手术配合系统康复治疗对脑瘫痉挛性马蹄足患儿步态的影响

Effects of surgical treatment combined with systematic rehabilitation on the gait of talipes equinovarus in children with spastic cerebral palsy

目的探究手术配合系统康复治疗对脑瘫痉挛性马蹄足患儿步态的影响。方法回顾性分析2016年7月—2019年5月广东三九脑科医院收治的32例(64足)痉挛型脑性瘫痪合并马蹄足患儿的临床资料,根据马蹄足分型制定跟腱延长术治疗策略,术后配合系统康复治疗。观察治疗前后患儿踝关节屈伸膝背曲度、爱丁堡视觉步态量表(EVGS)评分、步态轮廓评分(GPS)、步态偏离指数(GDI)及步速、步频、步长的变化。结果治疗后6、12、18个月患儿踝关节伸膝、屈膝背曲度均优于治疗前,而治疗后12、18个月较治疗后6个月有进一步改善,治疗后18个月较治疗后12个月改善更明显,差异均有统计学意义(P<0.05)。治疗后6个月EVGS评分、GPS较治疗前升高,GDI、步速、步频及步长则较治疗前降低(P<0.05);治疗后12个月EVGS评分、GPS、GDI、步速、步频及步长与治疗前相似(P>0.05);治疗后18月EVGS评分、GPS较治疗前降低,GDI、步速、步频及步长则较治疗前增加,差异均有统计学意义(P<0.05)。结论跟腱延长术配合系统康复治疗脑瘫痉挛性马蹄足效果良好,能有效改善患儿踝关节活动度,纠正异常步态。

Objective To explore the effects of surgical treatment combined with systematic rehabilitation on the gait of talipes equinovarus in children with spastic cerebral palsy(SCP).Methods Clinical data of 32 children(64 feet)who suffered from SCP with talipes equinovarus and received Achilles tendon lengthening(ATL)from July 2016 to May 2019 in Guangdong Sanjiu Brain Hospital were retrospectively analyzed.Treatment strategy of ATL based on the classification of talipes equinovarus was formulated following by postoperative systematic rehabilitation.Changes of the dorsal flexion angle of ankle joint at knee flexion and extension,Edinburgh visual gait scale(EVGS)score,gait profile score(GPS),gait deviation index(GDI),gait speed,gait frequency and stride length were observed before and after the treatment.Results The dorsiflexion angle of ankle joint with knee extension and flexion at 6,12 and 18 months after treatment were higher than those before treatment,in addition,the indicators at 12 and 18 months after treatment were higher than those at 6 months after treatment,furthermore,the improvements at 18 months were better than those at 12 months(P<0.05).At 6 months after treatment,EVGS and GPS of the patients were higher than those before treatment,while GDI,step speed,step frequency and step length were lower than those before treatment(P<0.05).At 12 months after the treatment,EVGS,GPS,GDI,step speed,step frequency and step length of the patients were similar to those before the treatment(P>0.05).However,EVGS and GPS at 18 months after treatment were lower,while GDI,step speed,step frequency and step length were higher than those before the treatment(P<0.05).Conclusions ATL combined with systematic rehabilitation has good effect for the treatment of talipes equinovarus in children with SCP,which can effectively improve the range of motion of ankle joint and correct the abnormal gait.