Abstract: Objective To compare the effect of different stretching methods on the muscle tension of children with spastic cerebral palsy (CP) and the differences in their tolerance. Methods A total of 53 CP patients, who were treated in Chengdu Women's and Children's Central Hospital from September 2019 to May 2020 and met the inclusion criteria, were randomly divided into observation group (n=27) and control group (n=26).The observation group was given a small range of progressive drafting method, while control group received a large range of static drafting method.Both groups received routine rehabilitation treatment, and were intervened for 12 weeks with the frequency of 30 minutes/time,1 time/day, 5 times/week.The changes of muscle tension in the children were observed by Modified Ashworth Scale(MAS), joint range of motion (ROM) and other indicators before and after the training.The modified CHEOPS pain scoring method was used to observe the changes in children's tolerance. Results After treatment, the muscular tension (MAS) scores of the two groups were lower than those before treatment (control group:t=2.121, 4.947, 2.476; observation group:t=3.422, 5.322, 2.933), the measurement of joint mobility improved compared with that before treatment (control group: t=2.061, 2.017, 2.053; observation group:t=4.357, 3.936, 3.349), and the modified CHEOPS pain score was significantly higher than that before treatment (t=39.817, 16.908,P＜0.05).After treatment, the muscle tension of adductor femoris, hamstrings and ankle plantar flexor of children in the observation group was significantly higher than that in control group (t=2.230, 2.133, 2.173, P＜0.05).The adductor angle, the popliteal angle and the dorsiflexion angle of the foot in the observation group improved more than the control group (t=2.059, 2.119, 2.105,P＜0.05 ),while the improvement of CHEOPS pain score during stretching treatment was more significant in control group(t=13.157, P<0.001). Conclusion Progressive stretching therapy is more effective in improving the muscle tension of children with spastic cerebral palsy, and is more easily accepted by children with high tolerance, so it is suitable for application and promotion in the rehabilitation of children with cerebral palsy.

Key words: drafting, small range progressive draft, large range static draft, spastic cerebral palsy

摘要： 目的 比较不同牵伸方式对痉挛型脑瘫患儿(CP)肌张力影响及患儿耐受程度的差异。方法 选取2017年9月-2020年5月在成都市妇妇儿童医院治疗的符合纳入标准的53例痉挛型脑瘫患儿随机分为渐进式牵伸法组(观察组)27例和静态式牵伸法组(对照组)26例,两组均进行常规康复治疗,30min/次,1次/d,5次/周,训练12周;训练前后分别采用改良Ashworth量表(MAS)观察患儿股内收肌、腘绳肌、踝跖屈肌肌张力变化情况,采用关节活动度(ROM)观察患儿内收肌角、腘窝角、足背屈角变化情况,采用改良CHEOPS疼痛评分法观察患儿耐受程度变化情况。结果 治疗后两组患儿肌张力(MAS)评分较治疗前降低(对照组:t=2.121、4.947、2.476,观察组:t=3.422、5.322、2.933)、关节活动度测量较治疗前改善(对照组:t=2.061、2.017、2.053,观察组:t=4.357、3.936、3.349)、改良CHEOPS疼痛评分较治疗前升高(t=39.817、16.908),差异均有统计学意义(P<0.05)。观察组与对照组治疗后比较,观察组患儿股内收肌、腘绳肌、踝跖屈肌肌张力降低更明显(t=2.230、2.133、2.173, P<0.05);内收肌角、腘窝角、足背屈角关节活动度观察组改善更显著(t=2.059、2.119、2.105, P<0.05),而对照组在牵伸治疗时改良CHEOPS疼痛评分升高情况更明显(t=13.157,P<0.001)。结论 渐进式牵伸治疗对改善痉挛型脑瘫患儿肌张力更明显,且患儿耐受度高更易接受,适宜在脑瘫儿童康复中应用、推广。

关键词: 牵伸, 渐进式牵伸, 静态式牵伸, 痉挛型脑瘫