早期使用踝足矫形器对脑性瘫痪婴儿预后的影响

Early use of ankle-foot orthoses for the prognosis of infantile spastic cerebral palsy

目的:分析早期使用踝足矫形器行站立位运动训练对脑性瘫痪(脑瘫)婴儿预后的影响。方法:选取2003-05/2004-05天津儿童医院康复科收治的8～12个月龄痉挛型双瘫及四肢瘫脑瘫患儿共80例,以随机双盲法分为两组:观察组40例,对照组40例。实验过程:观察组在常规康复治疗的基础上,从治疗初即开始使用踝足矫形器行站立位运动训练。训练内容如下:①辅助下站立位抗重力训练,包括“自由站”与“捆站”两种方式。②双下肢能充分承重基础上行单下肢承重。③双下肢能充分承重基础上行躯干运动训练。④为独站、独走准备的立位运动训练。⑤以上内容循序渐进进行,1h/d。直至下肢能完全承重,异常站立姿势有效控制,患儿能独走后再考虑停用踝足矫形器。对照组按常规康复治疗,在24个月的观察期内,能独走后需要时再使用踝足矫形辅助站行,改善步态。实验评估:①采用残疾儿童综合功能评定量表在治疗前和治疗12,24个月后进行功能评估。量表内容包括5个方面(认知功能、言语功能、运动能力、自理动作、社会适应能力),每个方面包括10项具体内容,采用百分制评分标准(每项完成得2分,大部分完成得1.5分,完成一半得1分,小部分完成得0.5分,不能完成0分,满分为100分)。②观察组与对照组治疗12,24个月后可独走(3步以上)患儿人数。结果:对照组中途脱落4例,最终76名患儿进入结果分析。①治疗前综合功能评定两组相比差异无显著性意义(P>0.05)。②治疗12个月后运动能力、自理动作和社会适应性方面分数观察组均高于对照组[(10.35±3.38),(8.25±2.71)分;(2.61±0.97),(2.01±0.82)分;(8.30±4.37),(6.36±3.26)分;P均<0.05],认知功能和言语功能两组相比差异无显著性意义(P>0.05),综合功能总分观察组高于对照组[(35.05±9.62),(29.00±7.10)分,P<0.05]。③治疗24个月后运动能力、自理动作和社会适应性方面分数观察组显著高于对照组[(15.15±2.25),(12.61±4.03)分;(4.35±1.24),(3.45±1.67)分;(10.61±4.71),(7.05±3.57)分;P均<0.001],认知功能和言语功能方面分数观察组高于对照组[(7.70±3.22),(6.22±3.15)分;(15.61±3.04),(13.50±5.02)分;P均<0.05],综合功能总分观察组显著高于对照组[(53.60±13.32),(42.83±10.48)分,P<0.001]。④观察组治疗12,24个月后能独走患儿人数均高于对照组[9例(22.5%),19例(47.5%);2例(5.6%),6例(16.7%),P<0.05]。结论:痉挛型脑瘫患儿8～12月龄开始使用踝足矫形器行站立位运动训练,可以更好地改善患儿综合功能,有助于实现尽早步行。

AIM： To evaluate the effect on prognosis of infantile spastic cerebral palsy by early application of ankle-foot orthoses （AFOs） for standing. METHODS： Totally 80 cases of spastic diplegic or quadriplegia cerebral palsy, who were admitted in Department of Rehabilitation Medicine, Tianjin Children＇s Hospital for 8-12 months, were divided into experimental group and control group at random, with 40 patients in each. Experimental process： The experimental group started to use AFOs for standing at the beginning of the treatment, and the control group within 24 months was only treated with the conventional method and began to use AFOs for assistant standing and gait improvement after they could walk. The standing exercise with AFOs included： ①Ioading resistant training on standing position of free or binding, ②loading of single legs.③body exercise. ④standing exercise prepared for single standing and single walk. ⑤above trainings were performed step by step, one hour daily. AFOs were removed when the children patients could walk under the complete loading of both legs and the abnormal standing pose was controlled effectively. Experimental evaluation：①Before treatment, after 12 and 24 months treatment, the therapeutic effect of the two groups was separately evaluated with Comprehensive Function Assessment for Disabled Children in 5 aspects （cognition function, speech function, gross movement, ability of daily living and social adaptation）, each containing 10 items. And hundred-mark system was adopted, 2 scores as complete achievement, 1.5 scores as most achievement, 1 score as half the achievement, 0.5 score as few achievement, and 0 score as no achievement.②The numbers of the children who could walk （more than 3 steps） after 12 and 24 months treatment were evaluated in the two groups. RESULTS： There were 4 cases in the control group who were losing in the term, finally 76 cases entered the result analysis. ①Before treatment there was no obvious significance in the comprehensive function between the two groups （P 〉 0.05）. ②Twelve months later, the scores of gross movement, ability of daily living and social adaptation of the children in experimental group were higher than those in the control group （10,35±3.38, 8,25±2.71; 2.61±0.97, 2.01± 0.82; 8.30±4.37, 6.36±3.26; P 〈 0.05）, but there was no obvious significance in the improvement of cognition and speech between the two groups （P 〈 0.05） and the comprehensive function assessment was higher in experimental group than in the control group （35.05±9.62, 29.00±7.10, P〈 0.05）.③Twenty-four months later, there were obvious improvements in gross movement, ability of daily living and social adaptation of the children （15.15±2.25, 12.61±4.03; 4.35±1.24, 3,45±1.67; 10.61±4.71, 7.05±3.57; P 〈 0.001）, and improvement of cognition and speech in the experimental group, compaed with control group （7.70±3.22, 6.22±3.15; 15.61±3.04, 13,50±5.02; P 〈 0.05）. The comprehensive function assessment in experimental group was apparently higher than that in control group （53.60±13.32, 42.83±10.48, P 〈 0.001）.④The numbers of the children who could walk after 12 and 24 months treatment were higher in experimental group than in control group [9 （22.5%）, 19 （47.5%）; 2 （5.6%）, 6 （16.7%）, P 〈 0.05]. CONCLUSION： Early application of AFOs to the 8-12 months children with spastic cerebral palsy can improve the comprehensive function of these children and contribute to their early and independent walking.