康复治疗对脊髓损伤患者功能恢复的影响

目的　研究不同水平、不同程度的脊髓损伤患者经过综合康复治疗后的功能恢复情况。方法　采用神经生理学方法配合传统疗法及矫形器的应用 ,对 50例患者进行了系统的康复治疗 ,用ASIA标准评分、ADLBarthel指数、Lindmark法中的平衡、转移能力和Ashworth痉挛分级评定SCI患者的功能状况。结果　治疗后 ,脊髓部分损伤者ASIA运动评分有显著提高 (P <0 .0 1) ,感觉评分亦明显提高 (P <0 .0 5) ,颈髓完全损伤者ASIA运动评分有明显提高 (P <0 .0 5) ,颈髓完全损伤者ASIA感觉评分和胸腰髓完全损伤者ASIA运动、感觉评分虽有改善 ,但差异无显著性意义 ,(P >0 .0 5) ;颈髓完全损伤者ADL平衡和转移能力均无明显改善 (P >0 .0 5) ,其他患者ADL、平衡和转移能力均有显著提高 (P <0 .0 1)。痉挛随病程的延长而加重 ,以颈部为明显 (P <0 .0 5)。使用步行矫形器后 ,5例完全性T10 以下截瘫患者达到了功能性步行。结论　综合康复治疗能显著改善和提高脊髓损伤患者的运动功能和综合功能 ,其中以平衡和转移能力改善最为显著 (P <0 .0 1)。

Effects of comprehensive rehabilitation on recovery of functional performance in patients with spinal cord injury

Objective To study the effects of co mprehensive rehabilitation on recovery of functions in patients with SCI at dif ferent levels and degrees of injuries. MethodsFifty patients with SCI were treated with comprehensive rehabilitation including PT, traditional Chinese therapeutics and orthosis etc. The functions of all patients were assessed by ASIA assessment, Barthel index, ability of balance and transfe r (Lindmark) and Ashworth scale before and after rehabilitation intervention. ResultsAfter rehabilitation intervention, the motor scores (ASIA)were significantly increased in patients with incomplete SCI ( P <0.01), sensory scores (ASIA) were also higher ( P <0.05), the motor scores ga ined in the patients with complete cervical injury were significantly higher ( P <0.05),the sensory scores in the patients with complete cervical injury as w ell as the motor scores gained in the complete thoracic injury were improved, bu t there was no significant difference among them ( P >0.05). The scores of ADL and abilities of balance and transfer were improved significantly ( P <0.01) in the patients other than those with complete cervical injury ( P >0.05). The spasticity became more serious with time since the injury, especially in the t etraplegics ( P <0.05). By using orthosis 5 patients with T10 complete paraple gic regained functional ambulation. ConclusionCompr ehensive rehabilitation is able to significantly improve multiple functions in p atients with SCI, especially to improve the ability of balance and transfer.