Chirurgische Verfahren zur Therapie von Spastik

Hurth, Helene; Morgalla, Matthias; Heinzel, Johannes; Daigeler, Adrien; Kolbenschlag, Jonas; Schuhmann, Martin

doi:10.1007/s00115-023-01568-3

Cited by 3 publications

(2 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dieser Artikel konzentriert sich jedoch ausschließlich auf die hyperselektive Neurektomie an der oberen Extremität. Andere chirurgische Techniken wie die Implantation von Baclofenpumpen, selektive dorsale Rhizotomien und der Transfer der C7-Nervenwurzel wurden an anderer Stelle beschrieben [3].…”

Section: Therapieoptionen Bei Spastizitätunclassified

“…▪ verminderte Muskelkraft (meist vorübergehend) oder Verlust der Muskelfunktion (bei zu starker Denervation), evt. mit nachfolgender Deformität (durch Übergewicht der Antagonisten) ▪ Wiederkehr der Spastik (Rezidiv) bei unzureichender Denervation oder Nervenregneration Eine erneute Zunahme des Tonus wird aus oben genannten Gründen nach einiger Zeit häufiger beobachtet [3,19]. Dennoch ist in der Regel eine dauerhafte Tonusreduktion zu erwarten.…”

Section: Risiken Und Komplikationen Und Rezidiveunclassified

See 1 more Smart Citation

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Megerle,

Gohritz

2024

Handchir Mikrochir Plast Chir

View full text Add to dashboard Cite

ZusammenfassungAls hyperselektive Neurektomie wird eine gezielte Durchtrennung motorischer Nervenfasern an ihrem Muskeleintritt bezeichnet, um bei spastischen Lähmungen den gesteigerten Muskeltonus zu reduzieren. Diese Technik hat in den letzten Jahren speziell an der oberen Extremität eine Renaissance erlebt. Wichtigste Grundlage ist die exakte Kenntnis der topographschen Anatomie der Muskelinnervation. Um Ausmaß und Lokalisation der Denervation exakt kontrollieren zu können, ist eine präzise Darstellung der motorischen Nervenäste notwendig. Für eine relevante Tonusminderung ist die Durchtrennung von 2/3 bis 4/5 der Nervenäste erforderlich. Diese Arbeit stellt die Entwicklung, Prinzipien und Anwendung dieser Techniken an der oberen Extremität dar und gibt einen Überblick über die klinischen Ergebnisse.

show abstract

Section: Therapieoptionen Bei Spastizitätunclassified

Section: Risiken Und Komplikationen Und Rezidiveunclassified

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Megerle,

Gohritz

2024

Handchir Mikrochir Plast Chir

View full text Add to dashboard Cite

show abstract

Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy

Novikov,

Umnov,

Zharkov

et al. 2024

Pediatr Traum Orthop Reconstr Surg

View full text Add to dashboard Cite

BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.

show abstract

Risk factors for post-stroke spasticity: a retrospective study

Zhu,

Li,

Qiu

et al. 2024

Front. Neurol.

View full text Add to dashboard Cite

BackgroundPost-stroke spasticity (PSS) is a common complication after stroke and is an important cause of high rates of disability after stroke. At present, modern medicine has made great progress in the treatment of PSS, ‘early detection, early treatment’ has become a general consensus for the treatment of PSS in the clinic. Clarifying the risk factors of PSS can help to detect and treat the functional disorders caused by PSS at an earlier stage.MethodsThis is a retrospective study. 436 stroke patients who visited the Neurology Department of the Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine from June 2020 to November 2020 were selected as study subjects, and finally 257 patients were included in the final analysis, and divided into 101 cases with spasticity and 156 cases without spasticity, depending on whether or not the stroke victim had a spasm at the time of admission.ResultsThe multivariate regression analysis showed that basal ganglia as the cerebral hemorrhage or infarction site (OR = 4.930, 95%CI = 2.743–8.86, p = 0.000), cerebral hemorrhage or infarction volume (OR = 1.087, 95%CI = 1.016–1.164, p = 0.016) and NIHSS scores (OR = 1.232, 95%CI = 1.089–1.393, p = 0.001) are independent influencing factors and independent risk factors for spasticity (p < 0.05). A risk prediction model for spasticity in stroke patients is derived with the multivariate logistic regression analysis Logit (P) = 1.595 * Basal ganglia +0.084 * infarct volume + 0.208 * NIHSS scores – 2.092. An evaluation of the goodness of fit using the ROC curve showed AUC (95% CI) = 0.786 (0.730–0.843), an indication of a high degree of model fit.ConclusionIndependent risk factors for Post-stroke spasticity include basal ganglia as the cerebral hemorrhage or infarction site, cerebral hemorrhage or infarction volume and NIHSS scores.

show abstract

Chirurgische Verfahren zur Therapie von Spastik

Cited by 3 publications

References 30 publications

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy

Risk factors for post-stroke spasticity: a retrospective study

Contact Info

Product

Resources

About