互动式推拿对痉挛型脑瘫患儿步态时空参数的影响

Effects of interactive Tuina on spatiotemporal gait parameters in children with spastic cerebral palsy

目的:探讨步行功能导向的互动式推拿对痉挛型脑瘫(CP)患儿步态时空参数的影响。方法:将50例痉挛型双侧瘫痪的CP患儿按照配对设计随机数字原则分为观察组和对照组,每组25例。观察组采用步行功能导向的互动式推拿;对照组采用“脊背六法”推拿。两组均每次治疗20 min,每周5次,连续治疗3个月。采用粗大运动功能评估量表88项(GMFM-88)中E能区(行走与跑跳)百分比及三维步态分析评估患儿的变化情况。结果:治疗后两组GMFM-88中E能区(行走与跑跳)百分比与本组治疗前差异均有统计学意义(P<0.05);两组GMFM-88中E能区(行走与跑跳)百分比差异有统计学意义(P<0.05)。治疗后观察组患者步长、步速、步频与治疗前有统计学差异(P<0.05),与对照组差异亦有统计学意义(P<0.05)。观察组治疗后支撑和双支撑相相较治疗前延长,摆动相较治疗前缩短(P<0.05),与对照组差异亦有统计学意义(P<0.05)。治疗后,观察组膝关节最大屈曲角度及骨盆最大后倾角度较治疗前减小,骨盆最大前倾角度较治疗前增大,组内差异均有统计学意义(P<0.05),与对照组差异亦有统计学意义(P<0.05)。结论:步行功能导向的互动式推拿较“脊背六法”被动推拿在改善痉挛型CP患儿步行功能方面有优势,可以更好地改善下肢关节力线,提高步行效率。

Objective:To discuss the effects of walking function-guided interactive Tuina(Chinese therapeutic massage)on spatiotemporal gait parameters in children with spastic cerebral palsy(CP).Methods:Fifty children with spastic diplegic CP were divided into an observation group and a control group following a paired design and random number principle,with 25 cases in each group.The observation group was treated with the walking function-guided interactive Tuina,and the control group was offered the“six methods of spine and back”Tuina,20 min for each session and 5 sessions weekly for 3 consecutive months.The children’s changes were assessed using the percentage of dimension E(walking,running,and jumping)of the gross motor function measure-88(GMFM-88)and three-dimensional gait analysis.Results:After treatment,the percentage of GMFM-88 dimension of dimension E(walking,running,and jumping)changed significantly in both groups(P<0.05),and the between-group difference was also statistically significant(P<0.05).After treatment,the step length,walking speed,and step frequency changed markedly in the observation group(P<0.05)and were significantly different from those in the control group(P<0.05).After the intervention,the stance phase and double support extended,and the swing phase became shorter in the observation group(P<0.05);the between-group differences were statistically significant(P<0.05).The maximal knee flexion angle and maximal posterior pelvic tilt angle decreased After treatment in the observation group,and the maximal anterior pelvic tilt angle increased,all showing statistical significance(P<0.05);the between-group differences were statistically significant(P<0.05).Conclusion:Compared with the passive Tuina manipulations,the“six methods of the spine and back”,walking function-guided interactive Tuina has its advantage in improving walking function in children with spastic CP,manifesting as better lower-limb force line and walking efficiency.