摘要
我国脑性瘫痪(CP)患儿发病率较高,给患儿、家庭、社会带来巨大的经济负担。剪刀步态、扁平足、足内翻或外翻等足部畸形是痉挛性CP患儿下肢痉挛的主要表现。CP属于非进行性脑损伤及神经受损。目前尚无有效治疗药物,若足部畸形长期得不到矫正,会导致肌肉、筋膜和韧带产生改变发生挛缩,可继发骨骼发育畸形,距跟、距舟和趾关节骨性关节炎,距跟关节和距跟舟关节骨性畸形,失去被动牵拉矫正的机会。扁平足者长期站立、行走、跑跳容易出现肢体疲劳和疼痛,必须尽早筛查确诊,实施康复训练。目前关于CP患儿足部畸形评定方法尚无统一标准。本研究对CP患儿足部畸形评定方法进行综述,主要阐述了静态分析评定法(足印分析法、影像学评定、立位跟骨休息位角度和距下关节硬度评定、表面肌电图检测等)、动态分析评定法(粗大运动功能分级系统、Berg平衡量表、足底压力系统等)相关评估工具的原理、检测评估方法、优缺点及适用范围,以期为CP患儿足部畸形的诊断、康复治疗和康复效果评估提供参考。研究发现,静态分析评定法主要倾向于结构的评价,动态分析评定法主要倾向于平衡与运动功能的评估。
The incidence of cerebral palsy(CP) is high in China,which brings huge economic burden to patients,families and society.Foot deformities such as scissors gait,flat foot,varus or valgus are the main manifestations of lower limb spasm in patients with spastic cerebral palsy.Cerebral palsy is a kind of non-progressive brain injury and nerve damage.At present,there is no effective treatment.If the foot deformity was not corrected for a long time,the muscles,fascia and ligament will change and contracture will occur,which can lead to secondary skeletal deformity,osteoarthritis of talocalcaneal,talonavicular and phalangeal joints,bony deformities of talocalcaneal joints and talonavicular joints,and miss the opportunity for passive traction correction.Patients with flat feet are prone to limb fatigue and pain when standing,walking,running and jumping for a long time,so it is necessary to screen and diagnose as soon as possible and implement rehabilitation training.Currently,there is no unified standard for the evaluation of foot deformity in children with CP.This review summarizes the evaluation methods for foot deformity in children with CP,mainly including the principles,evaluation methods,advantages,disadvantages and scope of application of related evaluation tools for static analysis(footprint analysis,imaging evaluation,angle of standing calcaneus rest position,subtalar joint hardness,surface electromyography,etc.) and dynamic analysis(gross motor function grading system,Berg balance scale,plantar pressure system,etc.).The purpose is to provide reference for the diagnosis,rehabilitation treatment and rehabilitation outcomes evaluation of foot deformities in children with CP.The review found that the static analysis and evaluation method was mainly used for structure evaluation,while the dynamic analysis and evaluation method was mainly used for the evaluation of balance and motor function.
作者
张雪原
马丙祥
李华伟
孔亚敏
李瑞星
谢克功
ZHANG Xueyuan;MA Bingxiang;LI Huawei;KONG Yamin;LI Ruixing;XIE Kegong(Medical School of Pediatrics,Henan University of Chinese Medicine,Zhengzhou,Henan 450046,China;The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,450003,China)
出处
《康复学报》
CSCD
2022年第6期562-568,共7页
Rehabilitation Medicine
基金
国家自然科学基金面上项目(81973904)
河南省中医药科学研究专项课题(2021JDZY021,20-21ZY2034)。
关键词
脑性瘫痪
足部畸形
静态分析评定法
动态分析评定法
儿童
cerebral palsy
foot deformity
static analysis and evaluation method
dynamic analysis and evaluation method
children
