摘要
目的:探讨腱部分松解术对脑损伤患者下肢挛缩或痉挛所导致的长期肢体运动功能静态或动态障碍的改善作用。方法:选择2002-03/2004-06在南京医科大学附属第一医院康复病区住院的脑损伤后下肢运动功能障碍患者10例,其中脑性瘫痪患者8例,外伤性脑损伤患者2例。术前进行2周至2个月康复治疗,在电诊断技术辅助下通过神经肌肉诊断阻滞方法判断下肢功能障碍的类型是动态痉挛还是静态挛缩占优势,然后确定手术方法与松解的具体肌群。手术选择在肌肉与肌腱移行部位横断,可延长2.0～3.0cm。术后矫形器外固定,并于3d后继续康复治疗,以牵伸为主,纠正站立或步态异常。所有患者入院时首先进行下肢各关键肌肌力、膝踝关节活动范围、改良Ashworth评定量表(评定痉挛状态,分6级,0～Ⅳ级分别表示无肌张力增高～强直)及10m步行时间的测量。术后1个月重复评定,并作前后对比。结果:10例患者全部进入结果分析,无脱落。7例脑性瘫痪患者跟腱部分松解术中距小腿(踝)关节背伸达5°～10°,术后均恢复步行,其中1例患者胫后肌腱手术切断,术后内翻明显改善。2例5次月国绳肌腱部分松解术患者,均达步行要求的静态膝关节被动活动范围。结论:上运动神经元损伤后下肢运动功能障碍在神经不能进一步恢复后,可采用神经骨科学手术方法行腱部分松解术。松解挛缩,改善肌痉挛,促进肢体被动与主动功能的恢复。
AIM：To investigate the role of partial tendon release in improving the lower limb contracture or spasm-induced long-term static or dynamic disorders of limbs＇ motor function in patients with brain injuries. METHODS：Ten inpatients with motor dysfunction of lower limbs after brain injuries,including 8 cases of cerebral palsy and 2 cases of traumatic brain injury,were selected from the Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University between March 2002 and June 2004.Before partial tendon release,the patients received rehabilitative treatment for 2 weeks to 2 months,whether dynamic contrature or static contracture was in advantage for the type of lower limbs＇ dysfunction was judged by means of neuromuscular blockade assisted by electrodiagnos-ic technique,and then the operative methods and the specific released muscle group were ascertained. The migrated site of muscle and muscle tendon was transected in the operation,it could be prolonged for 2.0-3.0 cm.After partial tendon release, external fixation with orthopedic instrument was performed,and the rehabilitative treatment was continued after 3 days,which was mainly stretching,standing and gait abnormalities were corrected.At admission, the key muscle force of lower limbs and ankle joint motion range were detected at first in all the patients,their spastic status was assessed with the modified Ashworth rating scale （6 grades,0- IV expressed no increase-stiff of muscular tension）, their 10 m walking time was also measured.They were evaluated again at 1 month after operation,the results were compared before and after operation. RESULTS：All the 10 patients were involved in the analysis of results. The extension of knee was about 0-5° in 7 patients of cerebral palsy in partial tendon release, walking was recovered after operation,including the posterior tibial muscle tendon was transected in 1 case,the inversion after operation was obviously improved.Two cases received partial popliteal tendon release all reached the static knee joint passive motion range required by walking. CONCLUSION：If the motor dysfunction of lower limbs cannot further recover after injury of upper motor neuron,the partial tendon release can be able to used by means of neurological orthopaedics,it can release contracture,improve muscular spasm, and accelerate the recovery of limbs＇passive and active functions.
出处
《中国临床康复》
CSCD
北大核心
2005年第33期32-33,共2页
Chinese Journal of Clinical Rehabilitation
