目的 探讨生物力学(ICB)矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响,为治疗痉挛型脑性瘫痪足外翻患儿提供有效的治疗方法及临床依据。方法 将2017年1月—2019年12月收治的80例痉挛型脑瘫患儿采用随机数字表法分为对照组和观察组,对照组(40例)行常规康复训练,观察组(40例)在常规康复训练的基础上联合ICB矫形鞋垫康复治疗,分别于治疗6月后进行内侧纵弓(MLA)、支撑相各分期、足弓指数(AI)、步长、步频、步速、88项粗大运动功能评定量表(GMFM-88)、Berg平衡量表(BBS)指标检测。结果 1)对照组与观察组组内治疗前后相比MLA、支撑相各分期、AI、步长、步频、步速、GMFM-88、BBS均呈明显的下降趋势,差异有统计学意义(P＜0.01);2)治疗后对照组右MLA、支撑相早、中、末期、AI、步长、步频、步速、BBS、GMFM-88的D能区和E能区与观察组之间有明显的统计学差异(t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P＜0.05);3)治疗后对照组左足内弓角与观察组之间无明显的统计学差异(P＞0.05),但观察组下降趋势优于对照组。结论 ICB矫形鞋垫联合康复训练能够改善痉挛型脑瘫患儿外翻足,提高双下肢运动功能及步行能力,可作为临床治疗痉挛型脑瘫患儿外翻足的辅助方法推广应用。
Abstract
Objective To investigate the effect of biomechanics orthopedic correction of insole(ICB insole) on lower limb function and gait in spastic cerebral palsy children with hallux valgus, in order to provide effective treatment and clinical basis for the treatment of spastic cerebral palsy children with hallux valgus. Methods From January 2017 to December 2019,80 children with spastic cerebral palsy were enrolled in this study and were randomly divided into control group (n=40) and observation group (n=40).The control group received rehabilitation training, while the observation group was given ICB orthopedic insole additionally.After 6 months of treatment, medial longitudinal arch (MLA), each stage of support phase, arch index (AI), step length, step frequency, step speed, Gross Motor Function Measure-88 (GMFM-88) and Berg Balance Scale (BBS) scores were measured. Results 1) After treatment, MLA, each stage of support phase, AI, step length, stride frequency, stride speed, GMFM-88 and BBS scores in control group and observation group showed a significant downward trend (P<0.01).2) After treatment, there were significant differences in right MLA, each stage of support phase, AI, step length, stride frequency, stride speed, BBS GMFM-88 and D.E region of scores between control group and observation group (t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P< 0.05).3) After treatment, there was no significant difference in the left inner arch angle between control group and observation group (P>0.05), but the downward trend of observation group was better than that of control group. Conclusions ICB orthopedic insole combined with rehabilitation training can improve the valgus foot of children with spastic cerebral palsy, improve the motor function and walking ability of both lower limbs, and can be used as an auxiliary method for the clinical treatment of valgus foot in children with spastic cerebral palsy.
关键词
脑性瘫痪 /
矫形鞋垫 /
外翻足 /
下肢功能 /
步态
Key words
cerebral palsy /
orthotic devices /
hallux valgus /
lower limb function /
gait
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 李晓捷, 唐久来, 马丙祥, 等.脑性瘫痪的定义、诊断标准及临床分型[J].中华实用儿科临床杂志,2014, 29 (19):1520
[2] 王丹, 钟清玲.脑瘫患儿家庭远程康复的研究进展[J].中华护理杂志, 2016, 51 (12): 1474-1478.
[3] Camasta CA, Graeser TA.Tarsal coalition and pes planovalgus: Clinical examination, diagnostic imaging, and surgical planning[M].The Pediatric Foot and Ankle,2020, 7:191-218.
[4] Venado CEF, Ayala AN, Trejo MSS, et al.Comparative assessment of flatfoot in preschool children[J].Bol Med Hosp Infant Mex, 2020, 77(6): 312-319.
[5] Abdul Yamin NAA, Basaruddin KS, Salleh AF, et al.Effects of running surface stiffness on three-segment foot kinematics responses with different shod conditions[J].Appl Bionics Biomech,2021,7(30):8842591
[6] 梁亚利, 张静, 廖瑞松, 等.痉挛型偏瘫脑性瘫痪患儿的步态分析[J].中华物理医学与康复杂志, 2017, 39 (6): 450-452.
[7] David Ó, Peter F.Identifying differences in gait adaptability across various speeds using movement synergy analysis [J].PLoS One,2021,16(1):e0244582.
