中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2013年
3期
209-213
,共5页
于荣%王秀娟%孙殿荣%侯梅%王珂%赵建慧%李玉堂
于榮%王秀娟%孫殿榮%侯梅%王珂%趙建慧%李玉堂
우영%왕수연%손전영%후매%왕가%조건혜%리옥당
脑瘫%影像学%类型%粗大运动功能分级系统%癫痫%智力低下
腦癱%影像學%類型%粗大運動功能分級繫統%癲癇%智力低下
뇌탄%영상학%류형%조대운동공능분급계통%전간%지력저하
Cerebral palsy%Neuroimaging%Gross motor function classification system%Epilepsy%Mental retardation
目的 探讨脑瘫患儿影像学与临床病情的相关性.方法 采用回顾性研究对295例脑瘫患儿进行影像学分类、粗大运动功能分级系统(GMFCS)分级及智力测试,分析不同类型的影像学改变与脑瘫类型、GMFCS分级及伴随障碍间的相关性.结果 MRI提示影像学异常者257例(异常率87.1％),正常者38例(正常率12.9％),其中脑发育畸形11例,脑室周围白质软化(PVL) 173例,皮质-皮质下损伤17例,基底核区损伤26例,小脑发育不良11例,其它19例.GMFCS分级为I、Ⅱ、Ⅲ、Ⅳ、Ⅴ级的患儿比例分别为26.1％、18.0％、17.3％、18.6％、20.0％.脑发育畸形患儿中,痉挛型双侧瘫占81.8％;PVL患儿中痉挛型双侧瘫占84.4％;皮质-皮质下损伤患儿中痉挛型双侧瘫占47.1％,痉挛型偏瘫占41.2％;基底核区损伤患儿中不随意运动型脑瘫占76.9％;小脑发育不良患儿则全部表现为共济失调型脑瘫.GMFCS I-Ⅱ级者中,痉挛型偏瘫、痉挛型双侧瘫、不随意运动型脑瘫及共济失调型脑瘫的比例分别为81.5％、47.1％、25.0％和30.7％;GMFCSⅣ-Ⅴ级者中,上述各类型的比例分别为3.7％、33.5％、64.1％和46.2％.GMFCS I-Ⅱ级者中,MRI表现为脑发育畸形、PVL、皮质-皮质下损伤、基底核区损伤及小脑发育不良的患儿比例分别为9.1％、43.9％、58.8％、19.2％和27.3％;GMFCSⅣ-Ⅴ级者中,上述MRI表现的患儿比例分别为45.5％、34.7％、29.4％、73.1％和45.5％.脑发育畸形、皮质-皮质下损伤患儿中癫痫的发生率分别为36.4％和41.2％ (P＜0.01);脑发育畸形、皮质-皮质下损伤及小脑发育不良患儿中智力低下的发生率较高,分别为45.5％、41.2％和36.4％(P＜0.01).GMFCSⅣ-Ⅴ级患儿与GMFCS Ⅰ-Ⅱ级患儿相比,前者癫痫及智力低下的发生率高于后者(P＜0.05).结论 脑瘫患儿的影像学改变与脑瘫类型及GMFCS分级密切相关,脑发育畸形、皮质-皮质下损伤患儿的癫痫发生率高,脑发育畸形、皮质-皮质下损伤及小脑发育不良患儿的智力低下发生率较高,GMFCSⅣ-Ⅴ级患儿癫痫及智力低下的发生率高于GMFCS I-Ⅱ级患儿.
目的 探討腦癱患兒影像學與臨床病情的相關性.方法 採用迴顧性研究對295例腦癱患兒進行影像學分類、粗大運動功能分級繫統(GMFCS)分級及智力測試,分析不同類型的影像學改變與腦癱類型、GMFCS分級及伴隨障礙間的相關性.結果 MRI提示影像學異常者257例(異常率87.1％),正常者38例(正常率12.9％),其中腦髮育畸形11例,腦室週圍白質軟化(PVL) 173例,皮質-皮質下損傷17例,基底覈區損傷26例,小腦髮育不良11例,其它19例.GMFCS分級為I、Ⅱ、Ⅲ、Ⅳ、Ⅴ級的患兒比例分彆為26.1％、18.0％、17.3％、18.6％、20.0％.腦髮育畸形患兒中,痙攣型雙側癱佔81.8％;PVL患兒中痙攣型雙側癱佔84.4％;皮質-皮質下損傷患兒中痙攣型雙側癱佔47.1％,痙攣型偏癱佔41.2％;基底覈區損傷患兒中不隨意運動型腦癱佔76.9％;小腦髮育不良患兒則全部錶現為共濟失調型腦癱.GMFCS I-Ⅱ級者中,痙攣型偏癱、痙攣型雙側癱、不隨意運動型腦癱及共濟失調型腦癱的比例分彆為81.5％、47.1％、25.0％和30.7％;GMFCSⅣ-Ⅴ級者中,上述各類型的比例分彆為3.7％、33.5％、64.1％和46.2％.GMFCS I-Ⅱ級者中,MRI錶現為腦髮育畸形、PVL、皮質-皮質下損傷、基底覈區損傷及小腦髮育不良的患兒比例分彆為9.1％、43.9％、58.8％、19.2％和27.3％;GMFCSⅣ-Ⅴ級者中,上述MRI錶現的患兒比例分彆為45.5％、34.7％、29.4％、73.1％和45.5％.腦髮育畸形、皮質-皮質下損傷患兒中癲癇的髮生率分彆為36.4％和41.2％ (P＜0.01);腦髮育畸形、皮質-皮質下損傷及小腦髮育不良患兒中智力低下的髮生率較高,分彆為45.5％、41.2％和36.4％(P＜0.01).GMFCSⅣ-Ⅴ級患兒與GMFCS Ⅰ-Ⅱ級患兒相比,前者癲癇及智力低下的髮生率高于後者(P＜0.05).結論 腦癱患兒的影像學改變與腦癱類型及GMFCS分級密切相關,腦髮育畸形、皮質-皮質下損傷患兒的癲癇髮生率高,腦髮育畸形、皮質-皮質下損傷及小腦髮育不良患兒的智力低下髮生率較高,GMFCSⅣ-Ⅴ級患兒癲癇及智力低下的髮生率高于GMFCS I-Ⅱ級患兒.
