带楔鞋与硬踝足矫形器联合应用对膝屈曲脑性瘫痪儿童膝关节伸展能力的改善效应

Improved influence of the combination of wedged shoes and ankle foot orthoses on the extension ability of knee joint in cerebral palsy children

目的：观察带楔鞋与硬踝足矫形器联合应用对膝屈曲挛缩脑性瘫痪儿童膝关节伸展能力和平衡功能的影响。方法：实验于2004-02/2006-02在解放军第四军医大学西京医院进行,选择13例膝屈曲挛缩脑性瘫痪儿童,使用硬踝足矫形器和带楔鞋（鞋楔高度为1.0～2.6cm,平均2.4cm）,要求每天使用至少6h以上,连续4周。第1次使用及使用4周后进行测量,观察其穿鞋、使用硬踝足矫形器、使用硬踝足矫形器和带楔鞋3种条件下,站立时膝关节伸展角度（即膝关节最大伸展时与中立位的角度）及站立静态平衡时间变化。结果：13例患者均进入结果分析。①站立时膝关节伸展角度：使用带楔鞋和硬踝足矫形器4周后小于单纯穿鞋[（21±5）°,（27±7）°,P〈0.05]。②站立静态平衡时间：第1次使用和使用4周后,穿带楔鞋和硬踝足矫形器后站立时间长于单纯穿鞋或单纯使用硬踝足矫形器[第1次使用：（78±22）,（23±11）,（38±14）s,P〈0.01;4周后：（129±37）,（27±9）,（50±18）s,P〈0.01]。结论：加楔的设计,使用硬踝足矫形器设计提高了膝屈曲脑性瘫痪患者站立平衡能力,增强了膝关节的伸展能力,为进一步提高行走功能提供了良好的基础条件。

AIM： To observe the influence of wedged shoes and ankle foot orthoses （WAFO） combination on the extension ability and balance function in spastic cerebral palsy children with lap inflexion. METHODS： The study was conducted in Xijing Hospital, Fourth Military Medical University of Chinese PLA from February 2004 to February 2006. Totally 13 cerebral palsy children wore the WAFO （the height of wedge in shoes ranged from 1.0-2.6 cm, averagely 2.4 cm） at least six hours per day for 4 weeks. The knee extension angle （the angle between knee joint at maximal extension and neutral position） and time of static standing balance were measured after the first using and 4 weeks later under wearing shoes, ankle foot orthosis and WAFO combination, respectively. RESULTS： Totally 13 patients were involved in the result analysis. （1）extension angle when standing： It was smaller in children with WAFO than children simply wearing shoes 4 weeks later [（21±5）°, （27±7）° ,P 〈 0.05]. （2）time of static standing balance： It was longer in children with WAFO than children simply wearing shoes or ankle foot orthosis after the first using and 4 weeks later [first using： （78±22）, （23±11）, （38±14） s,P 〈 0.01 ;4 weeks later： （129±37）, （27±9）, （50± 18） s,P〈 0.01]. CONCLUSION： The ability of standing balance of cerebral palsy children can be improved and extension ability of knee joint is strengthened by wearing a WAFO, so that a good basic condition is provided for enhancing walking function.