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目的观察经皮电神经刺激(TENS)结合功能训练对痉挛型脑性瘫痪(脑瘫)患儿运动功能的影响。方法 78例脑瘫患儿,年龄36～58个月[(45.6±8.5)个月],通过计算机分层(性别、年龄)后随机分为 TENS 组(40例)和对照组(38例)。2组患儿均接受功能训练。TENS 组使用2台TENS 治疗仪(每台2个输出通道),8个表面电极放在下肢痉挛肌群的两端肌腱和拮抗肌肌腹给予电刺激,每次20 min。以上治疗每日1次,每周5次,共治疗30次。之后指导家长实施家庭康复治疗。治疗前,治疗后的6、12、24周随访时进行以下评定:①综合痉挛量表(CSS),②粗大运动功能量表(GMFM)中的 D 和 E 两项,③步行速度。结果两组患儿的 CSS 评分、GMFM 评分及步行速度治疗前差异无统计学意义(P>0.05),治疗后6、12、24周组内差异均有统计学意义(P 均<0.05)。2组患儿的 CSS 评分、GMFM 评分及步行速度在治疗后6、12、24周组间差异均有统计学意义(治疗后24周:t 值分别为8.96、3.14、2.35,P 均<0.05)。结论与对照组比较,在痉挛型脑瘫患儿的患侧肢体上给予 TENS 治疗6周,能明显降低患儿下肢痉挛,提高其站立、步行功能和步行速度。
Objective To observe the effects of transcutaneous electrical nerve stimulation (TENS) combined with functional training on motor function in children with spastic cerebral palsy (cerebral palsy). Methods 78 children with cerebral palsy, aged 36-58 months (45.6 ± 8.5 months), were randomly divided into TENS group (40 cases) and control group (38 cases) by computer stratification (sex, age). Two groups of children received functional training. In the TENS group, two TENS devices (2 output channels per channel) were used. Eight surface electrodes were placed on the muscle of the lower extremity spastic muscles at both tendons and the muscle of the antagonist muscle for electrical stimulation for 20 min. The above treatment once a day, 5 times a week, a total of 30 treatments. After the guidance of parents to implement family rehabilitation treatment. Before treatment, 6,12,24 weeks after treatment were assessed at the follow-up: ① comprehensive spasticity scale (CSS), ② coarse motor function scale (GMFM) D and E two, ③ walking speed. Results There was no significant difference in CSS score, GMFM score and walking speed between the two groups before treatment (P> 0.05). There was significant difference between the two groups (P <0.05) at 6, 12 and 24 weeks after treatment. CSS score, GMFM score and walking speed of the two groups were statistically significant at 6,12,24 weeks after treatment (24 weeks after treatment: t values were 8.96,3.14,2.35, P <0.05 respectively ). Conclusion Compared with the control group, TENS treatment for 6 weeks in the affected limbs of children with spastic cerebral palsy can significantly reduce the lower extremity spasm and improve their standing, walking function and walking speed.