踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响

Effects in children with spastic cerebral palsy of wearing ankle-foot orthoses for different durations

目的研究踝足矫形器（AFO）不同的佩戴时间对痉挛型脑性瘫痪（脑瘫）儿童运动功能的影响。方法将52例痉挛型脑瘫儿童随机分为训练佩戴组16例、日间佩戴组19例和日夜佩戴组17例。3组患儿均给予常规康复治疗，训练佩戴组仅在运动训练时佩戴AFO；日间佩戴组平日运动时亦佩戴AFO，每日佩戴6～8h；日夜佩戴组除清洗及进行部分训练项目时取下AFO外，其余时间均佩戴。3组患儿总疗程均为2个月。分别在康复治疗前、后测定患儿踝关节被动活动范围（APROM），采用改良Ashworth量表（MAS）评定患儿痉挛情况，采用粗大运动功能测试量表（GMFM）中的D区及E区评定患儿的站立和步行能力。结果3组患儿的APROM、MAS评分和GMFM评分治疗前比较，差异无统计学意义（P〉0．05）。治疗后，日间佩戴组、日夜佩戴组患儿的APROM、MAS评分和GMFM评分均高于训练佩戴组（P〈0．05），日间佩戴组和日夜佩戴组的APROM、MAS评分组间比较，差异无统计学意义（P〉0．05），日间佩戴组GMFM评分明显高于日夜佩戴组（P〈0．05）。结论日间佩戴AFO6～8h对于缓解痉挛型脑瘫儿童踝跖屈肌群痉挛并提高其运动能力，较仅训练时佩戴AFO或日夜佩戴AFO更有效。

Objective To explore the effects of wearing ankle-foot orthoses （AFOs） on motor function in children with spastic cerebral palsy （SCP）. Methods Fifty-two children with SCP were randomly divided into a wearing-for-training group （ n = 16, group 1 ） , a day-wearing group （ n = 19, group 2） and a day-night-wearing group （n = 17, group 3）. In addition to the conventional rehabilitative treatment given to all participants, the children in group 1 wore AFOs during movement training, and children in group 2 wore AFOs in the daytime for 6-8 h per day, while AFOs were applied to the children in group 3 for 24 hours a day except for cleaning and during certain training routines. All the treatments were continued for 2 months. Clinical assessments included the range of passive ankle dorsi- and plantarflexion （APROM） , modified Ashworth scale （MAS） ratings, and the D and E dimensions of the Gross Motor Function Measure （ GMFM）. All were performed before and after treatment. Results Before treatment, no statistically significant differences were found among the three groups in terms of APROM, MAS, or GMFM. There were significant subsequent improvements in groups 2 and 3 when compared with group 1 in terms of APROM, MAS and GMFM results. Group 2＇s improvements in APROM and MAS results were not significantly better than those of group 3, but their average GMFM score improvements were significantly better. Conclusion Wearing AFOs in the daytime 6-8 hours per day is more effective in reducing spasticity and improving functional performance in children with SCP.