应用往复式截瘫步行器重建完全性截瘫病人的步行功能

Application of reciprocating gait orthosis in restoration of functional gait for paraplegic patients

目的应用自行研制的往复式截瘫步行器(RGO)帮助截瘫患者重建站立和行走功能,促进截瘫患者全面康复。方法为19例T4～L1脊髓完全性损伤患者安装往复式截瘫步行器,并对其进行肌肉力量、关节活动度、平衡、站立等综合康复训练。结果19例患者中,16例应用往复式截瘫步行器可作功能性家庭内步行,3例可作治疗性步行。通过电话或信件随访,5例患者对截瘫步行器逐步熟悉和适应,达到功能性社区内步行,11例患者可作功能性家庭内步行,2例患者应用步行器作治疗性步行,1例患者放弃应用步行器。结论T4～L1完全性脊髓损伤患者可以应用往复式截瘫步行器以重建站立及步行功能、防治并发症、提高生存质量。损伤平面高低决定患者能否应用截瘫步行器步行,治疗师对病人进行的综合康复训练是影响使用效果的重要因素。对T6以上的截瘫患者应慎重,安装前应考虑患者的年龄、体型、上肢力量、脊柱稳定性、躯干的控制能力及腰背肌、腹肌肌力等条件,心理因素也不能忽视。

Objective To introduce and evaluate the application of self manufactured Reciprocating Gait Orthosis (RGO) to restore standing and walking functions of the paraplegic patients, and consequently to facilitate their systemic rehabilitation. Methods 19 paraplegic patients with complete spinal cord injury of lesion level ranging from T4 to L1 were fitted up with the RGO. All of them were hospitalized for the adjustment and adaptation of RGO. A comprehensive rehabilitation training program, including muscle strength and endurance training, restoration of range of motion, sitting and upright balancing and standing training, was simultaneously executed for the patients. Results Functional gait was achieved in 16 of the 19 patients with RGO, and therapeutic ambulation in the rest 3 patients. At follow ups by telephone or letter, 5 patients were community ambulators, 11 were household ambulators, and 2 were therapeutic ambulators. One patient abandoned the orthosis. Conclusions The RGO is indicated for the paraplegia patients with complete spinal cord injury of lesion level ranging from T4 to L1 to restore standing and functional walking, to prevent the paraplegic complications and to improve the quality of patientshealth and life. The RGO is only optional to those whose lesion level ranges from T4 to T6, depending on their age, body type, upper extremity strength, control of trunk and abdominal musculature. In addition to the lesion levels and degrees, the stability of the spine, health conditions, range of joint motion and good motivation should be taken into account before application of the RGO can be decided.