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Objective To explore the value of diffusion tensor imaging (DTI)for the cerebral white matter recovery in children with cerebral palsy after cervical perivascular sympathectomy.Methods 30 children with hemiplegic cerebral palsy were recruited for clinical assessment and routine MRI and DTI examination before and after operation.The fractional anisotropy (FA)values for the regions including internal capsule and cerebral peduncle in the preoperative operation side and the opposite side,preoperative and postoperative were measured and compared.Gross motor function classification system (GMFCS)was used to evaluate the movement function of cerebral palsy in children.Paired sample t-test was performed to compare the differences of FA values between the preoperative operation side and the lateral,preoperative and postoperative white matter.Spearman relativity analysis was performed to assess correlation between DTI parameters in different white matter fiber bundles and GMFCS in patients.Results The FA values of white matter fiber bundle in different parts of the preoperative operation side were significantly lower in preoperative contralateral side,and the differences were statistically significant(P<0.001).Compared to preoperative,the FA values of white matter fiber bundle in different parts of the operation side were significantly increased in the six months after surgery (P<0.001),with the improvement of gross motor.Preoperative and postoperative FA value of the white matter fiber bundles in the different parts of the contralateral brain was not statistically significant(P>0.05).Clinical GMFCS in the patients were negatively correlated with the FA values (P<0.001).Moreover,the relativity between the GMFCS and the FA value of internal capsule and cerebral peduncle were both higher(r=-0.800,P<0.001;r=-0.786,P<0.001). Conclusion DTI can be used to quantitatively evaluate the postoperative recovery of white matter in children with cerebral palsy.The FA value can be used as a sensitive index for the evaluation of curative effect in children with cerebral palsy.
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Objective To investigate the effect of carotid sympathetic nerve net stripping operation in treating children patients with spastic unilateral cerebral palsy and its effect on motor function.Methods Seventy-six children cases of spastic unilateral cerebral palsy were divided into the control group and observation group.On the basis of routine therapy,the former was treated with type A botulinum toxin,while the latter used the carotid sympathetic nerve netting operation for the treatment.After 6-month treatment,the improvement degree of the Comprehensive Functional Rating Scale of Cerebral Palsy Children,Gross Motor Function Measure(GMFM) score and Ashworth spasm grade were compared between the two groups.Results after 6-month treatment,the improvement degrees of the Comprehensive Functional Rating Scale of Cerebral Palsy Children,GMFM scores and Ashworth spasm grade in the observation group were significantly greater than those in the control group,the difference was statistically significant (P＜0.05).Conclusion The carotid sympathetic nerve net stripping operation in treating children patients with spastic unilateral cerebral palsy has significant effect and is worthy to be popularized in clinic.
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Objective To investigate the correlation between serum matrix metalloproteinase-9 (MMP-9) and intracranial pressure after hematoma removal in patients with primary intracerebral hemorrhage (PICH). Methods From January 2015 to June 2017,72 consecutive patients with PICH treated with removal of hematoma + intracranial pressure probe implantation at the Department of Neurosurgery, the Second Affiliated Hospital of Xinjiang Medical University were enrolled retrospectively. They were divided into 3 groups:group A (n=25,intracranial pressure ≤10 mmHg);group B (n=24,intracranial pressure 11-20 mmHg),and group C (n=23,intracranial pressure >20 mmHg) according to the maximum value of monitoring intracranial pressure. The serum MMP-9 levels of all patients were detected using ELISA at 1, 3,5,7 and 14 d after procedure,the volume of cerebral edema was monitored by head CT,and intracranial pressure was continuously observed for 7 d after procedure using the intracranial pressure monitor. Results At 1,3,5,7,and 14 d after removal of the hematomas,the MMP-9 levels in group A were 82 ± 11,117 ± 12,156 ± 14,132 ± 14,and 108 ± 18 mg/L,respectively,and the volumes of brain edema were 15 ± 6,19 ± 7,22 ± 8,19 ± 7,and 17 ± 6 cm3 ,respectively. The MMP-9 levels in group B were 93 ± 14,138 ±13,188 ± 17,153 ± 17,and 134 ± 12 mg/L,respectively,and the volumes of brain edema were 19 ± 7,23 ± 8,30 ± 10,26 ± 8,and 20 ± 7 cm3 ,respectively;the MMP-9 levels in group C were 104 ± 16,199 ± 14,390 ± 22,296 ± 15,and 213 ± 15 mg/L,respectively,and the volume of brain edema were 22 ± 8,30 ± 10,42 ± 12,32 ±19,and 24 ±8 cm3,respectively. There was significant difference between groups (P<0. 05),and there was a moderate positive correlation between the changes of MMP-9 level and the volume of intracranial cerebral edema (r =0. 62,P <0. 01). Conclusion After the removal of the hematomas of primary cerebral hemorrhage, the MMP-9 level in blood serum of the patients was positively correlated with the volume of brain edema,the higher the level of MMP-9,the higher the intracranial pressure.
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Objective To investigate the clinical efficacy of L1 -S1 selective posterior rhizotomy (SPR)at the medullary conus level for the treatment of double lower extremities spastic cerebral palsy(CP).Methods A total of 1 09 double lower extremities spastic CP children underwent SPR at the level of medullary consul were selected in the Second Affiliated Hospital of Xinjiang Medical University from October 201 0 to May 201 4.The 4 groups were analyzed in terms of muscle tension and gross motor function of the lower limbs 6 months before and after operation,retrospective-ly.The SPSS 1 7.0 software was used for statistical analysis.Results Patients had different degrees of improvement in gross motor function and reduction of spasticity in all muscle groups of lower limbs after operation.Six months after the operation,the muscular tension of hip flexor,hip adductor,knee flexor and plantar flexors (modified Ashworth spastic scale score)were all improved compared with preoperation (t =1 6.635,27.41 1 ,31 .362,38.81 9,all P <0.01 ).Gross motor function of lower limbs (Gross Motor Function Measure)at 6 months after the operation was significantly im-proved compared with preoperation (51 .97 ±1 2.92 vs 41 .01 ±1 1 .46),and the difference was significant(t =26.67, P <0.01 ).The postoperative complications:intracranial hypotension headache (5 cases,4.59%),postoperative high fever (2 cases,1 .83%),incision fat liquefaction (2 cases,1 .83%),sensory barriers of lower limbs (1 case, 0.92%),and urine obstacles (1 case,0.92%).Conclusions SPR at the level of medullary conus has the advantages of minimal injury,rapid recovery and little influence on the stability of the spine.In addition,the procedure can relieve the spasticity of lower limbs of the CP patients effectively.