家庭髋关节姿势管理对痉挛型双瘫脑瘫儿童髋关节发育的影响:前瞻性随机对照研究

Effects of family hip postural management on the hip development in children with spastic bilateral cerebral palsy

目的:观察家庭髋关节姿势管理对痉挛型双瘫脑瘫儿童髋关节发育的影响。方法:选取2013年12月—2014年10月在我院治疗的2—4岁痉挛型双瘫儿童32例,粗大运动功能分级(gross motor function classification scale,GMFCS)Ⅲ-Ⅳ级,采用随机数字表法将上述患者分为试验组及对照组,对照组在我院行常规康复治疗,每年≥6个疗程,每个疗程10—14天,试验组在常规康复治疗基础上指导患儿监护人使用矫形器行家庭髋关节姿势管理,包括夜间髋关节外展位睡眠,白天髋关节外展位站立,每日髋外展站立时间≥1h。分别于治疗前、治疗后18—24个月拍摄骨盆平片,测量并比较两组患儿的双髋关节股骨头偏移百分比(migration percentage,MP)和髋臼指数(acetabular index,AI)。结果:治疗前,试验组MP值和AI值与对照组比较,差异无显著性意义。治疗后,试验组MP值为:20.96±6.35,对照组MP值为:29.78±9.38,试验组AI值为:18.53±2.54,对照组AI值为:21.17±2.73,治疗组均优于对照组,差异均有显著性意义。结论:家庭髋关节姿势管理可有效减轻较小年龄痉挛型脑瘫儿童髋关节的进行性移位,有助于患儿髋关节正常发育。

Objective：To investigate effects of family hip postural management on hip development in young children with spastic bilateral cerebral palsy.Method：Thirty two children with spastic bilateral cerebral palsy were selected, who received regular physical treatments in our hospital at 2—4 years old in Dec. 2013 to Oct. 2014, classified at level Ⅲ-Ⅳaccording to the gross motor function classification system（GMFCS）, and randomly divided into the control group and observation group according to a random number table. Both groups were given normal physical rehabilitation treatment, and the observation group were also given family hip postural management including daily standing program with hip abduction and nightly sleeping program with hip abduction. The migration percentage（MP）and acetabular index（AI） of hip radiographs were taken at baseline and 18—24 months after the therapy, and compared those from the two groups.Result：Before the treatment, there were no significant differences between the two groups in migration percentage value and acetabular index（P0.05）. At 18—24 months after the treatment, The migration percentage val-ue in observation group was 20.96 ±6.35, and those in control group was 29.78±9.38（P0.05）. The acetabular index in observation group was 18.53±2.54, and in control group was 21.17±2.73（P0.05）. The values in observation group are both better than control group.Conclusion：Family hip postural management can help in developing more normal hip in young children with spastic bilateral cerebral palsy.