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目的 探讨痉挛性脑瘫感觉和运动能力障碍的特点与机制。方法 分析 10 2例痉挛性脑瘫患儿临床感觉和运动能力的观察结果。取材 2 5例痉挛性脑瘫的周围神经标本 40个 ,骨骼肌标本 5 4个 ,进行透射电镜观察。结果 本组临床资料可见 ,浅感觉—痛觉基本正常 ,深感觉—关节觉障碍明显 ;主动随意活动能力 ,上肢远端肌肉比近端肌肉减退明显 ,而下肢远近端差异不显著。电镜观察 ,周围神经呈原发性脱髓鞘表现 ,有髓纤维病变明显于无髓纤维 ;骨骼肌纤维亚显微结构Ⅰ型纤维表现突出。结论 痉挛性脑瘫有明显的深感觉障碍 ,而浅感觉基本正常 ,周围神经的病变可能是其原因之一。运动能力障碍 ,在运动精细肌群表现更明显。骨骼肌纤维构型 ,Ⅰ型纤维占优势 ,势必影响其收缩特性
Objective To investigate the characteristics and mechanism of the spastic cerebral palsy sensation and dyskinesia. Methods The clinical observation and exercise capacity of 102 children with spastic cerebral palsy were analyzed. Twenty-five peripheral nerve specimens of 25 patients with spastic cerebral palsy and 54 skeletal muscle specimens were collected and observed by transmission electron microscopy. Results The clinical data of this group showed that the superficial sensory-analgesic sensations were basically normal, the deep sensory-sympathetic sensations were obvious. The ability of voluntary activities was significantly lower than that of the proximal muscles of the upper extremity muscles, but not significantly different between the proximal and distal extremities. Electron microscopy showed that peripheral nerves showed primary demyelination and myelinated fiber lesions were obvious in nonmyelinated fibers. Subtype Ⅰ fibers of skeletal muscle fibers were prominent. Conclusions Spastic cerebral palsy has obvious deep sensory disturbances, while the shallow sensations are basically normal. Peripheral neuropathy may be one of the reasons. Movement disorders, the performance of fine muscles in the exercise more obvious. Skeletal muscle fiber configuration, type Ⅰ fiber dominant, is bound to affect the contraction characteristics