不同步行矫形器在下胸段脊髓损伤中的应用探讨

探讨三种不同步行矫形器在下胸段脊髓损伤中的应用及对患者步行能力的影响。方法:T10-12完全性脊髓损伤患者16例,在装配步行矫形器前进行强化康复训练与治疗(包括肌力、心肺功能、转移、ADL、膀胱功能等),其中5例装配KAFO(KAFO组),5例装配Walkabout(Walkabout组),6例装配RGO(RGO组),矫形器装配后配合步态步行训练;分别于矫形器装配前和装配训练8周后应用ASIA运动评分、MBI及限时的步行功能检查(包括6min步行评测和10m步行时间评测)作为指标进行观察。结果:3组患者ASIA运动评分矫形器装配前后及组间比较差异无显著性意义(P>0.05),ADL(MBI)评分装配前后比较差异有显著性意义(P<0.01)、组间比较差异无显著性意义(P>0.05);装配训练8周后步行能力评分比较,Walkabout组与KAFO组差异具有显著性意义(P<0.01),RGO组与Walkabout组和KAFO组比较差异均具有显著性意义(P<0.01)。结论:步行矫形器与功能训练相结合对改善下胸段脊髓损伤患者的步行能力疗效显著,Walkabout和KAFO可恢复患者治疗性步行能力,而RGO则在恢复患者功能性步行能力方面效果理想。

Application of different walking orthoses in the lower thoracic spinal cord injury

Objective:To observe the influence on walking ability of patient with lower thoracic spinal cord injury after fitting three different types of walking orthoses.Method:16 patients with complete spinal cord injury at the level of T10-T12 received intensive training (including muscle strength,cardio-respiratory function,transferring, bladder function etc.) before fitting walking orthosis.And then, 5 cases fitting KAFO(KAFO group), 5 cases fitting Walkabout (Walkabout group) and 6 cases fitting RGO(RGO group) received gait walking training respectively.ASIA motor scores,MBI and Time-limited walking test(including 6-min Walking Test and Timed 10-meter Walking Test) were assessed respectively before fitting and 8 weeks after fitting orthosis.Result:There was no significant difference in movement function scores of patients inside group and among three groups before and after fitting walking orthosis(P>0.05). The significant difference inside group was found according to ADL(MBI)scores(P<0.01),but there was no significant difference among three groups(P>0.05).After fitting and training for 8 weeks,there was a significant difference between the Walkabout group and the KAFO group(P<0.05) in walking ability scores, the significant difference was also found between the RGO group with both the Walkabout group and the KAFO group(P<0.01).Conclusion: The walking orthosis combined with functional training can obviously improve walking ability of patient with lower thoracic spinal cord injury. The walkabout and KAFO can imorove the ability of therapeutic walking ,while RGO can effectively improve the ability of functional walking.