Al-Oraibi S, Tariah Hashem Abu, Alanazi Abdullah
College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
J Pediatr Rehabil Med. 2013;6(3):147-53. doi: 10.3233/PRM-130247.
Severe knee contractures that develop soon after muscle imbalance may not improve with stretching exercises and splinting. An alternative treatment is serial casting, which has been used to promote increased range of motion.
The purpose of this study was to compare the effectiveness of using serial casting and passive stretching approaches to treat knee flexion contracture in children with spina bifida.
In a pre/post randomized controlled study, ten participants were included in the serial casting group, while eight participants were included in the passive stretching intervention group. The degree of knee extension was measured at baseline, immediately after intervention, and at a one-year follow-up using a standard goniometer.
Both groups showed significant improvements in the degree of flexion contracture at the post-treatment evaluation and the follow-up evaluation. The serial casting group showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (9)=13.4, p < 0.001, and the one-year follow-up evaluation, t (9) = 7.46, p < 0.001. The passive stretching group also showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (7) =2.6, p < 0.05, and the one-year follow-up evaluation, t (7) = 3.6, p < 0.05. However, statistically significant improvements in the serial casting group compared with passive stretching group in relation to the degree of flexion contracture were found at the immediate post-treatment evaluation, F(1, 15)=246, p=0.0001, and the one-year follow-up evaluation, F (1, 15)=51.5, p=0.0001.
The outcomes of this study provide the first evidence that serial casting may be a useful intervention in treating knee flexion contracture in children with spina bifida. However, further investigations into serial casting, as well as investigations into the use of serial casting with other interventions, are warranted.
肌肉失衡后很快出现的严重膝关节挛缩可能无法通过伸展运动和夹板固定得到改善。一种替代治疗方法是连续石膏固定，已被用于促进活动范围增加。
本研究的目的是比较连续石膏固定和被动伸展方法治疗脊柱裂患儿膝关节屈曲挛缩的效果。
在一项前后随机对照研究中，连续石膏固定组纳入10名参与者，被动伸展干预组纳入8名参与者。使用标准测角仪在基线、干预后立即以及一年随访时测量膝关节伸展程度。
两组在治疗后评估和随访评估时屈曲挛缩程度均有显著改善。连续石膏固定组在治疗后评估时膝关节屈曲挛缩有显著改善，t(9)=13.4，p<0.001，在一年随访评估时，t(9)=7.46，p<0.001。被动伸展组在治疗后评估时膝关节屈曲挛缩也有显著改善，t(7)=2.6，p<0.05，在一年随访评估时，t(7)=3.6，p<0.05。然而，在治疗后立即评估时，连续石膏固定组与被动伸展组相比，在屈曲挛缩程度方面有统计学显著改善，F(1, 15)=246，p=0.0001，在一年随访评估时，F(1, 15)=51.5，p=0.0001。
本研究结果首次证明连续石膏固定可能是治疗脊柱裂患儿膝关节屈曲挛缩的有效干预措施。然而，有必要对连续石膏固定进行进一步研究，以及对连续石膏固定与其他干预措施联合使用进行研究。
