Borowski Andrzej, Pruszczyński Błazej, Miller Freeman, Synder Marek
Klinika Ortopedii i Ortopedii Dzieciecej, Uniwersytet Medyczny w Łodzi.
Chir Narzadow Ruchu Ortop Pol. 2010 Sep-Oct;75(5):318-22.
Most common disorder in patients with cerebral palsy (CP) is spasticity. It is a result of non-progressing damage of Upper Motor Neuron system, causing imbalance signals, and consequently increasing muscle activity. Spasticity decreased activity of daily living of the patient and their caregivers. It may cause many medical and social problems. Baclofen is a synthetic analog of gamma-aminobutryacid, admistrated in intrathecal space by pump. It inhibits both monosynaptical and polisynaptical spinal reflexes. First time baclofen pump (ITB) were applied by Penn and Kroin in 1984 to treat spasticity. ITB is indicated in severe children cerebral palsy, especially in tetraparesis. The purpose of this study is attempt for objective and subjective evaluation of the quality of life after implantation of ITB.
In this research data of 161 children were analyzed with spastic tetraparesis (GMFCS V). Evaluation was based on an analysis of the quantity of additional surgical procedures before and after ITB implantation. Subjective assessment was made using questionnaires addressed to parents on fundamental aspects of everyday activities and quality of life after implantation of ITB. RESULTS. The average age AT the time of surgery was 12 year and 2 months (SD 4.7). The average follow up was 3 years and 2 months (SD 2.4). During ITB implantation additional surgical procedure were performed in 43% of Children. During the next scheduled ITB pump exchange indication to addictional surgical procedure was reduced to 20%. The average questionnaire score was 13 points (0-16 max.). Fifty eight percents of caregivers of children who had any kind of device related complication scored with average score 13.5.
脑性瘫痪（CP）患者中最常见的病症是痉挛。它是上运动神经元系统非进行性损伤的结果，导致信号失衡，进而增加肌肉活动。痉挛会降低患者及其照料者的日常生活活动能力。它可能引发许多医学和社会问题。巴氯芬是γ-氨基丁酸的合成类似物，通过泵注入鞘内空间。它抑制单突触和多突触脊髓反射。1984年，佩恩和克罗因首次应用巴氯芬泵（ITB）治疗痉挛。ITB适用于重度儿童脑性瘫痪，尤其是四肢瘫。本研究的目的是对ITB植入术后的生活质量进行客观和主观评估。
本研究分析了161例痉挛性四肢瘫（GMFCS V级）儿童的数据。评估基于对ITB植入前后额外外科手术数量的分析。通过向家长发放问卷，对ITB植入术后日常活动和生活质量的基本方面进行主观评估。结果：手术时的平均年龄为12岁2个月（标准差4.7）。平均随访时间为3年2个月（标准差2.4）。在ITB植入期间，43%的儿童进行了额外的外科手术。在下次计划的ITB泵更换时，需要额外外科手术的比例降至20%。问卷平均得分为13分（满分0 - 16分）。有任何与设备相关并发症的儿童的照料者中，58%的平均得分为13.5分。
1）ITB植入治疗重度CP儿童可改善其生活质量。2）接受ITB治疗的患者进行外科手术的指征减少。3）ITB植入与照料者的高满意度相关，因为有改善的潜力，然而必须考虑并发症。
