小儿脑性瘫痪类型与手功能分级相关性初探

The Relationship Between the Damages of Hand Functions and the Type of Cerebral Palsy in Children

中文关键词:  肿瘤 PICC 知信行水平

英文关键词:Cerebral palsy The type of cerebral palsy Hand functions

中文摘要:

      目的 探讨脑瘫患儿的脑瘫类型和手功能受损情况以及两者之间的相关性。方法 采用中文版脑瘫患儿手功能分级系统 ( Manual Ability Classification System, MACS)对成都市20个区市县残疾人联合会登记在册的4～12岁脑瘫患儿手功能进行评定，并分析其与脑瘫类型的关系。结果 在调查的280例患儿中，痉挛型脑瘫195例（69.64%），其中痉挛型双瘫最多见（56.41%），痉挛型偏瘫最少见（1.03%）；在痉挛型脑瘫中，65.13%的患儿MACS分级为Ⅰ～Ⅱ级，而在混合型脑瘫和不随意运动型脑瘫中， 84.44%和80.95%的患儿MACS分级分别为Ⅲ～Ⅴ级。脑瘫患儿认知功能障碍程度的增加，其MACS功能分级水平也在增加（r=0.613, P<0.05）。脑瘫类型不同的患儿其MACS手功能分级有差别 ( P<0.05)，痉挛型脑瘫患儿大多表现为轻度手功能障碍，而混合型和不随意运动型脑瘫患儿大多表现为中重度手功能障碍。痉挛型脑瘫的不同亚型与MACS功能分级存在正相关（r=0.541, P<0.05），表现为绝大多数痉挛型双瘫的患儿手功能受损轻，而痉挛型四肢瘫患儿大多表现为中重度手功能障碍。MACS手功能分级与患儿父母受教育的程度及抚养人的类型无关（ P>0.05）。结论 脑瘫类型与MACS手功能分级有关，临床上根据脑瘫类型可预测脑瘫患儿的手功能受损情况，尽早制定有针对性的康复计划和分级管理措施。

英文摘要:

      Objective To establish correlations between joint proprioception, muscle flexion and extension peak torque, and functional ability in patients with knee osteoarthritis （OA）. Methods Fifty-six patients with symptomatic knee OA were recruited in this study. Both proprioceptive acuity and muscle strength were measured using the isomed-2000 isokinetic dynamometer. Proprioceptive acuity was evaluated by establishing the joint motion detection threshold (JMDT). Muscle strength was evaluated by Max torque （Nm） and Max torque/weight （Nm/kg）. Functional ability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index physical function (WOMAC-PF) questionnaire. Correlational analyses were performed between proprioception, muscle strength, and functional ability. A multiple stepwise regression model was established, with WOMAC-PF as dependent variable and patient age, body mass index (BMI), visual analogue scale (VAS)-score, mean grade for Kellgren-Lawrance of both knees, mean strength for quadriceps and hamstring muscles of both knees, and mean JMDT of both knees as independent variables. Results Poor proprioception (high JMDT) was negatively correlated with muscle strength ( P<0.05). There was no significant correlation between knee proprioception （high JMDT） and joint pain （WOMAC pain score）, and between knee proprioception （high JMDT） and joint stiffness （WOMAC stiffness score）. Poor proprioception (high JMDT) was correlated with limitation in functional ability (WOMAC physical function score r=0.659, P<0.05). WOMAC score was correlated with poor muscle strength (quadriceps muscle strength r=－0.511, P<0.05, hamstring muscle strength r=－0.408, P<0.05). The multiple stepwise regression model showed that high JMDT 〔standard partial regression coefficient (B)=0.385, P<0.05〕 and high VAS-scale score (B=0.347, P<0.05) were significant predictors of WOMAC-PF score. Conclusion Patients with poor proprioception is associated with poor muscle strength and limitation in functional ability. Patients with symptomatic OA of knees commonly endure with moderate to considerable dysfunction, which is associated with poor proprioception (high JMDT) and high VAS-scale score.