脑瘫

概述

脑瘫, 最常见的儿童身体残疾, 是由出生前还是婴儿期的大脑损伤引起的. People living with cerebral palsy can have neurological and musculoskeletal problems that affect posture, 感官知觉, 沟通, 运动及其他功能.

脑瘫:你需要知道的

  • Injuries to the brain before, during or after birth can cause cerebral palsy.
  • Symptoms of cerebral palsy are usually first noticed in infants and toddlers.
  • 几乎一半的脑瘫患儿会发展 高渗性 (过度的肌肉紧张)或 痉挛状态 (肌肉过度紧张，肌腱反射增加).
  • 目前还没有治愈脑瘫的方法, 但治疗可以解决相关的神经系统问题, 矫形和医疗条件.

什么是脑瘫?

脑瘫 (CP) is a condition that affects movement and muscle tone. 确切的原因, 在很多情况下, 是未知的, but the disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. 每1000个活产婴儿中约有3个患有CP.

什么导致脑瘫?

Several types of injuries can damage the parts of the brain that control motor function, 包括:

脑瘫的症状是什么?

患有CP的儿童通常在两岁前就表现出运动迟缓的迹象. CP通常直到2岁或3岁才被正式诊断出来. Babies with cerebral palsy are often slow to reach developmental milestones, 比如学会翻身, 坐, 爬或走. They may also have certain reflexes present that normally disappear in early infancy. 

CP的症状可能与其他疾病相似. Although each child exhibits a unique pattern of deficits, there are some common signs. 

You may notice that your child is showing exaggerated reflexes or floppiness in the trunk or limbs. 另一个迹象是 痉挛状态, which may show up as shaking or stiffness in the trunk, arms or  legs or clenched fists. Uncontrolled movements and abnormal gait may be part of the picture as well. 

Children with CP may have additional problems, 包括 the following:

脑瘫有哪些不同类型?

脑瘫 is classified according to which part of the body is affected. CP的痉挛表现为三种方式:

  • 痉挛性双侧瘫痪 腿部比手臂更重要. This type is more likely to affect babies born preterm, before 32 weeks.
  • 痉挛性四肢瘫痪 四肢或多或少都会受到影响. 足月或早产儿的CP可能是这种类型.
  • 痉挛性偏瘫 包括身体的一侧, and may occur in children who have had one or more bleeding episodes in the brain’s ventricles.

脑瘫治疗

目前还没有治愈CP的方法, but there are many treatment options to help with the problems associated with the condition.

巴氯芬—巴氯芬 is a muscle relaxant that can be given orally or directly into the cerebrospinal fluid in the spine through a baclofen pump surgically placed into the abdomen.

治疗性电刺激 —TES is a type of electrical stimulation that increases blood flow to weakened muscles.

选择性背根切断术(SDR) —Selective dorsal rhizotomy is a surgical procedure that involves cutting some of the lumbar and sacral sensory nerve fibers that come from the muscles and enter the spinal cord. The operation may reduce 痉挛状态 when used in conjunction with an intense course of physical therapy following surgery.

与脑瘫相关的骨科问题

髋关节发育不良

髋关节发育不良 is a deformity of the hip that can be found on one or both hips in children with an underlying neuromuscular condition such as CP. Increased or decreased tone in the muscles can lead to migration of the femoral head out of the hip socket, 需要额外处理, 如股骨近端截骨术或髋臼截骨术.

神经肌肉性脊柱侧弯

神经肌肉性脊柱侧弯 is a condition of the spine associated with an underlying neuromuscular condition, 比如脑瘫, 肌肉萎缩或脊髓损伤. 潜在的疾病通常会引起肌肉的变化, 使它们无法充分支撑脊柱. 这导致脊柱弯曲. 典型的表现是异常的S形或c形弯曲. The spine can also have rotation, creating a multidimensional curve. 弯曲可以是渐进的，尤其是在生长突增的时候. 治疗可能包括支具或脊柱融合手术.

马蹄内翻足(畸形足)

畸形足 常见于CP患儿. Due to muscle imbalance, the deformity can make weight-bearing activities challenging. Surgical procedures your doctor may recommend include split anterior tibial tendon transfer or calcaneal osteotomy

神经肌肉扁平足

This is a deformity of the foot due to an underlying neuromuscular condition. The abnormality of the muscles in the feet leads to a flat foot with minimal or no arch. This condition is commonly seen in children with hypotonia or low muscle tone. Braces or orthotic devices may provide arch support and decrease pain, 或者建议手术来解决这个问题.

脚趾行走

脚趾行走 is a condition in children with an underlying neuromuscular disorder that leads to high tone or muscle tightness in a child’s ankles, 并可能导致他们用脚趾或脚掌走路. 物理治疗是有益的, as can a series of casts that gradually repo坐ion the foot and ankle. Your doctor may recommend surgical lengthening of the Achilles tendon or gastrocnemius if these approaches are not effective.

肢长不等

肢长不等 is a difference in the lengths of a child’s lower extremities (legs). The difference in length can be found in children with hemiplegic CP. 对于腿长稍有差异的人，提鞋可能会有帮助. 对于更明显的差异, surgical treatment may be recommended to shorten the longer leg and provide more balance in leg length as your child grows.

扭转失调

Some children with CP develop an inward or outward twist in the bones of their lower extremities, 包括 胫骨内扭. 当过量时，它会干扰它们的步态模式. A surgical procedure called rotational osteotomy can correct the deformity.

肌肉挛缩

Children with a neuromuscular disorder can exhibit increased muscle tone that leads to a contracture of the muscle, 防止它很好地伸展. The hamstrings, adductors, hip flexors and gastrocnemii can be affected by contracture. 物理治疗, 支撑, botulinum injections or tendon lengthening surgery may be necessary to provide relief.

治疗，测试和疗法