重心移动式截瘫步行矫形器对脊髓损伤患者日常生活活动能力及生存质量的影响

关键词：截瘫  步行矫形器  往复式步行矫形器  日常生活活动  重心移动式步行矫形器  日常生活活动  生存质量

Keywords:paraplegia  gait orthosis  reciprocating gait orthosis  alternative gait orthosis  activities of daily living  quality of life

摘要：

      目的：了解装配重心移动式截瘫步行矫形器（AGO）后脊髓损伤患者日常生活活动能力（ADL）及生存质量（QOL）情况，证实AGO的应用价值。方法：完全性胸腰段脊髓损伤患者58例，按住院先后顺序及装配矫形器类型分为AGO组（27例）、交替迈步式步行矫形器（RGO）组（15例）、膝踝足矫形器（KAFO）组（6例）和对照组（10例）。各组均进行8周常规训练，包括肌力训练、平衡训练、转移训练、轮椅使用训练、ADL训练等，并在常规康复治疗的基础上使用步行矫形器并进行针对性步行训练6—8周。分别于入院时、装配矫形器前、装配矫形器后8周进行ADL评定和QOL评定。结果：组内比较，各组经常规康复治疗后ADL能力及QOL（生理及心理方面）均有所改善，治疗前后对比具有显著性意义（P<0.01）。组间比较， AGO组、RGO组在改善ADL能力和QOL-生理及心理方面优于KAFO组（P<0.05）和对照组（P<0.01），AGO组与RGO组相比无显著性意义（P>0.05），但在QOL-人际关系和周围环境方面，各组治疗前后均无明显改变。结论：AGO与进口截瘫步行矫形器一样在改善ADL和QOL方面有着良好的效果，但其价格便宜，可以广泛应用。

Abstract:

      Objection: To explore the effects on activity of daily living(ADL) and quality of life(QOL) after fitting alternative gait orthosis（AGO） in spinal cord injury(SCI) patients. Method: A total of 58 patients with complete SCI were according to the type of fitting walking orthosis divided into four groups， including AGO group（27 cases）， reciprocating gait orthoses(RGO) group（15 cases）， knee-ankle-foot orthoses(KAFO) group（6 cases） and control group（10 cases）. All the patients received 8 weeks rehabilitation training （including muscle strength training， balance training， transferring training， wheelchair using and ADL training etc.）. After fitting orthosis， the former three groups received 6—8 weeks standing and walking training. ADL assessment（BI and FIM） and QOL evaluation （WHOQOL-BREF） were taken before rehabilitation training， before fitting orthosis and 8 weeks after fitting respectively. Result: The abilities of ADL and QOL in physical health domain and psychological health domain elevated markedly after 8 weeks basic training in all the groups（P<0.01）. The effects in AGO group and RGO group were better than that in others（P<0.01 or P<0.05） and there was no difference between AGO group and RGO group after fitting orthosis（P>0.05）. On the other hand， there was no statistical difference in QOL of social relationships domain and environment domain in any group all the time. Conclusion: The using of AGO can improve the patients′ abilities of ADL and QOL as well as RGO. But the cost of AGO is much more lower， so it is suggested that AGO should be widely applied in the future.