卢海燕,胡恕香,李培,等.两种腕手矫形器对痉挛型偏瘫脑瘫患儿上肢运动功能的影响[J].中华物理医学与康复杂志,2026,48(4):317-322
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| 两种腕手矫形器对痉挛型偏瘫脑瘫患儿上肢运动功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20241222-00998 |
| 中文关键词: 脑瘫 痉挛型 偏瘫 腕手矫形器 |
| 英文关键词: Cerebral palsy Spasticity Hemiplegia Wrist-hand orthoses |
| 基金项目:福建省卫生健康科技计划项目资助 (2022TG02) |
| 作者 | 单位 | | 卢海燕 | 厦门大学附属妇女儿童医院,儿科学系,儿童神经康复科,厦门 361003 | | 胡恕香 | 厦门大学附属妇女儿童医院,儿科学系,儿童神经康复科,厦门 361003 | | 李培 | 厦门大学附属妇女儿童医院,儿科学系,儿童神经康复科,厦门 361003 | | 郭培坚 | 厦门大学附属妇女儿童医院,儿科学系,儿童神经康复科,厦门 361003 | | 俞陈雨 | 厦门大学附属妇女儿童医院,儿科学系,儿童神经康复科,厦门 361003 |
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| 中文摘要: |
| 目的 探讨功能位腕手矫形器和屈曲限动型腕矫形器对痉挛型偏瘫脑瘫患儿上肢运动功能的影响。 方法 选取痉挛型偏瘫脑瘫患儿93例，采用随机数字表法将其分为对照组、观察组、联合组，每组31例。对照组进行偏瘫侧上肢目标导向性训练，观察组在此基础上于夜间睡眠时佩戴功能位腕手矫形器，联合组则在观察组基础上于日间目标导向性训练时佩戴屈曲限动型腕矫形器。治疗前及治疗12周后（治疗后），分别采用Peabody运动功能发育量表的精细运动部分、徒手肌力评定（MMT）、改良Ashworth量表（MAS）评定3组患儿的精细运动发育商（FMQ）、腕伸肌肌力、腕屈肌肌张力，利用量角器测量患儿腕背伸的被动关节活动度（PROM）及主动关节活动度（AROM)。 结果 与组内治疗前比较，3组患儿治疗后的FMQ评分、MMT评分、MAS评分、PROM、AROM均有所改善（P＜0.05）。与对照组治疗后比较，观察组治疗后仅FMQ评分［(65.09±4.22)分］、MAS评分［(2.74±0.26)分］、PROM［(35.66±4.21)°］改善较为优异（P＜0.05），联合组治疗后的所有指标均显著优于对照组（P＜0.05）。与观察组治疗后比较，联合组治疗后的FMQ评分［(68.25±6.92)分］、MMT评分［(2.75±0.51)分］、MAS评分［(2.43±0.58)分］、PROM［(40.03±6.65)°］、AROM［(19.26±4.40)°］改善均较为优异（P＜0.05）。 结论 在日间目标导向性训练的基础上，夜间佩戴功能位腕手矫形器能有效改善痉挛型偏瘫脑瘫患儿的上肢运动功能，联合日间训练时佩戴屈曲限动型腕矫形器的改善效果更佳。 |
| 英文摘要: |
| Objective To compare the effects of a functional position wrist-hand orthosis with those of a flexion-limiting wrist orthosis in terms of the upper limb motor function of children with spastic hemiplegic cerebral palsy(SHCP). Methods Ninety-three children with SHCP were randomly assigned to either a control group, an observation group or a combination group, each of 31. Everyone received goal-directed training of their hemiplegic upper limb, but those in the observation group wore a functional position wrist-hand orthosis at night while sleeping while the combination group wore a flexion-limiting wrist orthosis during the daytime training for 12 weeks. Before and after the training, everyone′s fine motor quotient(FMQ) was assessed using the fine motor section of the Peabody Developmental Motor Scale-2(PDMS-2). Wrist extensor muscle strength was evaluated through manual muscle testing(MMT), and wrist flexor muscle tone was quantified using the modified Ashworth Scale(MAS). A goniometer was used to quantify both passive range of motion(PROM) and active range of motion(AROM) during wrist dorsiflexion. Results After the treatment, significant improvements in FMQ, MMT results, MAS ratings, PROM and AROM were observed in all three groups. Compared with the control group, there was significant improvement only in the average FMQ, MAS score and PROM of the observation group after the treatment. In the combination group, however, all of the indicators were significantly better, on average, than among the controls. The combination group significantly outperformed the observation group in terms of its average post-treatment FMQ, MMT results, MAS rating, PROM and AROM. Conclusions Based on daytime goal-directed training, nighttime wearing of a functional position wrist-hand orthosis can effectively improve the upper limb motor functioning of children with spastic hemiplegic cerebral palsy. The therapeutic effects are further enhanced when combined with a flexion-restricting wrist orthosis during daytime training. |
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