摘要
目的:观察脑性瘫痪患儿选择性脊神经后根切断术术后综合康复治疗的效果,并与未进行康复的患儿进行比较。方法:选择2003-10/2005-10吉林大学第一医院收治的痉挛性脑性瘫痪患儿60例,均进行了选择性脊神经后根切断术治疗。术后根据监护人意愿分为两组(n=30):①对照组不进行康复训练。②康复组执行预先拟定的综合康复治疗,采用Bobath技术,以一对一方式,进行康复训练,每天一两次,20～30min/次;同时进行体针和头针治疗,隔日针1次,30d为1个疗程,间隔半个月,再进行第2个疗程。术后1年进行肌力、肌张力和关节活动度及病理反射的测定,日常生活活动能力评估应用改良的Barthel指数(满分100分,<60分为不能自理)进行评定。结果:60例全部进入结果分析。①改良的Barthel指数:康复组得分显著高于对照组(78.50±0.97,70.70±0.56,t=12.07,P<0.01)。②肌力:评定了5块肌肉,康复组均高于对照组(P<0.01)。③肌张力:康复组降低比较明显,基本上降至正常,除髋内收肌外,均低于对照组(P<0.05或0.01)。④关节活动度:康复组内收肌角、窝角、足背屈角3个角度变化均优于对照组(P<0.01)。⑤病理反射:除跟腱反射外,其他变化均优于对照组(P<0.05)。结论:综合康复治疗可使选择性脊神经后根切断术术后患儿在肌力、肌张力、关节活动度以及日常生活活动能力的恢复中受益,是患儿术后进一步改善功能的有效手段。
AIM： To observe the curative effect of comprehensive rehabilitation in patients with spastic cerebral palsy following selective posterior rhizotomy.
METHODS： Sixty childhood patients with spastic cerebral palsy treated in the First Hospital of Jilin University from October 2003 to October 2005 were selected, and all subjects received treatment of selective posterior rhizotomy. After the operation, they were divided into two groups with 30 patients in each group according to guardian＇s will： ①Patients in the control group received no rehabilitative training. ②Patients in the rehabilitative group received advanced laying combined rehabilitative treatment with Bobath technique in one-to-one manner. The rehabilitative training was done for 20-30 minutes each time and twice per day; Meanwhile, treatment of body acupuncture and head acupuncture were given once every other day, and one course of treatment including 30 days with the intermission of half an month among courses of treatment. The muscle force, muscular tension, joint range of motion （ROM） and pathologic reflex were assayed one year after the operation, and the activities of daily living were evaluated with Barthel index （totally 100 points, 〈 60 as unable to care onself） .
RESULTS：A total of 60 patients were involved in the analysis of results. ①Improved Barthel index： It was significantly higher in the rehabilitative group than that in the control group （78.50±0.97,70.70±0.56,t=12.07,P 〈 0.01 ）. ②Muscle force： A total of 5 muscles were assayed, they were higher in the rehabilitative group than those in the control group （P 〈 0.01）. ③ Muscular tension： It was obviously decreased in the rehabilitative group than that in the control group, except hip adductor, they were decreased to normal range （P 〈 0.05 or 0.01）. ④ROM： Changes from angel of adductor, fossa poplitea and dorsiflexion of foot in the rehabilitative group were better than those in the control group （P 〈 0.01）.⑤Pathologic reflex： Except chilies reflex, other changes were better in the rehabilitative group than those in the control group （P 〈 0.05）.
CONCLUSION： Comprehensive rehabilitative treatment can benefit the recovery of muscle force, muscular tension, ROM, pathologic reflex as well as activities of daily living in childhood patients treated with selective posterior rhizotomy, it is an effective means of ameliorating patients＇ function after operation.
出处
《中国临床康复》
CAS
CSCD
北大核心
2006年第4期57-59,共3页
Chinese Journal of Clinical Rehabilitation
