were divided into rootlets and stimulated with a 1-second 50 Hz train. Motor responses were recorded by electromyography. Rootlets were assigned according to the extent of abnormal electrophysiological propagation, and grades of 3+ to 4+ were cut. If no electrical response was observed, the second criterion is the behavioral response (that is, muscle contraction in the legs or toes) assessed by the physical therapist, when rootlets were stimulated at the lowest threshold with a 1-second 50 Hz train.</p><p><b>RESULTS</b>The rootlets of 340 dorsal roots were assigned according to the extent of abnormal electrophysiological propagation, 324 (83.5%) roots were assigned the maximally abnormal response of grade 3+ (76, 22.4%) or 4+ (248, 72.9%) in EMG monitoring and were cut. For no electrical response was observed, according to the second criterion, 48 roots were partially cut. It was also be found that free running EMG occurred earlier than stimulus triggered EMG, and identified "abnormal" rootlets on free running EMG monitoring was more easily and quickly than on stimulus triggered EMG. During the postoperative 2 weeks in hospital, there was a significant decrease in lower-limb spasticity and an increase in range of movement in all patients, and no one case occurred obvious loss of muscle strength, abnormity of sensory, or deterioration of bladder/bowel control.</p><p><b>CONCLUSIONS</b>The spread of electromyography response to the contra lateral limb and/or upper extremity remains a valid criterion to define a "abnormal" posterior nerve rootlet that feeds into a disinhibited spinal circuit involved in uncontrolled spasticity. Intraoperative electrophysiological monitoring is reproducible and reliable for selection of "abnormal" rootlets.</p>

Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy for treating spastic cerebral paralysis of the upper limbs caused by cerebral palsy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy.</p><p><b>METHODS</b>From March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment.</p><p><b>RESULTS</b>All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P < 0.01).</p><p><b>CONCLUSION</b>Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy was used to treat spastic cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.</p>

Treatment of equinovarus caused by cerebral palsy with neurotomy of muscular branch of tibial nerve / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical effect of neurotomy of muscular branch of tibial nerve for the treatment of equinovarus caused by cerebral palsy.</p><p><b>METHODS</b>Fifty-two cases of equinovarus caused by cerebral palsy were treated with neurotomy of muscular branch of tibial nerve. The male was 33 (38 feet) and the female 19 (26 feet) with the average age of 7.8 years old (from 6 to 10). The muscular tension according to Ashworsh grade, 34 cases were grade III and 18 cases were grade IV. The ankle clonus was positive in 42 cases.</p><p><b>RESULTS</b>All cases were followed up for 1-3 years with the average of 2.6 years. The spastic gait of cases had obviously improved and abnormity had no recurred. According to corrective degree of abnormity and satisfactive condition of patients, evaluation of the effect were excellent in 32 cases, good in 14, poor in 6.</p><p><b>CONCLUSION</b>Neurotomy of muscular branch of tibial nerve is the safe and effective method for the treatment of equinovarus caused by cerebral palsy.</p>

Application of exercise therapy on rehabilitation after selective posterior rhizotomy (SPR) in children with cerebral palsy / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical effect of exercise therapy on rehabilitation after selective posterior rhizotomy (SPR) in children with cerebral palsy, so as to provide reliable rehabilitation method for children with cerebral palsy.</p><p><b>METHODS</b>Two hundred and twenty-six children with cerebral palsy were treated in the study during September 2003 to April 2007. All the patients were randomly divided into the training and control groups. There were 113 patients in the treatment group, including 66 males and 47 females, ranging in age from 3 to 8 years, with an average of (6.5 +/- 1.2) years, and the patients were treated with SPR as well as exercise therapy. Among 113 patients in the control group, 59 patients were male and 54 patients were female, ranging in age from 3 to 10 years, with an average of (6.9 +/- 1.5) years, and the patients were treated with SPR simply. Gross Motor Function Measure (GMFM), passive range of motion and muscle tension were used to evaluate therapeutic effects before and after treatment for both groups.</p><p><b>RESULTS</b>All the patients were followed up for 6 to 18 months (averaged 8 months). There were significant improvements in training group compared with the control group on GMFM (134.29 +/- 46.43, P < 0.05), passive range of motion (dorsiflexion of the ankle 14.2 +/- 3.1 degree, P < 0.05) and muscle tension (1.27 +/- 0.42, P < 0.05).</p><p><b>CONCLUSION</b>Physical therapy has more effective on rehabilitation after SPR for children with cerebral palsy, which can decrease spasticity and muscle tension and improve motor function.</p>

Ilizarov external fixator for the treatment of severe genuflex deformity in spastic cerebral palsy patients / 中国骨伤

<p><b>OBJECTIVE</b>To explore the application and efficacy of Ilizarov external fixator in the treatment of severe genuflex deformity in spastic cerebral palsy patients.</p><p><b>METHODS</b>The individualized Ilizarov external fixtor was designed to have two hinges posteriorly and one hinges anteriorly based on the tension-stress law. Distraction posteriorly and simutaneously compression anteriorly started 3 to 5 days after surgery. Extension on the flexion side was 2 mm every day. Check toe movement, wound and wire tension everyday. The deformity were corrected in 3 to 6 weeks. Then the fixator were kept in overextension of about 10 degrees for about 3 weeks before the Ilizarov external fixator were removed. The patients were encourged to start knee rehabilitation program and discharged. And a long leg brace was prescribed to wear while walking for 2 to 3 months.</p><p><b>RESULTS</b>The average genuflex deformity was (80.61 +/- 25.51) degrees preoperatively and (8.91 +/- 2.39) degrees postoperatively. The patients were followed up for 5 months, 21 of which got an excellent results, 4 joints had recurrence of the deformity with an average of (9.32 +/- 7.33) degrees.</p><p><b>CONCLUSION</b>The proper use of Ilizarov technique in the treatment of severe genuflex deformity in spastic cerebral palsy patients could get satisfactory results with few complications.</p>