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前文介绍了Duchenne型肌营养不良(Duchennemuscular dystrophy,DMD)诊治与管理的多学科协作理念,重点探讨了DMD的诊断和药物治疗。本文将探讨康复、矫形、呼吸、心脏、胃肠道、心理等的管理。两部分相结合,将提供一个全面的DMD诊治与管理方案,以期提高我国DMD患儿的诊治与管理水平。1关节伸展性及挛缩的管理多种因素,如关节丧失全方位活动能力、静态固定于屈曲位、肌肉维持不平衡及纤维化等可导致DMD患儿关节伸展性减小,挛缩发生。关节挛缩的管理需要神经科、康复科、骨科医师的参与,并根据DMD患儿疾病所处阶段、对治疗的反应及耐受性制定个体化方案,每4个月调整1次。
The previous article introduced Duchenne muscular dystrophy (Duchennemuscular dystrophy, DMD) diagnosis and management of multidisciplinary collaboration concept, focusing on the diagnosis of DMD and drug treatment. This article will explore the management of rehabilitation, orthopedics, respiration, heart, gastrointestinal tract, psychology and so on. Combination of two parts, will provide a comprehensive program of DMD diagnosis and management, with a view to improving the diagnosis and management of children with DMD in our country. 1 joint extensibility and contracture management A variety of factors, such as joint loss of all-round activity, static fixation in flexion, muscle imbalance and fibrosis can lead to DMD children with reduced joint extensibility, contracture. The management of joint contractures requires the involvement of neurology, rehabilitation and orthopedics, and individualized regimens based on the stage of disease in children with DMD, response to treatment, and tolerance, adjusted once every 4 months.