社区开具的踝足矫形器对痉挛型脑瘫患儿步态参数的影响。
The effect of community-prescribed ankle-foot orthoses on gait parameters in children with spastic cerebral palsy.
作者信息
Hayek Shlomo, Hemo Yoram, Chamis Sam, Bat Reuven, Segev Eitan, Wientroub Shlomo, Yzhar Ziva
机构信息
Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv, 64239, Israel,
出版信息
J Child Orthop. 2007 Dec;1(6):325-32. doi: 10.1007/s11832-007-0055-z. Epub 2007 Nov 1.
PURPOSE
To evaluate the efficacy of ankle foot orthoses (AFOs) prescribed in the community for children with cerebral palsy (CP).
METHODS
Fifty-six children (32 boys and 24 girls, mean age 8.9 years, range 4-17) who were diagnosed as having CP were enrolled. They were grouped according to the type of CP, diplegic (n = 38) and hemiplegic (n = 18). Three-dimensional gait analyses while patient were barefoot and with AFOs were obtained and analyzed.
RESULTS
The spatio-temporal findings were the most significantly changed as a result of AFO use. In the hemiplegic group, stride length was 11.7% (p = 0.001) longer with AFOs in both affected (10.2%) and non-affected (12.4%) legs, and cadence was reduced by 9.7%; walking speed was not affected. In the diplegic group, stride length with AFOs was 17.4% longer compared to barefoot (p < 0.001) and walking velocity improved by 17.8% (p < 0.001); cadence was unchanged. AFOs also increased ankle dorsiflexion at initial contact in both groups. In the hemiplegic group, AFOs produced an average 9.4 degrees increase of dorsiflexion at initial contact (IC) on the affected side (p < 0.001) and 5.87 degrees on the unaffected side (p = 0.007), and an increase of 9.9 degrees (p < 0.001) dorsiflexion at swing, on the affected side. In the diplegic group, dorsiflexion at IC was increased by 13.4 degrees on the right side and 7.8 degrees on the left side (p = 0.05; p > 0.001, respectively) and an increase of 6 degrees (p = 0.005) at swing. In the hemiplegic group of patients, knee flexion at initial contact on the affected side was reduced by 8.5 degrees (p = 0.032) while in the diplegic group we found no influence. The number of patients that reached symmetry at initial double support tripled (from 5.6 to 16.7%) with the use of AFOs.
CONCLUSIONS
Our results showed that the use of AFOs improves spatio-temporal gait parameters and gait stability in children with spastic cerebral palsy. It has a lesser effect on proximal joint kinematics. Children with spastic hemiplegia display greater improvement than those with spastic diplegia.
目的
评估社区中为脑性瘫痪（CP）儿童开具的踝足矫形器（AFO）的疗效。
方法
纳入56名被诊断为患有CP的儿童（32名男孩和24名女孩，平均年龄8.9岁，范围4 - 17岁）。他们根据CP类型分组，双瘫型（n = 38）和偏瘫型（n = 18）。获取并分析了患者赤脚和佩戴AFO时的三维步态分析结果。
结果
使用AFO后，时空参数变化最为显著。在偏瘫组中，佩戴AFO时，患侧（10.2%）和非患侧（12.4%）的步幅长度均增加了11.7%（p = 0.001），步频降低了9.7%；步行速度未受影响。在双瘫组中，佩戴AFO时的步幅长度比赤脚时增加了17.4%（p < 0.001），步行速度提高了17.8%（p < 0.001）；步频未变。AFO还增加了两组在初始接触时的踝关节背屈角度。在偏瘫组中，佩戴AFO使患侧在初始接触（IC）时背屈平均增加9.4度（p < 0.001），非患侧增加5.87度（p = 0.007），在摆动期患侧背屈增加9.9度（p < 0.001）。在双瘫组中，IC时右侧背屈增加13.4度，左侧增加7.8度（分别为p = 0.05；p > 0.001），摆动期增加6度（p = 0.005）。在偏瘫组患者中，患侧在初始接触时的膝关节屈曲减少了8.5度（p = 0.032），而在双瘫组中未发现影响。使用AFO后，在初始双支撑期达到对称的患者数量增加了两倍（从5.6%增至16.7%）。
结论
我们的结果表明，使用AFO可改善痉挛型脑性瘫痪儿童的时空步态参数和步态稳定性。对近端关节运动学的影响较小。痉挛型偏瘫儿童比痉挛型双瘫儿童改善更明显。
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