目的 应用Gesell发育量表测查脑瘫儿在治疗前后的能区发育,探讨患儿的发育结构及治疗后的能区进步情况。方法 采用Gesell量表对在青岛市妇女儿童医院长期康复治疗的脑瘫儿进行治疗前后的发育测查,治疗后期对其进行粗大运动功能分级,评估不同粗大运动功能进步情况。结果 105例患儿完成测查,其中痉挛型74例,占70.48%,不随意运动型24例(22.86%)。脑瘫儿各能区的发育商均值在低下-边缘水平,大运动能区分数最低(56.22±16.64)。不同类型脑瘫的能区发育是不同的,痉挛型双瘫以大运动能区(51.92±10.18)、偏瘫以细动作能区(66.07±25.90)、不随意运动型以大运动(43.64±14.64)及细动作能区(47.07±19.27)发育商落后最明显。治疗后,患儿各能区的发育龄均有进步,差异具有统计学意义(P<0.05),其中大运动能区的进步月龄最少(P<0.05)。治疗后大运动能区和应物能区的发育商较治疗前差异有统计学意义(P<0.05)。大运动功能分级越高,大运动发育月龄及发育商越低、治疗后的进步月龄越少(P<0.05)。结论 不同类型脑瘫患儿的能区障碍分布不同,大运动障碍是脑瘫患儿的核心症状,且系统康复治疗后,进步最缓慢。临床工作中,应定期应用Gesell发育测查量表进行评估。

Objective To find the development structure of cerebral palsy by Gesell Development Scale and improvement after the treatment. Methods Cerebral palsy (CP) children had Gesell Development Scales test before and after treatment,and a gross motor function classfication after treatment. Results A total of 105 children had the tests,spastic CP was predominant (74/105,70.48%),dyskinetic CP secondly(24/105,22.86%).The development quotient of CP was at the low-edge level,and gross motor area was the lowest(56.22±16.64).The development structure of the CP subtypes was different,gross motor area in spastic diplegia (51.92±10.18),fine motor area in hemiplegia(66.07±25.90),gross and fine motor areas in the dyskinetic children(43.64±14.64,47.07±19.27) were fell most.After the treatment,the development age was improved(P<0.05);development quotient of gross motor and adaption to other subject areas had differences than before.And the higher the GMFCS was,the lower DA and DQ were,children had less improvement(P<0.05). Conclusion Gross motor retardation was the core symptom of CP,the intelligence structure of CP subtypes was different.After the treatment,the gross motor area had less improvement,and the rate of the improvement had a correlation with GMFCS.In the clinical work,Gesell Development Scales test should be had at regular intervals.