步行矫形器对腰2节段A-B级脊髓损伤患者步行能力的影响

Effects of a walking orthosis on the walking ability of patients with spinal cord injury at L2

目的观察穿戴膝踝足矫形器(KAFO)和截瘫步行矫形器(WO)对腰2节段A-B级脊髓损伤步行能力及生理消耗指数(PCI)的影响。方法纳入30例腰2节段A-B级脊髓损伤患者,年龄20-45岁,根据患者穿戴的步行矫形器不同,按随机数字表法分为KAFO组(穿戴KAFO)和WO组(穿戴WO),每组15例,2组患者均行常规康复治疗,包括肌肉力量训练、关节活动度维持训练、站立床训练、平衡训练、坐位下重心转移训练、日常生活活动训练以及电疗和针灸等。在穿戴步行矫形器后,KAFO组及WO组患者穿戴相应的步行矫形器进行步行训练,每日训练60 min,每周6 d,共12周;并对比2组患者穿戴不同步行矫形器第2周和第12周后的步长、步速、步频、10 m步行时间、6 min步行距离及PCI。结果经常规康复治疗后,KAFO组和WO组患者在穿戴不同步行矫形器步行训练第12周后的步长[(43.45±12.33)和(46.21±11.45)cm]、步速[(44.74±10.32)和(50.18±9.56)cm/s]、步频[(45.29±14.11)和(48.14±15.32)步/min]、10 m步行时间[(20.89±19.22)和(17.33±18.26)s]、6 min步行距离[(391.12±100.89)和(480.56±108.12)m]及PCI[(0.89±0.86)和(0.50±0.53)次/m]较训练第2周后的步长[(40.12±15.11)和(45.65±13.12)cm]、步速[(36.74±11.29)和(39.12±12.35)cm/s]、步频[(42.34±14.23)和(44.58±13.87)步/min]、10 m步行时间[(27.14±18.15)和(25.02±17.19)s]、6 min步行距离[(350.15±110.23)和(430.10±99.23)m]、PCI[(1.67±0.72)和(0.91±0.81)次/m]均有明显改善。组内比较,除WO组的步长差异无统计学意义(P>0.05)外,2组患者的上述各项观察指标组内差异均有统计学意义(P<0.05);而且2组患者在穿戴步行矫形器的同时间点上述各项观察指标组间比较,差异均有统计学意义(P<0.05)。结论KAFO和WO两种步行矫形器对腰2节段A-B级脊髓损伤的步行参数、步行能力及PCI均有明显改善作用,且WO较KAFO更具有优势。

Objective To compare the effect of a knee-ankle-foot orthosis(KAFO)and a paraplegic walking orthosis(WO)on the walking ability and the physiological cost index(PCI)of persons suffering from AIS A-B spinal cord injury(SCI)at the L2 level.Methods Thirty subjects with AIS A-B SCI at L2,aged 20 to 45,were assigned randomly into a KAFO group(n=15)or a WO group(n=15).All received muscle strength,range of motion,standing,balance and weight shifting training and training in the activities of daily life.Electrotherapy and acupuncture were also administered.Both groups underwent 60 minutes of walking training 6 times per week for 12 weeks,wearing either a KAFO or a WO.Step length,gait speed,step frequency,10-metre walk time,6-minute walk distance and PCI were compared after 2 and 12 weeks.Results The average step length,gait speed,step frequency,10-metre walk time,6-minute walk distance and PCI of both groups had improved significantly between the 2-week and 12-week evaluations,with significantly greater average improvement among the WO group at both time points.Conclusion A WO or KAFO facilitates better walking after an AIS A-B spinal cord injury at L2.Wearing a WO is more effective than wearing a KAFO,on average.