不随意运动型脑性瘫痪患儿不同亚型运动功能预后回顾性分析.docVIP

不随意运动型脑性瘫痪患儿不同亚型运动功能预后回顾性分析 　【摘要】 目的 分析不随意运动型脑性瘫痪(简称脑瘫)患儿不同亚型运动功能预后。方法 回顾性调查46例不随意运动型脑瘫患儿的临床特点，对张力障碍型、舞蹈徐动型、徐动痉挛型3种不同亚型患儿脑瘫粗大运动功能分级系统(GMFCS)分级、粗大运动功能测试量表(GMFM88量表)评估结果进行分析。结果 舞蹈徐动型、张力障碍型、徐动痉挛型组间比较GMFCS级别差异有统计学意义，其中徐动痉挛型级别最低，舞蹈徐动型最高(F=71.596，Plt;0.001);徐动痉挛型在GMFM88量表各功能区均明显低于舞蹈徐动型(Plt;0.001);张力障碍型在站立位、行走与跑跳能区明显低于舞蹈徐动型(Plt;0.001)。结论 舞蹈徐动型脑瘫患儿多在4岁前获得自身行走能力，张力障碍型患儿部分可获得自身行走能力，徐动痉挛型患儿运动功能较其他类型明显落后，较难获得自身行走能力。 【关键词】 脑性瘫痪; 不随意运动型; 运动障碍; 儿童 　　【Abstract】 Objective To analyze the motor function and prognosis of different subtypes of dyskinetic cerebral palsy.Methods A retrospective survey of 46 cases of dyskinetic cerebral palsy who were treated in Nanhai Affiliated Maternity and Children Hospital of Guangzhou TCM University from January 2005 to October 2009 was carried out.Based on the clinical characteristics,all the patients were divided into 3 types:dystonic type,choreaathetoid type and athetoidspastic type.Files of GMFCS classification and GMFM88 assessment were collected and analyzed.Results There was significant difference of GMFCS levels among the 3 types.Choreaathetoid type had the highest level and the athetoidspastic type had the lowest(F=71.596,Plt;0.001).Each functional area of GMFM88 scale in athetoidspastic type was significantly lower than that of the Choreaathetoid type(Plt;0.001).The scale of standing position,walking,running and jumping area of dystonic type was significantly lower than that of Choreaathetoid type(Plt;0.001).Conclusions Most children of Choreaathetoid type can obtain their own walking ability before 4 years old.Some children of dystonic type can obtain their own walking ability.Children of athetoidspastic type have significant motor delay compared with other types and have difficulty in obtaining their own walking ability. 　　【Key Words】 Cerebral palsy; Dyskinetic; Motor dysfunction; Child 　　小儿脑性瘫痪(简称脑瘫)是继脊髓灰质炎后引致儿童肢体残疾的最重要疾病，严重影响着儿童的心身发育。不随意运动型脑瘫是锥体外系损伤引起的主要脑瘫类型，占各型脑瘫的20%～30%[1]。根据临床特点，可将不随意运动型脑瘫分为：张力障碍型、舞蹈徐动型、徐动痉挛型3种不同亚型，其临床表现依