Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Orthopaedics, The Royal Children's Hospital, Parkville, Victoria, Australia.
Curr Opin Pediatr. 2018 Feb;30(1):57-64. doi: 10.1097/MOP.0000000000000567.
The review provides an update on the treatment of hypertonia in cerebral palsy, including physical management, pharmacotherapy, neurosurgical, and orthopedic procedures.
Serial casting potentiates the effect of Botulinum neurotoxin A injections for spasticity. Deep brain stimulation, intraventricular baclofen, and ventral and dorsal rhizotomy are emerging tools for the treatment of dystonia and/or mixed tone. The long-term results of selective dorsal rhizotomy and the timing of orthopedic surgery represent recent advances in the surgical management of hypertonia.
Management of hypertonia in cerebral palsy targets the functional goals of the patient and caregiver. Treatment options are conceptualized as surgical or nonsurgical, focal or generalized, and reversible or irreversible. The role of pharmacologic therapies is to improve function and mitigate adverse effects. Further investigation, including clinical trials, is required to determine the role of deep brain stimulation, intraventricular baclofen, orthopedic procedures for dystonia, and rhizotomy.
本文就脑瘫患者的治疗进展进行综述，包括物理治疗、药物治疗、神经外科治疗和矫形手术等。
连续石膏固定可增强肉毒毒素 A 注射治疗痉挛的效果。深部脑刺激、脑室内巴氯芬、腹侧和背侧脊神经根切断术是治疗肌张力障碍和/或混合张力障碍的新兴工具。选择性脊神经后根切断术的长期疗效和矫形手术的时机是治疗脑瘫患者张力障碍的最新进展。
脑瘫患者的张力障碍管理以患者和照护者的功能目标为靶向。治疗方案包括手术或非手术、局灶性或全身性以及可逆或不可逆。药物治疗的作用是改善功能并减轻不良反应。需要进一步研究，包括临床试验，以确定深部脑刺激、脑室内巴氯芬、治疗肌张力障碍的矫形手术和脊神经根切断术的作用。
