动态与静态踝足矫形器对痉挛型脑性瘫痪儿童的疗效比较

关键词：动态踝足矫形器  静态踝足矫形器  脑性瘫痪  痉挛

Keywords:dynamic ankle-foot orthosis  solid ankle-foot orthosis  cerebral palsy  spasticity

摘要：

      目的：探讨动态踝足矫形器（DAFO）与静态踝足矫形器（SAFO）在痉挛型脑性瘫痪（脑瘫）治疗中的应用及疗效。方法：38例具有行走能力（辅助行走或独立行走）但因腓肠肌痉挛致踝跖屈的双瘫患儿，年龄21—71个月，将其随机分为DAFO组18例及SAFO组20例。患儿入选后均进行康复训练及穿戴DAFO或SAFO。康复训练1次/d，1h/次，5次/周，12周为1个疗程。踝足矫形器每日至少穿戴2h以上，12周为1个疗程。分别于穿戴AFO前、穿戴AFO 1个月、3个月时进行以下评估：腓肠肌痉挛评分（改良Ashworth分值 MAS）、踝关节活动范围（ROM）、Berg平衡功能量表（BBS）及粗大运动功能量表（GMFM）的D区及F区百分比。结果：两组患儿穿戴踝足矫形器1个月和3个月后，MAS量化评分下降，踝关节ROM、Berg平衡功能和GMFM站立及走跑跳两大功能区评分均明显提高，与各自穿戴前相比，有显著性意义（P＜0.05或0.01）。穿戴踝足矫形器后组间比较，3个月评定点DAFO组踝关节ROM，Berg平衡功能评分，GMFM站立及走跑跳两大功能明显高于SAFO组（P＜0.01），而DAFO组与SAFO组相应评定点的MAS量化评分比较，无显著性意义（P＞0.05）。结论：DAFO既能帮助纠正足下垂，同时在步行时又提供足背屈功能，改善行走及提高平衡功能，可作为SAFO脱换成普通鞋前的一种过渡类型。

Abstract:

      Objective：To compare the therapeutic effects of two ankle-foot orthosis(AFO) configurations (dynamic DAFO and solid SAFO) for cerebral palsy children with spastic diplegia. Method：Thirty-eight patients (aged 21—71 months) with spastic diplegia possessed walking ability, but affected by the spasticity of gastrocnemius and plantar flexion of ankles, were randomly divided into DAFO group (n=18) and SAFO group(n=20). All patients were treated with rehabilitation training, while the patients in DAFO group wore DAFOs, and those in SAFO group wore SAFOs. AFOs were worn 3 months with more than 2h per day, while rehabilitation training was given 5d weekly for 3 months with 1h per day. The modified Ashworth Scale（MAS）, range of motion（ROM）, Berg balance Scale （BBS）and the gross motor function measure（GMFM）were performed at the beginning and at the end of the 1st month and 3rd month of treatment course respectively. Result： After wore AFOs, spasticity of gastrocnemius decreased and ROM, BBS and GMFM scores in the standing and walking function improved significantly（P<0.05 or 0.01） in two groups. The MAS, ROM, BBS and GMFM scores in DAFOs group patients were significantly better than those in SAFOs group after 3 months of treatment（P<0.01）. Conclusion：DAFOs can correct drop-foot and increase muscle strength of ankle dorsiflexors while walking, so DAFOs can be utilized as a transitional form between SAFOs and ordinary shoes.