목적 탐토뇌탄환인영상학여림상병정적상관성.방법 채용회고성연구대295례뇌탄환인진행영상학분류、조대운동공능분급계통(GMFCS)분급급지력측시,분석불동류형적영상학개변여뇌탄류형、GMFCS분급급반수장애간적상관성.결과 MRI제시영상학이상자257례(이상솔87.1％),정상자38례(정상솔12.9％),기중뇌발육기형11례,뇌실주위백질연화(PVL) 173례,피질-피질하손상17례,기저핵구손상26례,소뇌발육불량11례,기타19례.GMFCS분급위I、Ⅱ、Ⅲ、Ⅳ、Ⅴ급적환인비례분별위26.1％、18.0％、17.3％、18.6％、20.0％.뇌발육기형환인중,경련형쌍측탄점81.8％;PVL환인중경련형쌍측탄점84.4％;피질-피질하손상환인중경련형쌍측탄점47.1％,경련형편탄점41.2％;기저핵구손상환인중불수의운동형뇌탄점76.9％;소뇌발육불량환인칙전부표현위공제실조형뇌탄.GMFCS I-Ⅱ급자중,경련형편탄、경련형쌍측탄、불수의운동형뇌탄급공제실조형뇌탄적비례분별위81.5％、47.1％、25.0％화30.7％;GMFCSⅣ-Ⅴ급자중,상술각류형적비례분별위3.7％、33.5％、64.1％화46.2％.GMFCS I-Ⅱ급자중,MRI표현위뇌발육기형、PVL、피질-피질하손상、기저핵구손상급소뇌발육불량적환인비례분별위9.1％、43.9％、58.8％、19.2％화27.3％;GMFCSⅣ-Ⅴ급자중,상술MRI표현적환인비례분별위45.5％、34.7％、29.4％、73.1％화45.5％.뇌발육기형、피질-피질하손상환인중전간적발생솔분별위36.4％화41.2％ (P＜0.01);뇌발육기형、피질-피질하손상급소뇌발육불량환인중지력저하적발생솔교고,분별위45.5％、41.2％화36.4％(P＜0.01).GMFCSⅣ-Ⅴ급환인여GMFCS Ⅰ-Ⅱ급환인상비,전자전간급지력저하적발생솔고우후자(P＜0.05).결론 뇌탄환인적영상학개변여뇌탄류형급GMFCS분급밀절상관,뇌발육기형、피질-피질하손상환인적전간발생솔고,뇌발육기형、피질-피질하손상급소뇌발육불량환인적지력저하발생솔교고,GMFCSⅣ-Ⅴ급환인전간급지력저하적발생솔고우GMFCS I-Ⅱ급환인.
Objective To investigate neuroimaging and its correlation with clinical aspects of cerebral palsy (CP).Methods A retrospective study of 295 children with CP was conducted.Magnetic resonance imaging (MRI),the gross motor function classification system (GMFCS) and intelligence testing were administered,and any correlations among these measures was analysed.Results Among the 295 cases,257 presented abnormal MRIs (87.1％) due to brain maldevelopment (n =11),periventricular leukomalacia (PVL) (n =173),cortical/subcortical lesions (n =17),basal ganglia lesions (n =26),cerebellar maldevelopment (n =11) or others lesions (n =19).Thirty-nine presented with normal MRIs.About 26％ were rated at GMFCS level 1,18％ at level 2,17％ at level 3,19％ at level 4 and 20％ at level 5.Almost 82％ of the children presented with brain maldevelopment and 84.4％ with PVL-induced spastic bilateral paralysis.In 41％ of the children with cortical or subcortical lesions,induced spastic hemiplegia was observed,whereas 47％ had induced spastic bilateral paralysis.In 77％ of the children with basal ganglia lesions induced involuntary movement was observed,and all of those with maldevelopment of the cerebellum were ataxic.Most of those with spastic hemiplegic,bilateral paralysis,involuntary movement and ataxia were on GMFCS levels 1 or 2,with only 3.7％,33.5％,64.1％ and 46.2％ respectively on GMFCS level 4 or 5.Among those in whom the MRI revealed brain maldevelopment,9.1％ were on GMFCS level 1 or 2.The corresponding percentage for PVL was 43.9％,for cortical or subcortical lesions 58.8％,for basal ganglia lesions 19.2％ and for cerebellar maldevelopment 27.3％.The balance in each category were on GMFCS level 4 or 5.Epilepsy was most common in the children with brain maldevelopment (36.4％) or cortical or subcortical lesions (41.2％).Mental retardation was most common in cases of brain maldevelopment (45.5％),cortical or subcortical lesions (41.2％) or cerebellum maldevelopment (36.4％).The incidence of epilepsy and mental retardation was higher among the children on levels 4 and 5 than on levels 1 and 2.Conclusions Neuroimaging correlates significantly with the type of CP and GMFCS level.Epilepsy and mental retardation are most common in children with brain maldevelopment or lesions.The incidence of epilepsy and mental retardation is higher among children rated at GMFCS level 4 or 5 than among those on levels 1and 2.