[8] 白啸天, 霍洪峰.足踝功能的生物力学测评:构建足静态和动态评价指标[J].中国组织工程研究, 2021, 946 (17):129-136.
[9] 李波, 赵佳华,仲映旭.足弓结构对足部运动特性的影响[J].中国皮革,2016,45(7):52-55.
[10] Hollander K, Stebbins J,Albertsen IM, et al.Arch index and running biomechanics in children aged 10-14 years[J].Gait & Posture, 2018, 61 (12):210-211.
[11] Reddy S,Balaji GK.Dynamic surface exercise training in improving trunk control and gross motor functions among children with quadriplegic cerebral palsy: A single center, randomized controlled trial[J].J Pediatr Neurosci, 2020, 15 (3):214-215.
[12] Sperotto L.Gross Motor Function Measure (GMFM-66 & GMFM-88) User′s Manual[J].Intl J Disabil Dev Educ, 2016,63 (6):654-655.
[13] Lee BJ,Joo NY, Kim SH, et al.Evaluation of balance functions using temporo-spatial gait analysis parameters in patients with brain lesions[J].Sci Rep,2021,11 (1):2745-2746
[14] Xu MJ, Qiu ZW, Qiu LY, et al.Therapeutic effect of 3D insole combined with exercise rehabilitation training on plantar fasciitis[J].World Latest Medicine Information, 2019, 19 (30):28-29,32.
[15] Kanatl U, Aktas E, Yetkin H.Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet?[J].Orthop Sci, 2016, 21 (5):662-665.
[16] Lee J S, Kim K B,Jeong J O, et al.Correlation of foot posture index with plantar pressure and radiographic measurements in pediatric flatfoot[J].Ann Rehabil Med, 2015, 39 (1):10-17.
[17] 李阳, 宋毓, 姜淑云, 等.三维步态分析技术在矫形器领域的应用[J].中国康复医学杂志, 2018,33(7):874-877.
[18] Pasin Neto H,Grecco LAC,Ferreira LAB, et al.Postural insoles on gait in children with cerebral palsy: Randomized controlled double-blind clinical trial [J].J Bodyw Mov Ther, 2017, 21(4):890-895.
[19] Deepa J, Doreen B.Subgrouping children with cerebral palsy from a broader perspective using two methods[J].Physiother Theory Pract,2018, 34 (109):1-11.
[20] Andrea F.A novel mobility device to improve walking for a child with cerebral palsy[J].Pediatr Phys Ther, 2017, 29 (4):E1-E7.
[21] Grant AD .Gait analysis: Normal and pathological function[J].Physiotherapy, 2010, 97(8):180-180.
[22] 刘帅, 黄艳.生物力学矫形鞋垫在痉挛型偏瘫患儿平衡及步行能力中的应用效果[J].医学理论与实践, 2020, 33 (5):155-157.
[23] Wang C,Goel R, Rahemi H, et al.Effectiveness of daily use of bilateral custom-made ankle-foot orthoses on balance, fear of falling, and physical activity in older adults:a randomized controlled trial[J].Gerontology, 2019, 65 (3):299-307.
[24] 郭朋, 罗聪.基于儿童扁平足病因、检测方法和治疗现状研究[J].医学信息, 2018, 31 (5):56-61.
[25] 陈秀华, 唐亮, 戴燕琼,等.矫形鞋垫联合踝关节持续被动运动用于偏瘫型脑瘫患儿步态稳定性控制的临床研究[J].现代生物医学进展,2018,18(11):2094-2097,2121.
[26] 周伊敏, 宋福祥, 张朋, 等.ICB矫形鞋垫对矫正痉挛型脑性瘫痪患儿足外翻及粗大运动功能的影响[J].黑龙江医药科学, 2018, 41(5):9-10,14.
[27] Jagadamma KC, Coutts FJ, Mercer TH, et al.Effects of tuning of ankle foot orthoses-footwear combination using wedges on stance phase knee hyperextension in children with cerebral palsy-preliminary results.[J].Disabil Rehabil Assist Technol, 2009, 4(6):406-413
[28] Jones RK,Zhang M,Laxton P,et al.The biomechanical effects ofa new design of lateral wedge insole on the knee and ankle during walking[J].Hum Mov Sci, 2013, 32 (4):596-604.
[29] Shonglun S, Zhongjun M, Junchao G, et al.The effect of arch height and material hardness of personalized insole on correction and tissues of flatfoot[J].J Healthc Eng,2017, 6 (12):1-9.
基金
国家自然基金面上项目(81973904);河南省中医药科学研究专项课题(20-21ZY2034;2019JDZX2053)
PDF(1707 KB)
