全身垂直律动疗法改善痉挛型双瘫脑性瘫痪患儿扁平外翻足的临床疗效观察

关键词：脑性瘫痪  痉挛型双瘫  足底压力  步态  跖屈外翻

Keywords:cerebral palsy  spastic and diplegic cerebral palsy  foot pressure  gait  plantar flexor valgus

摘要：

      摘要 目的：量化分析全身垂直律动（whole body vibration，WBV）疗法改善痉挛型双瘫脑性瘫痪（脑瘫）患儿扁平外翻足的临床疗效观察。 方法：随机选取上海儿童医学中心康复医学科收治的5—7岁痉挛型双瘫脑瘫患儿18例（对照组），同期与同济大学附属养志康复医院门诊收治的72例痉挛型双瘫脑瘫患儿按照相同年龄、相同性别、相同GMFCS分级进行1∶1配对（试验组），总计36例，且纳入的36例痉挛型脑瘫患儿皆有扁平外翻足表现。两组患儿均给予综合康复训练，试验组在综合康复训练基础上给予垂直律动疗法干预，观察两组患儿治疗前后扁平外翻足改善的临床疗效。疗效评价采用足底压力评估系统，应用2m足底压力测试系统（Rsscan International，比利时）对两组患儿在自然行走过程中进行测试。采用两独立样本t检验及配对样本t检验对两组患儿治疗前后的足底压力参数进行差异性检验。 结果：两组患儿治疗后与治疗前比较，在全足支撑时第1趾骨、第1—2跖骨、足跟内侧与地面接触面积降低（P<0.05）；第2—5趾骨、第4—5跖骨、足跟外侧与地面接触面积增加（P<0.05）；中足面积未见明显变化（P>0.05），足跟面积增加（P<0.05）；第1趾骨、第1—2跖骨、足跟内侧平均压力峰值降低（P<0.05），第2—5趾骨、第4—5跖骨、足跟外侧平均压力峰值增加（P<0.05）。两组患儿治疗后组间比较，第1趾骨、第1—2跖骨、第2—5趾骨、第4—5跖骨、足跟内外侧与地面接触面积及平均压力峰值、足跟面积有显著差异（P<0.05）。 结论：全身垂直律动疗法可有效缓解痉挛型双瘫脑瘫患儿跖屈外翻肌群痉挛状态，缓解其足外翻及步行时异常跖屈程度。但针对扁平足情况，未见明显临床疗效。

Abstract:

      Abstract Objective： To quantitatively analyze the clinical effect of whole body vibration therapy on flat valgus of patient with spastic diplegic cerebral palsy. Method： 18 subjects with cerebral palsy, ages ranging from 5 to 7 years old, from rehabilitation department in Shanghai children's medical center were randomly selected as control group. 18 of 72 cases from outpatient department in Yangzhi Rehabilitation Hospital Affiliated to Tongji University, 1:1 matched in age, sex, GMFCS, were selected as trial group. All the 36 cases had flat valgus and were given comprehensive rehabilitation training. Besides, the trial group was given vertical vibration therapy. The efficacy was evaluated using the pedobarography assessment system and the 2m foot pressure testing system (Rsscan International, Belgium). Independent sample T test and paired sample T test were used to test the differences of plantar pressure parameters before and after treatment. Result：For both the two groups, after treatment， the ground contact area of the 1st phalangeal bone, the 1st—2nd metatarsal bone, the medial side of the heel were decreased (P<0.05). The ground contact area between the metatarsal bone (2—5), metatarsal bone (4—5)， the lateral heel increased (P<0.05). There was no significant change in the middle foot area. The mean peak pressure of the 1st phalangeal bone, the 1st—2nd metatarsal bone and the medial side of the heel decreased (P<0.05), while the average peak pressure of the 2nd - 5th phalangeal bone, the 4th—5th metatarsal bone and the lateral side of the heel increased (P<0.05). After treatment， there were significant differences in the contact area between the first phalangeal bone， the first 1—2 metatarsal bone， the second 5 phalangeal bone， the fourth 5 metatarsal bone， the inner and outer surface of the heel and the ground， the average pressure peak， and the heel area between the two groups (P<0.05). Conclusion： The whole body vertical vibration therapy can effectively relieve the spastic state of plantar valgus flexor in CP children with spastic diplegia， and relieve the extent of valgus and abnormal plantar flexion during the walking process. But for flat foot， no obvious clinical effect was found.