健侧颈7神经根移位治疗中枢性偏瘫患者相关腕关节痉挛畸形的生物力学改变与调控研究

The central nerve damage, which could be caused by stroke, traumatic brain injury or cerebral palsy, is one of the pathologies with highest disability rate. It often manifests as central hemiplegia, with severe spastic deformity in the wrist joint. Our previous studies have found that the contralateral cervical 7 nerve root transfer can connect undamaged hemicerebrum with spastic upper extremity to improve the upper extremity functions. The wrists with mild spasm got a better recovery than those with severe spasm. It is desiderated to explore a safe and effective method which could regulate the wrist from severe spasm to mild spasm. Tendon transfer procedures could be used in the correction of the deformity, which aimed to improve appearance and hand hygiene, rather than to modulate the wrist spastic to be more functional. The biomechanical model and experimental data is limited to be used as a reference for the application of tendon transfers in this kind of patients. This study intends to perform the biomechanical torque resistance test for the clinical central hemiplegia patients to get the parameters associated with wrist spasm. According to these parameters, the fresh frozen upper limb cadavers would be used to establish a biomechanical wrist spastic model, with which the correlations between wrist spastic and dynamic torque resistance, wrist intraarticular pressure were studied. Then, pronator teres transfer or flexor carpi ulnaris transfer were performed. The effectiveness was assessed with the test of dynamic torque resistance changing, while the safety was assessed with the test of wrist intraarticular pressure changing, to explore the regularity of applying these transfers in modifying wrist spasm, with which the contralateral cervical 7 nerve root transfer would be combined to develop a more effective comprehensive strategies to for the treatment of central hemiplegia.

中枢神经损害可由脑卒中、脑外伤或脑瘫引起，有极高致残率，常出现中枢性偏瘫，在腕关节表现为屈曲痉挛畸形。我们前期研究发现健侧颈7神经根移位术可连接健侧半球与瘫痪手从而改善上肢功能，对腕关节轻度痉挛疗效明显，对重度痉挛疗效则相对有限，临床急需将痉挛程度从重度调整为轻度的安全有效方式。肌腱移位是可行的整形手术方法，但既往主要用于改善外观及局部手卫生，对于调控为功能性手腕的研究极少，因而关于术式及参数选择尚无依据，需相应生物力学模型研究作为依据。本研究拟首先对临床中枢性偏瘫患者进行生物力学检测获得相关扭矩阻抗参数，再根据该参数用新鲜冰冻上肢标本建立腕关节重度痉挛模型，探明不同痉挛类型与动态扭矩阻抗、腕关节内压力之间的关系，然后在标本上进行肌腱移位术，以生物力学方法进行检测，掌握不同术式及参数对屈曲痉挛状态的调控规律，为临床上配合健侧颈7神经根移位术组成更有效的综合方案治疗中枢性偏瘫提供参考依据。

中枢神经损害可由脑卒中、脑外伤或脑瘫引起，有极高致残率，常出现中枢性偏瘫，在腕关节表现为屈曲痉挛畸形。我们前期研究发现健侧颈7神经根移位术可连接健侧半球与瘫痪手从而改善上肢功能，对腕关节轻度痉挛疗效明显，对重度痉挛疗效则相对有限，临床急需将痉挛程度从重度调整为轻度的安全有效方式。肌腱移位是可行的整形手术方法，但既往主要用于改善外观及局部手卫生，对于调控为功能性手腕的研究极少，因而关于术式及参数选择尚无依据，需相应生物力学模型研究作为依据。本研究通过对中枢性偏瘫患者的静态及动态扭矩阻抗检测，建立了腕关节痉挛生物力学实验室模型所需的与腕关节痉挛程度相关的生物力学参数。利用腕关节重度痉挛模型，比较了不同痉挛类型与动态扭矩阻抗、腕关节内压力、肌腱拉力之间的关系。利用腕关节屈腕旋前重度痉挛模型，进行旋前圆肌移位术、尺侧屈腕肌移位术后，比较腕关节痉挛程度发生的动态扭矩阻抗与关节压力等生物力学参数的变化，为临床上对于手术方法的选择与参数的制定提供参考依据。