Activated conduction by small incision and moderate stimulation for treatment of cerebral palsy in 182 cases

BACKGROUND： Intemationally, methods to treat cerebral palsy （CP） are basically the same, including correction of deformity with orthopaedic operation, selective posterior rhizotomy（SPR）, rehabilitation therapy and so on. Domestic methods to treat CP are basically close to the international methods. Traditional Chinese medical therapies, such as, acupuncture and moxibustion, acupoint injection, massage and so on, also have good curative effects. OBJECTIVE ： To observe the effect of activated conduction by small incision and moderate stimulation （ACSIMS） on limb function and living ability in patients with spastic CP at different degrees.DESIGN： Retrospective case analysis.SETTING： Department of Medical Education, Shanxi Medical College for Continuing Education.PARTICIPANTS ： A total of 182 patients with CP, including 97 males and 85 females, aged 3 to 23 years, who received treatment in Beijing Haidian District Diaoyutai Hospital during October 1996 to September 2005, were involved in this trial. The involved patients met the diagnostic criteria proposed in 2004 National Special Seminar of Cerebral Palsy. According to typing criteria of CP purposed in 1990 Brioni International Conference, the involved patients were typed： 117 with spastic CP, 14 with involuntary movement CP, 19 with defective coordination CP, 5 with hypotonia CP and 27 with mixed type CP. The guardians of underage patients and adult patients themselves were all informed of the therapeutic regimens. METHODS： ①According to CP typing assessment quantitative criteria of Li, the involved patients were assigned from limb position, daily living and movement 3 aspects： mild 23, moderate 75, severe 62 and extremely severe 22. ② Operation methods： The lower limb of moderate spastic CP patient was taken as an example. A median incision or paramedian incision was made between L2 and S1, and it was also the first incision in lower limb. The second incision was made at the center of buttock or at the midpoint of the line of sciatic tuber and greater trochanter. The third incision was determined according to the posture of shank of patients. The located region was locally anesthetized, then in which a small incision was made. Moderate stimulation was performed by a smooth mental instrument in muscular layer from different angles. Surgical catgut-embedding therapy was used after stimulation in CP patients who had hyperexplexia and obvious muscular atrophy. Anti-inflammatory was taken orally 3 to 5 days; physical treatment was daily conducted 10 to 15 minutes within 5 to 7 days, one course of treatment. Operation was needed once or twice in mild CP patients, twice or three times in moderate CP patients, three or four times in severe CP patients and three to five times in extremely severe CP patients. ③Assessment criteria of therapeutic effect of CP： cured, significantly effective, effective and non-effective based on a favorable tum in the limb position, daily living and movement 3 aspects. ④Chi-square test was used for difference comparison of enumeration data. MAIN OUTCOME MEASURES ： Comparison of therapeutic effect of patients with CP at different degrees after ACSIMS treatment.RESULTS ： Totally 182 CP patients were involved in the result analysis. ① Effective rate： ACSIMS had remarkably therapeutic effect in treatment of spastic CP. The effective rate of mild, moderate, severe and extremely severe CP was 100.0%, 97.3%, 95.2%, and 90.9%, respectively. The total effective rate reached 96.2%. The effective rate of CP at different degrees was close after treatment （P 〉 0.05）. ② Operation frequency： The mild patients began to recover within one to three days after one or two operations and moderate patients within one week to one month after two or three operations. After one to three times of treatments, the function of lower limbs of patients with mild or moderate CP was close to normal; After three to five times of operations, patients with severe or extremely severe CP began to recover within one week to three months, and their muscular tensions were decreased by one or two degrees, and walking was obviously improved as compared with preoperation. CONCLUSION ： ACSIMS has different therapeutic effects in treatment of spastic CP at different degrees. It can improve the limb function and daily living ability of CP patients. It needs fewer operations and has rapid response to treat mild CP with ACSIMS; on the contrary, it needs more operations and has slow response to treat severe CP with ACSMS.