目的 分析比较痉挛型和不随意运动型脑瘫儿童疼痛的特点,探讨疼痛对脑瘫儿童康复治疗效果的影响。方法 采用自制脑瘫儿童疼痛调查问卷,对2017年1月至10月,125例明确诊断为痉挛型和不随意运动型的适龄脑瘫儿童进行问卷调查,并对回收的调查表进行分析。据疼痛调查问卷将其分为疼痛组(n=40)和无疼痛组(n=85)。两组分别取痉挛型和不随意运动型脑瘫患儿各15例作为观察对象,均接受常规康复治疗。分别于治疗前、治疗4周、治疗8周后采用粗大运动运动功能测试(GMFM-88)、精细运动功能测试(FMFM)、儿童功能独立性评定(WeeFIM)进行评估,并记录内收肌角、腘窝角和足背屈角角度。结果 痉挛型与不随意运动型脑瘫患儿疼痛特点不同。疼痛组与无疼痛组治疗4周和8周后,GMFM-88标准分、FMFM标准分、WeeFIM评分以及内收肌角、腘窝角和足背屈角角度较治疗前均明显提高(P<0.01),且两组在治疗前和治疗4周后均无显著性差异(t<1.732, P>0.05),但在治疗8周时无疼痛组各项指标均优于疼痛组(t>2.119, P<0.05)。结论 痉挛型脑瘫儿童和不随意运动型脑瘫儿童疼痛特点存在差异,疼痛可能影响脑瘫儿童康复治疗效果和功能独立性。
Objective To analyze the characteristics of pain in children with spastic and dyskinetic cerebral palsy, and to explore the influence of pain on the functional independence and rehabilitation.Methods A self-made Pain Questionnaire for Children with Cerebral Palsy was used to conduct a questionnaire survey on 125 children who were diagnosed as spastic and dyskinetic cerebral palsy from January to October, 2017, and the returned questionnaires were analyzed. According to the pain questionnaires, the subjects were divided into pain group (n=40) and no pain group (n=85). Then, 15 cases of spastic cerebral palsy and 15 cases of dyskinetic cerebral palsy were selected in each group. Both of them received routine rehabilitation. They were assessed with Gross Motor Function Measure-88 (GMFM-88), Fine Motor Function Measure (FMFM) and Wee Functional Independence Measure (WeeFIM), and the adductor angle, popliteal angle and foot dorsiflexion angle were recorded before, and four weeks and eight weeks after treatment.Results The pain characteristics of spastic and dyskinetic cerebral palsy were different. Four weeks and eight weeks after treatment, all the indexes improved in both groups (P<0.01). There was no significant difference in all the indexes before and four weeks after treatment between two groups (t<1.732, P>0.05), however, all the indexes were significantly better in the no pain group than in the pain group eight weeks after treatment (t>2.119, P<0.05).Conclusion The pain characteristics are different in children with spastic and dyskinetic cerebral palsy. The pain may affect their rehabilitation and functional independence.
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