痉挛型脑瘫患儿个体化康复治疗前后步态特征分析  

Gait characteristics and walking ability before and after Individualized treatment of children with spastic cerebral palsy

作　　者：孙爱萍 毕胜 赵海红 张学敏 季润 霍剑菲 吴慧楠 Sun Aiping;Bi Sheng;Zhao Haihong(Department of Neurological Rehabilitation, National Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids, Beijing 100176, China)

机构地区：[1]国家康复辅具研究中心附属康复医院神经康复科,北京100176 [2]国家康复辅具研究中心,北京市老年功能障碍康复辅助技术重点实验室,北京100176 [3]国家康复辅具研究中心,民政部人体运动分析与康复技术重点实验室,北京100176

出　　处：《中国康复》2020年第6期317-320,共4页Chinese Journal of Rehabilitation

摘　　要：目的:采用三维步态分析定量评价痉挛型脑瘫患儿下肢步态特征,为其下肢功能的康复疗效提供量化评定依据。方法:选取我院10例脑瘫患儿为观察组,再将12例健康儿童为对照组,应用三维运动捕捉系统采集2组的步态时空参数及运动学参数,根据评定结果为观察组制定个体化康复训练,在训练1个月前后分别对观察组采用粗大运动功能评定(GMFM)、Berg平衡量表(BBS)、改良Ashworth肌张力评定量表(MAS)及三维步态分析系统进行评定。结果:治疗1个月后,观察组GMFM和BBS评分较治疗前均明显提高(均P<0.01),MAS评分较治疗前明显下降(P<0.01)。观察组步态周期和跨步时间较治疗前均明显降低(均P<0.05),步频、跨步长、步长及髋、膝关节的关节活动度和屈曲最大角度以及踝关节的关节活动度较治疗前均明显增加(P<0.05,0.01);观察组治疗前后较对照组比较,步频、步速、跨步长及步长均明显降低(均P<0.01),除了膝关节屈曲最大角度差异无统计学意义,其余髋、膝及踝关节各运动学参数均明显增加(均P<0.01)。结论:三维步态分析可以量化评定脑瘫患儿的下肢运动功能,能为患儿康复治疗方案的精确制订及疗效评估提供客观科学依据。Objective:To analyze the gait characteristics of lower limbs in children with spastic cerebral palsy by three-dimensional gait analysis and provide quantitative evaluation basis for rehabilitation of lower limb function in children with cerebral palsy.Methods:Ten children with cerebral palsy in our hospital were selected as the treatment group,and 12 healthy children as the control group.The gait time and space parameters and kinematics parameters of the 2 groups were collected by three-dimensional motion capture system.Before and after training for 1 month,the treatment group was assessed by gross motor function measure(GMFM),Berg balance scale(BBS),modified Ashworth Scales scores(MAS)and three-dimensional gait analysis system.Result:After one month of treatment,GMFM and BBS scores in the treatment group were significantly higher than those before treatment(both P<0.01),and MAS scores were significantly lower than those before treatment(P<0.01).The gait cycle and stride time in the treatment group were significantly lower than those before treatment(both P<0.05),and the stride frequency,stride length,stride length,joint mobility and maximum flexion angle of hip and knee joint and joint mobility of ankle joint were significantly increased as compared with those before treatment(P<0.05,0.01).As compared with the control group before and after treatment,the step frequency,pace,stride length and step length in the treatment group were significantly reduced(all P<0.01).Except for the maximum angle difference of knee joint flexion,the remaining kinematic parameters of the hips,knees and ankle joints were significantly increased(all P<0.01).Conclusion:Three-dimensional gait analysis can quantify the function of lower limb movement in children with cerebral palsy,and can provide objective scientific basis for the precise formulation of rehabilitation treatment and the evaluation of efficacy.

关 键 词：脑瘫 痉挛 步态分析 康复 

分 类 号：R49[医药卫生—康复医学] R742[医药卫生—临床医学]