矫形术对脑瘫患儿精神心理及生活质量的影响

The effect of orthopedic intervention on the psychology and quality of life of children with cerebral palsy

[目的]分析矫形术前后脑瘫患儿的精神心理状态及生活质量水平,探索矫形治疗的适宜时机。[方法]选取2012年6月～2013年10月于本院行矫形术治疗的脑瘫患儿,采用症状自评量表SCL-90、儿童生存质量普适性核心量表-Peds QL4.0分别对脑瘫需行矫形术患者术前及术后6个月进行评价,将脑瘫患者按性别、年龄分组,评估矫形手术对脑瘫患者的精神心理及生活质量的效果,在不同性别、年龄之间的差异,从精神心理及生存质量的角度,探索矫形治疗的适宜时机。[结果]共纳入病例34例,男19例,女15例;平均年龄（10.12±4.47）岁,矫形术治疗前后SCL-90评分躯体化、强迫症状、敌对和其他因子各项分数差异无统计学意义（P〉0.05）,总均分、人际关系敏感、抑郁、焦虑、恐怖、偏执、精神病性因子评分治疗后对比治疗前均减少（P〈0.01）;生存质量Peds QL得分除情感功能外,生理功能、社交功能评分均提高（P〈0.01）;男女脑瘫患者行矫形术前和术后半年SCL-90总均分均下降,Peds QL总分术后较术前升高（P〈0.01）;不同年龄段手术前后SCL-90均分差值之间没有统计学意义（P=0.54）。不同年龄组手术前后Peds QL总分差值不同,差异具有统计学意义（P〈0.05）。[结论]矫形手术治疗脑瘫患者能显著改善精神心理及生活质量,尽早进行矫形手术有助于患儿日后生存质量提高及精神心理健康。

[Objective] To analyze the psychological conditions and quality of life of children with cerebral palsy before and after orthopedic surgery,and to find suitable uses for orthopedics in the treatment of cerebral palsy. [Methods] Patients with cerebral palsy scheduled for orthopedic surgery between June 2012 and October 2013 were allocated into groups according to gender and age. The effects of orthopedic intervention and the diversity in gender and age on psychology and quality of life were assessed using the SCL- 90 and Peds QL4. 0 scales before surgery and six months after surgery. [Results] There were 34 participants（ 19 boys and 15 girls） with an average age of（ 10. 12 ± 4. 47） years. Comparing the signs of somatization,compulsive symptom,hostility,and other factors of SCL90,we were unable to identify a significant difference between before and after surgery（ P〈0. 05）. However,the signs of behavioral issues,including interpersonal sensitivity,depression,anxiety,terror,paranoia,and psychosis,declined after orthopedic intervention（ P〈0. 01）. Moreover,the physiological functioning scores and social functioning scores（ except emotional functioning） from Peds QL4. 0 were significantly enhanced following orthopedic intervention（ P〈0. 01）. Meanwhile,all the boys and girls with cerebral palsy had improved SCL- 90 and Peds QL4. 0scores after the surgery（ P〈0. 01）. There was no significant difference between ages after the surgery（ P = 0. 54）; however,the different age groups had significant differences in the Peds QL4. 0 scores after the surgery（ P〈0. 05）. [Conclusion] Orthopedic intervention for children with cerebral palsy can significantly improve their psychology and quality of life. As such,timely orthopedic surgery is necessary for improving the future health of these children.