悬吊运动训练对痉挛型双瘫患儿选择性脊神经后根切断术后步行能力的影响

Study on the effect of sling exercise training on the walking ability of children with spastic diplegia cerebral palsy after selective posterior rhizotomy

目的分析悬吊运动训练(SET)应用于痉挛型双瘫患儿选择性脊神经后根切断术(SPR)后改善步行能力的疗效,以期为痉挛型双瘫患儿SPR后康复提供临床依据。方法选取2018年5-12月在湘雅博爱康复医院住院的69例痉挛型双瘫患儿SPR后按照随机分类的原则分成对照组35例,观察组34例,对照组在SPR后行常规康复训练,观察组在此基础上增加SET,采用粗大运动功能评定量表-E区(GMFM-E区)、粗大运动功能分级系统(GMFCS)、10 m最快步行速度(10 mMWS)、步行参数(步长和步宽)对术前、术后治疗1月、3月和6月的粗大运动功能及分级、步行能力及步态性能进行治疗前后疗效的对比。结果术前、治疗1月,两组患儿GMFM-E区、10 mMWS、步长和步宽评分比较,差异均无统计学意义(P>0.05);治疗3月、6月,两组患儿各项指标较治疗前均改善(t3月=-2.727、-2.468、-2.595、2.597,t6月=-3.218、-3.479、-5.132、4.677,P<0.05);治疗6月后,两组各项指标均优于同组治疗1月和3月,且观察组改善更显著(P<0.05),并观察组GMFCS总变化率32.35%优于对照组的14.29%。结论SET可有效改善痉挛型双瘫患儿SPR后的粗大运动功能、行走能力和步态性能。

Objective To analyze the effect of children′s sling exercise training(SET)on walking ability in children with spastic diplegia cerebral palsy after selective posterior rhizotomy(SPR),in order to provide clinical basis for the rehabilitation of children with spastic diplegia cerebral palsy.Methods A total of 69 children with spastic diplegia cerebral palsy in Xiangya Boai Rehabilitation Hospital from May to December 2018 were enrolled in this study,and were randomly divided into control group(n=35)and experiment group(n=34).The control group received routine rehabilitation training after SPR,while the experimental group was given SET additionally.Gross Motor Function Measurement E zone(GMFM-E),Gross Motor Function Classification System(GMFCS),10 m Maximum Walking Speed(10 mMWS)and walking parameter(step length and step width)were used to assess the gross motor function and classification,walking ability and the gait situation before the operation,1 month,3 months and 6 months after the operation.Results There were no significant differences on GMFM-E area,10 m MWS,step length and step width scores between the two groups before operation and 1 month after treatment.The above indexes of two groups were all improved in 3 and 6 months after treatment(t3月=-2.727、-2.468、-2.595、2.597,t6月=-3.218、-3.479、-5.132、4.677,P<0.05).And the indexes of walking ability of the two group in 6 months of treatment were better than those in 1 month and 3 months of treatment.Additionally,improvement of walking ability in the experiment group was more significant than that in the control group(P<0.05).The total rate of change in GMFCS of the experiment group(32.35%)was higher than that in the control group(14.29%).Conclusion Sling exercise training after SPR play a crucial role in improving the gross motor function,walking ability and gait performance of children with spastic diplegia cerebral palsy.