邳州市小儿麻痹后遗症评估分析报告

背景15年前国内在江苏省与山东省交界地区大规模爆发脊髓灰质炎流行,15年后存活患儿日常生活能力以及功能概况如何?目的明确残存患儿的功能状态,提出适合的康复医学建议.设计以患者为对象的横断面的调查.单位南京医科大学第一附属医院康复医学科.对象1989年发病的邳州小儿麻痹后遗症患者共545例,以当地希望之家为中心随机化选取能够接受调查与评估的患儿333例小儿麻痹后遗症患者,采用集中方式在一周内完成评估.方法邳州市进入康复项目的333例小儿麻痹后遗症患者集中至希望之家,由2位康复医师和1位治疗师为一个评估小组,共5组同时进行肢体功能与肌力、生活自理能力、手术矫治和辅助具配置的评定.肌力评定、肢体功能情况采用积分评定.关节活动检查用关节角度计方式.肢体长度测量采用皮尺测定髂前上棘至内踝和脐至内踝的距离,分别测定解剖长度和功能长度.肢体畸形分析主要采用目测和体检的方式.主要观察指标主要结局包括足的形态、骨盆位置、髋关节、膝关节和踝关节的外形、肢体围度等. 结果按意向处理分析,333例小儿麻痹后遗症患者进入结果分析,年龄主要集中在15～17岁,占总例数的97%.独立行走135例(40.5%),使用双拐148例(44.4%).双下肢功能长度差距最小值0.5 cm,最大值13.0 cm.双下肢累及(112例,33.6%)少于单下肢累及(211例,65.8%),四肢累及3例,上肢累及仅2例.另外已有46例患者已经行脊柱侧弯矫正术.使用矫形器的患者共计254例,其中双长腿矫形器110例,单腿131例.其中单左腿62例,单右腿79例.踝足矫形器3例.结论除了肌力的因素外,导致步行能力障碍的重要原因是肢体畸形,多数肢体畸形可以通过手术、矫形器和康复训练得到显著改善,所有接受调查患儿存在进一步康复治疗的必要.建议成立多学科合作的团队,建立集体讨论制度,使这批小儿麻痹后遗症患者的康复功能达到最好的水平.

Poliomyelitis sequela in Pizhou city

BACKGROUND: An epidemic outbreak of poliomyelitis occurred in Pizhou City, Jangsu Province, 15 years ago. It is important to appraise the daily living and function of those survived children.OBJECTIVE: To investigate the physical status of the survived children and propose appropriate suggestions on rehabilitation.DESIGN: Case-based cross-sectional study based on patients.SETTING: Department of Rehabilitative Medicine of First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 545 patients with poliomyelitis sequela, which was onset in 1989, were found in Qizhou, and 333 of them were randomly selected from the local"New Hope" nursing house and its surrounding areas.All patients were assayed in one week.METHODS: The survey included 333 polio victims in the nursing house or from the surrounding areas. The study was conducted by five research groups, with two physiatrists and one therapist in each group. Assessment included muscle strength, joint rang of motion, limb deformities, activities of daily living, previous surgical interventions and orthosis. The distance was measured from the anterior superior iliac to medial malleolus and from nave to the medial malleolus, respectively. Anatomic length and functional length were also measured.MAIN OUTCOME MEASURES: Major outcomes included the forms,shapes, or functions of foot, pelvic, hip, knee and ankle joints.RESULTS: According to intention-to-treat analyses, 333 patients with poliomyelitis sequela entered the final analysis. Most of them aged from 15 to 17 years old, which accounted for 97%. Totally 135 patients(40.5% )walked independently and 148 (44.4%) walked with-orthsis and/or crutches. The discrepancy was between 0. 5 cm to 13.0 cm. Patients with paraplegia were 112(33.6% ), which was lesser than those with monoplegia (211, 65.8% ). There were 3 cases with quadriplegia and 2 cases with upper limb involvement. Another 46 sufferers had already underwent the scoliosis prthomorphia. There were 254 subjects with orthosis, including 110 knee ankle feet orthosis for both legs and 131 knee ankle feet orthosis for one leg,with 62 at left and 79 at right. Only three ankle-foot orthosis were employed.CONCLUSION: Besides the factor of muscle strength, limb teratism is the key factor that causes walking disorders. Physical functions maybe improved through surgical intervention, orthosis modification, and rehabilitation training. Every child who received survey required further rehabilitative therapy. A multi-disciplinary team is essential to achieve a better outcome.