重心移动式截瘫步行矫形器对胸腰段脊髓损伤患者的疗效分析
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摘要
目的观察胸腰段完全性脊髓损伤患者应用重心移动式截瘫步行矫形器(AGO)后对步行能力、日常生活活动能力和生存质量的临床疗效。方法胸腰段完全性脊髓损伤患者60例,随机分为AGO组和对照组,各30例。所有患者均进行SCI常规康复训练和处理,AGO组在常规治疗的基础上,装配AGO及进行步行训练。两组分别在入院时、装配AGO前、装配AGO后8周进行步行能力评定、ADL评定和生存质量评定。结果经4个月的治疗前后,进行组间比较,AGO及训练后,均可借助肘拐或步行器步行,患者10 m步行时间平均87.27s,6 min步行距离平均46.35 m;ADL能力在装配后比较治疗组明显优于对照组(P<0.01);生存质量评分中的生理和心理方面改善具有统计学意义(P<0.05)。结论AGO配合系统的康复治疗对改善胸腰完全性脊髓损伤患者日常生活活动能力、步行能力及生存质量有一定效果,值得临床进一步应用。
Objective To investigate the effects on walking ability, activity of daily living(ADL) and quality of life(QOL) after fitting the alternative gait orthosis(AGO) in thoracolumbar spinal cord injury(SCI)patients. Methods 60 patients with complete SCI were randomly divided into an AGO group(30 subjects)and a control group(30 subjects). All patients received a standard rehabilitation training(including muscle strength training, balance training, transferring training, wheelchair using and ADL training). Patients in the AGO group received an additional 8 weeks of standing and walking training. Outcome measurement including the walking ability, ADL and QOL assessment were taken before rehabilitation training, before fitting orthosis and after fitting respectively. Results After 4 months of treatment, AGO group patients can use the orthosis to walk; average 10 m walking time was 87.27 s, average 6 min walking distance was 46.35 m; ADL ability in the treatment group was significantly improved when compared with the control group(P<0.01); the improvement in physiological and psychological aspects of QOL score was statistically significant(P<0.05).Conclusion The using of AGO can improve the walking ability, ADL ability and QOL for patients with the thoracolumbar SCI, implicating that AGO should be widely applied in the future.
Objective To investigate the effects on walking ability, activity of daily living(ADL) and quality of life(QOL) after fitting the alternative gait orthosis(AGO) in thoracolumbar spinal cord injury(SCI)patients. Methods 60 patients with complete SCI were randomly divided into an AGO group(30 subjects)and a control group(30 subjects). All patients received a standard rehabilitation training(including muscle strength training, balance training, transferring training, wheelchair using and ADL training). Patients in the AGO group received an additional 8 weeks of standing and walking training. Outcome measurement including the walking ability, ADL and QOL assessment were taken before rehabilitation training, before fitting orthosis and after fitting respectively. Results After 4 months of treatment, AGO group patients can use the orthosis to walk; average 10 m walking time was 87.27 s, average 6 min walking distance was 46.35 m; ADL ability in the treatment group was significantly improved when compared with the control group(P<0.01); the improvement in physiological and psychological aspects of QOL score was statistically significant(P<0.05).Conclusion The using of AGO can improve the walking ability, ADL ability and QOL for patients with the thoracolumbar SCI, implicating that AGO should be widely applied in the future.
引文
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[7]Dumont RJ,Verma S,Okonkwo DO,et al.Acute spinal cord injury,part II:contemporary pharmacotherapy[J].Clin Neuropharmacol,2001,24(5):265-279.
[8]Karimi MT,Fatoye F.Evaluation of the performance of paraplegic subjects during walking with a new design of reciprocal gait orthosis[J].Disabil Rehabil Assist Technol,2016;,11(1):72-79.
[9]Ahmadi Bani M,Arazpour M,Farahmand F,et al.The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients:a literature review[J].Disabil Rehabil Assist Technol,2015,10(3):183-190.
[10]Hirokawa S,Grimm M,Thanh L,et al.Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and eletric stimulation of the thigh muscles[J].Arch Phys Med&Rehabil,1990,71(9):687-694.
[11]Jeffries EC,Hoffman SM,de Leon R et al.Energy expenditure and heart rate responses to increased loading in individuals with motor complete spinal cord injury performing body weight-supported exercises[J].Arch Phys Med Rehabil,2015,96(8):1467-1473.
[12]Cameron AP,Rodriguez GM,Schomer KG.Systematic review of urological follow up after spinal cord injury[J].J Urol,2012,187(2):391-397.
[2]Shingu H,Ohama M,Ikata T,et al.A nationwide epidemiologica survey of spinal cord injures in Japan from January 1990 to Decembe1992[J].Paraplegia,1995,33(4):183-188.
[3]Douglas R,Larson PF,D'Ambrosia R,et al.The LSU reciprocation-gai orthosis[J].Orthopedics,1983,6(7):834-839.
[4]Esquenazi A,Talaty M,Packel A,et al.The Re Walk powered exoskeleton to restore ambulatory function to individuals with thoracic level motor-complete spinal cord injury[J].Am J Phys Med Rehabil2012,91(11):911-921.(下转第231页)
[5]Menon N,Gupta A,Khanna M,et al.Ambulation following spinal cord injury and its correlates[J].Ann Indian Acad Neurol,2015,18(2):167-170.
[6]唐丹,裴国献,刘浩,等.往复式截瘫步行器及其在脊髓损伤患者中的应用[J].中国脊柱脊髓杂志,2010,20(1):75-77.
[7]Dumont RJ,Verma S,Okonkwo DO,et al.Acute spinal cord injury,part II:contemporary pharmacotherapy[J].Clin Neuropharmacol,2001,24(5):265-279.
[8]Karimi MT,Fatoye F.Evaluation of the performance of paraplegic subjects during walking with a new design of reciprocal gait orthosis[J].Disabil Rehabil Assist Technol,2016;,11(1):72-79.
[9]Ahmadi Bani M,Arazpour M,Farahmand F,et al.The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients:a literature review[J].Disabil Rehabil Assist Technol,2015,10(3):183-190.
[10]Hirokawa S,Grimm M,Thanh L,et al.Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and eletric stimulation of the thigh muscles[J].Arch Phys Med&Rehabil,1990,71(9):687-694.
[11]Jeffries EC,Hoffman SM,de Leon R et al.Energy expenditure and heart rate responses to increased loading in individuals with motor complete spinal cord injury performing body weight-supported exercises[J].Arch Phys Med Rehabil,2015,96(8):1467-1473.
[12]Cameron AP,Rodriguez GM,Schomer KG.Systematic review of urological follow up after spinal cord injury[J].J Urol,2012,187(2):391-397.