胸段脊髓损伤患者应用截瘫步行矫形器对下肢康复的影响  

Effect of paraplegia walking orthosis on rehabilitation of the lower extremity in patients with thoracic spinal cord injury

作　　者：杨勤 唐丹 赵艳玲 朱正坤 颜修盛 胡佛生 徐鸿辉 

机构地区：[1]广东省工伤康复医院从化院区康复部,广东省广州市510970 [2]广东省工伤康复医院康复研究所,广东省广州市510440 [3]广东省工伤康复医院语言治疗科,广东省广州市510440 [4]广东省工伤康复医院从化院区骨创烧伤康复科,广东省广州市510970

出　　处：《中国组织工程研究》2015年第31期4967-4972,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:胸段脊髓损伤常导致双下肢截瘫,截瘫步行矫形器能帮助截瘫患者改善下肢功能障碍,提高日常生活活动能力,重获站立和行走能力。目的:探讨截瘫步行矫形器对胸段脊髓损伤患者下肢肌肉痉挛及功能恢复的影响。方法:将20例胸段脊髓(T5-12)损伤患者根据损伤平面按美国脊髓损伤协会(American Spinal Injury Association,ASIA)标准分为完全损伤组和不完全损伤组,各10例,均装配截瘫步行矫形器。分别于装配前进行残余肌力训练、坐位平衡训练、转移训练;装配后平行杆内站立训练、平衡及转移训练;室内、户外助行器、肘拐步行训练。结果与结论:与治疗前相比,胸髓完全性损伤患者装配截瘫步行器治疗12周后ASIA评分增加,感觉无明显变化,痉挛随病程的延长而加重;不完全性损伤患者治疗12周后ASIA评分增加,感觉明显改善,痉挛随病程的延长无改变;两组患者日常生活活动能力(改良Barthel指数、功能独立性评测)有显著改善。与治疗2周时相比,治疗12周时2组患者10 m行走时间显著减少,6 min步行距离延长。说明胸段脊髓损伤患者装配截瘫步行器,能显著改善患者的运动功能、日常生活活动能力和步行能力,对肌痉挛控制也有一定的影响。BACKGROUND：Thoracic spinal cord injury often leads to double lower limb paralysis. Paraplegia walking orthosis can improve lower limb dysfunction, improve the daily living activity, and regain the ability to stand and walk in patients with paraplegia. OBJECTIVE：To discuss the effects of paraplegia walking orthosis on muscle spasticity and recovery of function of the affected lower extremity in patients with thoracic spinal cord injury. METHODS：The 20 patients with thoracic spinal cord injury （T5-12）, according to the damage plane by Americannbsp;Spinal Injury Association standard, were divided into complete damage group and incomplete damage group （n=10）. Al patients were fitted out paraplegia walking orthosis. They received residual muscle strength training, sitting balance training, and transfer training prior to assembly, and then subjected to standing exercise within paralel bar, balance and transfer training, and walking aid devices training indoor and outdoor, and elbow crutch training on foot after the assembly. RESULTS AND CONCLUSION：Compared with pre-treatment, American Spinal Injury Association score increased at 12 weeks after treatment with paraplegia walking orthosis, and sensation did not obviously alter. Spasm worsened with prolonged course of disease in the complete damage group. At 12 weeks after treatment, American Spinal Injury Association score increased, sensation apparently improved, and the spasm did not change with time in the incomplete damage group. Activities of daily living （modified Barthel index, and functional independence evaluation） evidently improved in both groups. Compared with 2 weeks, the 10-m walking time was noticeably reduced and the 6-minute walking distance was prolonged at 12 weeks in both groups. These results confirm that paraplegia walking orthosis fitted out in patients with thoracic spinal cord injury significantly improves the patient’s motor function, activities of daily living and walking ability, and also has certain influence on muscle sp

关 键 词：植入物 脊柱植入物 步行矫形器 脊髓损伤 截瘫 下肢 康复功能 肌肉痉挛 日常生活活动能力 步行能力 

分 类 号：R318[医药卫生—生物医学工程]