生物力学矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响

Effect of biomechanics correction insole on lower limb function and gait of spastic cerebral palsy children with hallux valgus

目的探讨生物力学(ICB)矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响,为治疗痉挛型脑性瘫痪足外翻患儿提供有效的治疗方法及临床依据。方法将2017年1月—2019年12月收治的80例痉挛型脑瘫患儿采用随机数字表法分为对照组和观察组,对照组(40例)行常规康复训练,观察组(40例)在常规康复训练的基础上联合ICB矫形鞋垫康复治疗,分别于治疗6月后进行内侧纵弓(MLA)、支撑相各分期、足弓指数(AI)、步长、步频、步速、88项粗大运动功能评定量表(GMFM-88)、Berg平衡量表(BBS)指标检测。结果1)对照组与观察组组内治疗前后相比MLA、支撑相各分期、AI、步长、步频、步速、GMFM-88、BBS均呈明显的下降趋势,差异有统计学意义(P<0.01);2)治疗后对照组右MLA、支撑相早、中、末期、AI、步长、步频、步速、BBS、GMFM-88的D能区和E能区与观察组之间有明显的统计学差异(t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P<0.05);3)治疗后对照组左足内弓角与观察组之间无明显的统计学差异(P>0.05),但观察组下降趋势优于对照组。结论ICB矫形鞋垫联合康复训练能够改善痉挛型脑瘫患儿外翻足,提高双下肢运动功能及步行能力,可作为临床治疗痉挛型脑瘫患儿外翻足的辅助方法推广应用。

Objective To investigate the effect of biomechanics orthopedic correction of insole(ICB insole)on lower limb function and gait in spastic cerebral palsy children with hallux valgus,in order to provide effective treatment and clinical basis for the treatment of spastic cerebral palsy children with hallux valgus.Methods From January 2017 to December 2019,80 children with spastic cerebral palsy were enrolled in this study and were randomly divided into control group(n=40)and observation group(n=40).The control group received rehabilitation training,while the observation group was given ICB orthopedic insole additionally.After 6 months of treatment,medial longitudinal arch(MLA),each stage of support phase,arch index(AI),step length,step frequency,step speed,Gross Motor Function Measure-88(GMFM-88)and Berg Balance Scale(BBS)scores were measured.Results 1)After treatment,MLA,each stage of support phase,AI,step length,stride frequency,stride speed,GMFM-88 and BBS scores in control group and observation group showed a significant downward trend(P<0.01).2)After treatment,there were significant differences in right MLA,each stage of support phase,AI,step length,stride frequency,stride speed,BBS GMFM-88 and D.E region of scores between control group and observation group(t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P<0.05).3)After treatment,there was no significant difference in the left inner arch angle between control group and observation group(P>0.05),but the downward trend of observation group was better than that of control group.Conclusions ICB orthopedic insole combined with rehabilitation training can improve the valgus foot of children with spastic cerebral palsy,improve the motor function and walking ability of both lower limbs,and can be used as an auxiliary method for the clinical treatment of valgus foot in children with spastic cerebral palsy.