不同时机康复干预对脑瘫患儿足外翻步态矫正及预后的影响

Effect of rehabilitation intervention at different timings on the gait correction and prognosis of talipes valgus in children with cerebral palsy

目的探讨不同时机康复干预对脑性瘫痪(脑瘫, CP)患儿足外翻步态矫正及预后的影响。方法 60例脑瘫患儿,采用随机数字表法分为A组和B组,每组30例。A组患儿在出生后12个月内(0~12个月)开始接受正规康复干预, B组患儿则在出生后12个月后(13~24个月)开始接受正规康复干预。比较两组患儿治疗后各足底区域占全掌压力百分比、各足底区域占支撑期百分比及粗大运动功能分级系统(GMFCS)分级。结果治疗后, A组患儿足前掌内侧缘、足弓内侧缘占全掌压力百分比(36.5±5.3)%、(6.1±2.0)%均低于B组患儿的(45.2±7.6)%、(12.8±5.2)%,足前掌外侧缘、足弓外侧缘和足跟占全掌压力百分比(19.5±4.8)%、(8.9±3.0)%、(28.9±5.2)%均高于B组患儿的(16.0±3.8)%、(7.1±2.4)%、(18.8±4.8)%,差异均有统计学意义(P<0.05)。治疗后,两组患儿着地实相、前掌接触实相占支撑期百分比比较,差异无统计学意义(P>0.05);A组患儿整足接触实相占支撑期百分比(41.7±1.3)%低于B组的(49.7±1.8)%,离地实相占支撑期百分比(45.2±2.0)%高于B组的(37.1±3.4)%,差异均有统计学意义(P<0.05)。治疗后,两组患儿GMFCS分级比较,差异有统计学意义(P<0.05)。结论早期(出生后12个月内)进行康复干预能显著改善脑瘫患儿足外翻畸形,为脑瘫康复治疗提供新的方法。

Objective To discuss the effect of rehabilitation intervention at different timings on the gait correction and prognosis of talipes valgus in children with cerebral palsy(CP). Methods A total of 60 children with cerebral palsy were divided into group A and group B by random number table method, with 30 cases in each group. Group A received regular rehabilitation intervention within 12 months after birth(0-12 months), while group B received regular rehabilitation intervention 12 months after birth(13-24 months). The percentage of plantar area in total pressure, percentage of plantar area in supporting period, and gross motor function classification system(GMFCS) classification after treatment were compared between the two groups. Results After treatment, the percentage of pressure of the medial margin of forefoot and arch in the whole palm of group A(36.5±5.3)% and(6.1±2.0)% were lower than(45.2±7.6)% and(12.8±5.2)% of group B, and the percentage of pressure of the lateral margin of forefoot, arch and heel in the whole palm were(19.5±4.8)%,(8.9±3.0)% and(28.9±5.2)%, which were higher than those of group B(16.0±3.8)%,(7.1±2.4)% and(18.8±4.8)%, and the difference was statistically significant(P<0.05). After treatment, there was no statistically significant difference in percentage of landing phase and forehand contact phase in supporting period between the two groups(P>0.05). After treatment, the whole foot contact phase in supporting period of group A(41.7±1.3)% was lower than that of group B(49.7±1.8)%, off-ground contact phase in supporting period(45.2±2.0)% was higher than that of group B(37.1±3.4)%, and the difference was statistically significant(P<0.05). After treatment, there was statistically significance in GMFCS classification between the two groups(P<0.05). Conclusion Early rehabilitation intervention(within 12 months after birth) can significantly improve the talipes valgus of children with cerebral palsy, and provide a new method for the rehabilitation of cerebral palsy.