基于悬吊运动系统的骨盆稳定性训练法对痉挛型脑性瘫痪儿童粗大运动功能的影响

The effect of pelvic stability training based on sling exercise therapy on the gross motor function of the children with spastic cerebral palsy

目的:探讨基于悬吊运动(sling exercise therapy,SET)系统骨盆稳定性训练法对痉挛型脑性瘫痪(脑瘫)儿童粗大运动能力的影响,提高痉挛型脑瘫儿童粗大运动功能的康复疗效。方法:采用前瞻性队列研究。纳入2018年1月—2019年6个月安徽医科大学第一附属医院小儿神经康复中心收治的72例痉挛型脑瘫(偏瘫和双瘫);随机分为SET组(n=36)和对照组(n=36),两组均给予综合康复训练,共6个月,SET组同时加用SET系统支持下的骨盆稳定性训练。治疗前(入院时)和治疗后(治疗后6个月)分别采用粗大运动功能功能测试(GMFM-88及D区,E区)、徒手肌力评定(MMT)、儿童平衡量表(PBS)、改良Ashworth量表(MAS)、日常生活活动能力(ADL)量表对两组患儿进行评定。结果:SET组与对照组治疗前后差值组间GMFM-88评分相比(t=-5.31,P<0.01)差异有显著性意义;SET组与对照组治疗前后差值组间GMFM-D区(t=-9.085,P<0.01)和GMFM-E区(t=-6.239,P<0.01)评分相比差异有显著性意义;SET组与对照组治疗前后差值组间PBS评分相比(t=-7.807,P<0.01)差异有显著性意义;SET组与对照组治疗前后差值组间内收肌MAS(t=2.561,P<0.05)、腓肠肌MAS(t=4.12,P<0.01)和比目鱼肌MAS(t=6.035,P<0.01)评分相比差异有显著性意义;SET组与对照组治疗前后差值组间ADL评分相比(P>0.05)差异无显著性意义;SET组与对照组治疗前后差值组间MMT评分相比(P>0.05)差异无显著性意义。结论:SET组对痉挛型脑瘫儿童粗大运动能力功能、平衡功能和肌张力方面的疗效优于对照组;SET组和对照组对痉挛型脑瘫儿童日常生活和肌力的治疗均有显著效果。

Objective:To investigate the effect of pelvic stability training based on sling exercise therapy(SET)on the gross motor function of the children with spastic cerebral palsy.Method:A total of 72 cases of spastic cerebral palsy(spastic hemiplegia and spastic diplegia)were enrolled from the Children's Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medical University from January 2018 to June 2019.They were randomly divided into SET group(36 cases)and control group(36 cases).Both groups received multimodality rehabilitation training of 6 months,while the SET group received Pelvic stability training based on sling exercise therapy.Gross Motor Function Scale(GMFM-88 and area D,area E),Manual Muscle testing(MMT),Pediatric Balance Scale(PBS),the Modified Ashworth Scale(MAS)and Activities of daily living(ADL)scores were used for assessment and comparison before and after treatment.Result:Before and after treatment,GMFM-88 score of SET group was significantly higher than that of control group(t=-5.31,P<0.01),D area and E area of GMFM-88 in SET group were significantly higher than those in control group(D area,t=-9.085,P<0.01)(E area,t=-6.239,P<0.01).PBS score of SET group was significantly higher than that of control group(t=-7.807,P<0.01).There were statistically significant differences in scores of adductor MAS(t=2.561,P<0.05),gastrocnemius MAS(t=4.12,P<0.01)and soleus MAS(t=6.035,P<0.01)between SET group and control group before and after treatment.There was no significant difference in ADL score and MMT score between SET group and control group before and after treatment(P>0.05).Conclusion:The pelvic stability training based on sling exercise therapy is better than the conventional rehabilitation training to improve function of the gross movement,balance ability and muscular tension of children with cerebral palsy.Both SET group and control group showed significant improvement on daily life and muscle strength of children with spastic cerebral palsy.