GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育的研究及康复治疗方案

Study on the development of foot arch and rehabilitation treatment plan for children with spastic diplegia in cerebral palsy gross motor function classification system gradeⅠ-Ⅱ

目的探讨GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育的康复治疗方案,为临床诊疗提供参考依据。方法选取粗大运动功能分级系统(GMFCS)为Ⅰ-Ⅱ级的50例痉挛型双瘫儿童,采用随机数字表法分成观察组(25例)和对照组(25例),对照组辅以常规运动治疗,观察组则在此基础上给予足弓矫正操治疗,观察组和对照组患者均每天治疗1次,每周治疗5d,于介入前、介入6个月后评估,分别测量足弓指数F、电子足底压力测量指标和粗大运动功能测试量表(GMFM、GMFM-88)中的D、E区评分,以评定扁平外翻足严重程度及运动发育水平。结果介入前观察组和对照组儿童的足弓指数F、电子足底压力测量指标及GMFM-88评分比较,差异无统计学意义(P>0.05)。与介入前比较,介入6个月后,两组儿童的足弓指数F(t=9.89、5.35)及GMFM-88评分(t=6.59、3.46)均显著升高(P<0.05);且观察组和对照组足弓指数F和GMFM-88评分(26.08±0.73、30.24±7.94)均显著高于对照组(25.34±0.64、25.20±7.06),差异有统计学意义(t=3.81、2.37,P<0.05)。电子足底压力测量指标足底压力图片显示足部外侧压力与内侧压力相比逐渐增加,中足足弓区域压力减少,说明足外翻程度减少和足弓的渐进发育。结论融合足弓矫正操治疗的综合康复治疗技术能促进GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育,对改善其足踝功能及运动发育水平具有积极作用。

Objective To investigate the development of the foot arch and develop a rehabilitation treatment plan for children with spastic diplegia of cerebral palsy gross motor function classification(GMFCS)system gradeⅠ-Ⅱ.Methods Fifty children with spastic diplegia and flat exostosis with GMFCS gradeⅠ-Ⅱwere selected into this study,and were divided into observation group(n=25)and control group(n=25)using the random number table method.The control group received conventional exercise therapy,while the observation group received arch correction exercises additionally.Both groups underwent treatment once a day for 5days a week.Children in both groups were evaluated before and 6months after the intervention.The arch index F,electronic plantar pressure measurement index,and the D and E scores of the Gross Motor Function Measure(GMFM-88)were used to assess the severity of clubfoot and the level of motor development.Results Bofore intervention,there were no significant differences in the arch index F,electronic plantar pressure measurement index,and GMFM-88score between the observation group and the control group(P>0.05).After 6months of intervention,the scores of arch index F(t=9.89,5.35),and GMFM-88(t=6.59,3.46)in both groups increased significantly(P<0.05).The scores of foot arch index F(26.08±0.73)and GMFM-88(30.24±7.94)in the observation group and control group were significantly higher than those in the control group(25.34±0.64,25.20±7.06)(t=3.81,2.37,P<0.05).Plantar pressure pictures showed a gradual increase in lateral foot pressure compared to medial pressure,and a decrease in pressure in the midfoot arch area,indicating a decrease in foot valgus and progressive development of the arch.Conclusion The comprehensive rehabilitation therapy technique incorporating arch correction and gymnastics treatment can promote the arch development in children with GMFCS gradeⅠ-Ⅱspastic diplegia,which is important for improving their foot and ankle function and motor development level.