跪位姿势控制训练结合应用踝足矫形器在提高脑瘫儿步行水平中的作用研究

The Research of the Functions in the Cerebral Palsy Children Walking level Improvement by Combining the Kneeling Posture Control Training with the Application of Ankle foot Orthosis

目的：研究经过康复治疗改善脑瘫（cerebralpalsy）患儿的跪位姿势控制能力并结合应用踝足矫形器在提高脑瘫儿步行水平中所起的作用。方法：选择2011年9月-2013年7月收治的脑瘫患儿50例，随机分为治疗组和对照组，治疗组在常规康复治疗的基础上，重点强化跪位姿势控制训练并佩戴踝足矫形器（anklefootorthoses，AFO），对照组常规康复治疗，跪位姿势控制能力采用粗大运动功能量表（grossmotorfunctionmeasure，GMFM）的c区评定，步行水平采用Gillette功能性步行量表评定。结果：对照组中途脱落2例，共有48例患儿进入结果分析。结果表明治疗组治疗后GMFMC区评分显著高于治疗前（P〈0．01），并且治疗后治疗组GMFMC区评分显著优于对照组（P〈0．01）；Gillette功能性步行量表步行水平分级评定显示：治疗后治疗组步行水平显著优于对照组（P〈0．05）。结论：跪位姿势控制能力（髋关节运动控制）、踝足控制的稳定性在脑瘫儿步行中的作用非常重要，这2方面的作用主要在于维系步行中控制重心的稳定，在此基础上步态才能改善，步行水平才能提高。

Objective ：To study the cerebral palsy children＇s kneeling posture control ability improved through rehabilitation therapy, and the function of combined application of ankle foot orthoses in improving the walking level of cerebral palsy children. Methods：The 50 cases of children with cerebral palsy received and cured during 2011.09 -2013.07 were selected and randomly divided into treatment group and control group. On the basis of routine rehabilitation therapy, the treatment group more focused on kneeling posture control train- ing and wore ankle foot orthoses （AFO） ; while the control group was treated with routine rehabilitation therapy, the kneeling posture con- trol ability was assessed by C - zone of the gross motor function measure （GMFM）, and walking level was evaluated with Gillette function- al walking measure. Results：In the control group, 2 cases were off on midway, so a total of 48 cases of children entered into the result a- nalysis. Results ： showed that, after treatment, GMFM C - zone grade of the treatment group was significantly higher than that before treat- ment （ P 〈 0.01 ）, and after treatment, GMFM C - zone grade of the treatment group was notably better than that of control group （ P 〈 0. 01 ） ; Gillette functional walking measure walking level grading assessment showed that： After treatment, the walking level of treatment group was remarkably better than that of control group （P 〈 0.05 ）. Conclusions：Kneeling posture control ability （hip joint motor control） and the stability of the ankle foot control play a very important role in cerebral palsy children walking, and the role of these two aspects mainly lies in maintaining the stability of gravity center in walking, only on the basis of which, can the gait be improved, and can walking level be enhanced.