脑性瘫痪患儿下肢皮-肌反射变化研究

Study on cutaneomuscular reflex recorded in the lower limbs in children with cerebral palsy

目的观察脑性瘫痪患儿下肢皮－肌反射 (Cutaneomuscular Reflex,CMR)的异常改变，为临床诊断提供客观依据。方法对 40例 2～ 5岁脑性瘫痪患儿及 30例正常儿下肢 CMR进行检测。结果 (1)与对照组相比，痉挛型脑性瘫痪患儿 I1、 E2潜伏期延长 (P< 0.05)， E2/E1波幅比降低 (P< 0.05);E2和 I1＋ E2缺失率为 51.72％；痉挛型偏瘫患儿 CMR异常程度与临床偏瘫程度一致，轻重两侧间 E2潜伏期比较有差异 (P< 0.05)， E2/E1波幅比有显著差异 (P< 0.01);(2)与对照组相比，手足徐动型脑性瘫痪患儿 E2/E1波幅比增大 (P< 0.05)， E1波幅显著增高 (P< 0.01)。结论 (1)CMR异常改变提示痉挛型脑性瘫痪以运动皮层和锥体束损伤为主，手足徐动型脑性瘫痪以锥体外系损伤为主； (2)CMR可以作为脑性瘫痪临床诊断的客观依据。

Objective To observe the abnormal cutaneomuscular reflex(CMR) changes recorded in the lower limbs in children with cerebral palsy(CP),provide the basis for clinical diagnosis.Method CMR were recorded in the lower limbs in 40 cerebral palsy children and 30 normal children.Result Compar with the control group,the latency of I1 and E2 of spastic cerebral palsy prolonged(P< 0.05).The amplitude ratio of E2 and E1 reduced (P< 0.05).The absence rate of E2 and I1＋ E2 was 51.72％ .The abnormal degree of CMR in spastic hemiplegia child accorded with degree of clinical hemipligia.There were significant differences in the latency of E2 and the amplitude ratio of E2 and E! between the mild and severe side or side of health and sick in spastic hemiplegia (P< 0.05 and P< 0.01).Compared with the control group,the amplitude rate of E2 and E1 increased in athetoid cerebral palsy(P< 0.05). Conclusion It was suggested that the main damage of spastic cerebral palsy were motor cortex and pyramidal tract,the main lesion of athetoid cerebral palsy was extrapyramidal system.CMR was objective basis for diagnosis of cerebral palsy.