RU2804194C1 - Method for correcting spasticity in cerebral palsy - Google Patents

Abstract

FIELD: neurology.

SUBSTANCE: invention can be used to correct spasticity in cerebral palsy. The method involves making skin incisions up to 0.5 cm long under general anesthesia on the most affected upper or lower limb, outside the passage of the neurovascular bundle, and forming musculoskeletal canals by perforating the tubular bones of the thigh, leg and foot on the lower limb or shoulder, forearm and hands on the upper limb with penetration into the medullary canal. The size of the perforations varies from 1 to 5 mm, and the number of perforations is 30-35.

EFFECT: method ensures prevention of disability by activating the proprioceptor field of the limb, which stimulates brain neurons, forming new efferent connections.

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Description

The invention relates to the field of medicine, namely neurology, and can be used in the treatment of children with cerebral palsy.

As a result of spasticity, movement disorders develop that deform limbs and joints and prevent the child from moving normally.

Traditionally, physical therapy, massage, physiotherapy, botulinum therapy, Ulzibat myofibrotomy, selective dorsal rhizotomy, and installation of a baclofen pump are used to correct spasticity [1, 2, 3, 4, 5].

The technical problem solved by this invention is aimed at correcting spasticity, which prevents disability of a child with cerebral palsy.

This is achieved by the formation of percutaneous muscle-bone marrow canals along the thigh, leg and foot on the lower limb; shoulder, forearm and hand on the upper limb, which activates the proprioceptor field of the limb, stimulates brain neurons, forms new efferent connections, correcting spasticity in cerebral palsy.

The method is carried out as follows. Under general anesthesia, skin incisions up to 0.5 cm long are made on the upper or lower limb, outside the passage of the neurovascular bundle. Musculoskeletal canals are formed and tubular bones are perforated with penetration into the bone marrow canal. Perforation of the bones is carried out with an electric drill, the size of the milling holes varies from 1 mm to 5 mm, depending on the diameter of the tubular bone, the number of perforations is 30-35 and is determined by the long limb.

Example. In the clinic of the State Autonomous Healthcare Institution of the Amur Region “Amur Regional Children's Clinical Hospital”, a method for correcting spasticity in cerebral palsy was performed on 235 patients, from 1.5 to 25 years old. The results were assessed after 3 years. In all patients, spasticity was eliminated, the development of contractures and limb deformities was prevented, a stable gait was formed, close to normal, fine motor skills improved, and the quality of life increased.

The technical result of using the invention is that when forming transcutaneous muscle-bone marrow canals along the thigh, lower leg and foot on the lower limb; shoulder, forearm and hand on the upper limb, the proprioceptor field of the limb is activated, which stimulates the neurons of the brain, forms new efferent connections, correcting spasticity in cerebral palsy.

Clinical examples

1. Patient B., 1.5 years old. Diagnosis: Cerebral palsy. Lower spastic diplegia. Equinus feet. Inability to move independently. In order to correct spasticity, under general anesthesia, 32 mm long skin incisions were made along the thigh, leg and foot in the amount of 32. Musculoskeletal canals were formed and perforation of the femur, tibia, metatarsal bones and phalanges of the fingers of the right lower limb was made with milling holes with a diameter of 1.5 mm on the thigh and lower leg, 1 mm on the foot. Long-term result after 3 years: the lower limbs are symmetrical, complete regression of the equinus of the right foot. There are no restrictions on active movements in the knee and ankle joints.

2. Patient K., 15 years old. Diagnosis: Cerebral palsy. Left-sided spastic hemiparesis. Equinus of the left foot. In order to correct spasticity, under general anesthesia, 5 mm long skin incisions were made along the thigh, lower leg and foot in the amount of 34. Musculoskeletal canals were formed and perforation of the femur and tibia was made with milling holes with a diameter of 4 mm on the thigh and lower leg, 1.5 mm on the foot. Long-term result after 3 years: the lower limbs are symmetrical, complete regression of the equinus of the left foot. There are no restrictions on active movements in the knee and ankle joints.

3. Patient M., 7 years old. Diagnosis: Cerebral palsy. Left-sided spastic hemiparesis. Functional shortening of the left upper limb. In order to correct spasticity of the left upper limb, under general anesthesia, 3 mm long skin incisions were made along the shoulder, forearm and hand in the amount of 31. Musculoskeletal canals were formed and perforation of the humerus, ulna, radial metacarpal bones and phagang of the fingers was made with milling holes with a diameter of 2. 5 mm on the shoulder and forearm, 1.5 mm on the hand and phalanges of the fingers. Long-term result after 3 years: the upper limbs are symmetrical, there is no shortening of the left upper limb. There are no restrictions on active movements in the shoulder, elbow, or wrist joints.

Literature:

1. Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. Kyiv: Healthy. 1988. 328 p.

2. Baranov A.A., Namazova-Baranova L.S., Kurenkov A.L., Klochkova O.A., Karimova Kh.M., Mamedyarov A.M., Zherdev K.V., Kuzenkova L.M. ., Bursagova B.I. Comprehensive assessment of motor functions in patients with cerebral palsy: textbook. -method. allowance / Baranov A.A. [and etc.]; Federal state budgetary scientific institution Scientific children's health center. – M.: Pediatr, 2014. – 84 p.

3. Kurenkov, A.L., Batysheva, T.T., Vinogradov, A.V., Zyuzyaeva, E.K. Spasticity in cerebral palsy: diagnosis and treatment strategies / A.L. Kurenkov // Journal of Neurology and Psychiatry. - 2012. - vol. 7. - No. 2. — pp. 24-28.

4. Semenova K.A., Mastyukova E.M., Smuglin M.Ya. Clinic and rehabilitation therapy for cerebral palsy. M.: Medicine. 1972. 328 p.

5. Semenova K.A. Restorative treatment of children with perinatal damage to the nervous system and cerebral palsy. M.: - 2007.

Claims (1)

A method for correcting spasticity in cerebral palsy, including making skin incisions up to 0.5 cm long under general anesthesia on the most affected upper or lower limb, outside the passage of the neurovascular bundle, and forming musculoskeletal canals by perforating the tubular bones of the thigh, leg and foot on the lower limb or shoulder, forearm and hand on the upper limb with penetration into the medullary canal, while the size of the perforations varies from 1 to 5 mm, and the number of perforations is 30-35.