杨潍嘉 陈智 刘向阳 伍宝银 唐智生 覃英 黄光良

【摘要】 目的 觀察中药外敷对小儿痉挛型脑瘫踝关节活动度改善情况。方法 选择2018年4月～2019年6月桂林市妇女儿童医院小儿康复科43例、桂林市人民医院优生遗传门诊和康复科19例、平乐县人民医院康复科2例，共64例小儿痉挛型脑瘫患儿为研究对象，采取随机数字表将患儿分为治疗组（32例）和对照组（32例），对照组采用推拿+运动功能训练方式治疗，治疗组在对照组基础上加用中药外敷踝关节，比较两组患儿治疗3个疗程后疗效、踝关节活动度改善情况。结果 治疗后两组患儿疗效均较好，治疗组显效率96.88%优于对照组显效率68.75%，差异有统计学意义（P<0.01）。治疗3个疗程后，两组踝背屈、踝跖屈活动度均较治疗前明显改善（P<0.05），治疗后组间比较虽无统计学意义（P>0.05），但治疗组治疗前后的差值大于对照组，差异有统计学意义（P<0.01或0.001）。结论 中药外敷联合推拿+功能训练疗效较好，能改善小儿痉挛型脑瘫患儿踝关节活动度，且流浸膏外敷安全、方便、无毒副作用，操作简单，适合推广。

【关键词】 痉挛型脑瘫;功能训练;中药;流浸膏剂;踝关节

中图分类号：R272   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2020.07.006

【Abstract】 Objective To observe the improvement of ankle joint activity in children with spastic cerebral palsy by external application of traditional Chinese medicine.Methods A total of 64 children with spastic cerebral palsy treated in the Department of Pediatric Rehabilitation of Guilin Women and Children's Hospital（43 cases），the Department of Eugenics and Genetics and the Department of Rehabilitation of Guilin People's Hospital（19 cases） as well as the Department of Rehabilitation of Pingle People's Hospital（2 cases） from April 2018 to June 2019 were selected as research objects.The children were divided into treatment group（32 cases） and control group（32 cases） according to random number table.The control group were treated with massage and exercise function training，while the treatment group were treated with external application of Chinese medicine on ankle joint on the basis of the control group.And then，the curative effect and the improvement of ankle joint activity were compared between the two groups after 3 courses of treatment.Results After treatment，the curative effect of the treatment group（96.88%） was better than that of the control group（68.75%），difference was statistically significant（P<0.01）.After 3 courses of treatment，ankle dorsiflexion and ankle plantar flexion activities of the two groups significantly improved compared with those before treatment（P<0.05）.Although there was no statistically significant difference between the two groups after treatment（P>0.05），the difference before and after treatment in the treatment group was larger than that in the control group，and the difference was statistically significant （P<0.01 or 0.001）.Conclusion External application of traditional Chinese medicine combined with massage and functional training can effectively improve ankle joint mobility of children with spastic cerebral palsy，and the external application of flow extract is safe，convenient and simple to operate without toxic side-effects，which is suitable for promotion.

【Key words】 spastic cerebral palsy;functional training;traditional Chinese medicine;liquid extract;ankle joint

小儿脑性瘫痪（cerebral palsy，CP）简称脑瘫，是指从出生到生后1个月内由于各种原因导致的发育缺陷或脑损伤造成的姿势异常及运动障碍[1]临床上分痉挛型、手足徐动型、强直型、共济失调型、震颤型、肌张力低下型、混合型七种类型，其中痉挛型最常见，占所有脑瘫的60%～70%[2] 。痉挛型脑瘫患儿由于下肢肌张力高、足踝变形，踝关节运动受限而呈现尖足，继而步行姿势异常，严重影响患儿正常生活。传统的推拿+运动疗法等综合康复治疗对改善痉挛型脑瘫患儿生活质量有明显效果，常用康复手法有Bobath法、Vojta法、Rood法等，主要是针对患兒的运动障碍、智力低下、语言障碍和听力障碍等进行治疗。……