脊髓损伤合并截肢患者的康复效果分析

Rehabilitation of spinal cord injury complicated with amputation

中文关键词:  脊髓损伤  截肢  康复效果

英文关键词:Spinal cord injury  Amputation  Rehabilitation engineering

中文摘要:

  【摘要】 目的：探讨脊髓损伤合并截肢患者的康复治疗效果。方法：1991年～2011年共收治脊髓损伤合并截肢者6例，ASIA分级A级5例，C级1例；右下肢截肢者3例，左下肢截肢者1例，左上肢截肢者1例，右下肢与右上肢截肢者1例，均进行康复评价并确定康复方案。在患者全身情况和残肢关节活动度获得改善后，对截瘫合并下肢截肢者予穿戴假肢和矫形器行站立和行走训练，合并上肢截肢者予佩戴功能性假肢等康复治疗。经过物理治疗（PT）、作业治疗（OT）训练及佩戴相应的假肢和矫形器，并经过反复训练和强化后观察康复效果。应用脊髓损伤神经学分类国际标准（ASIA标准）评估患者神经功能，使用功能独立性评定（FIM）量表评估患者生活自理能力。结果：本组病例平均住院康复时间为126d（58~236d）。5例截瘫患者ASIA神经功能无明显改善（P＞0.05），但FIM运动评分显著提高（入院得分为25.83分，出院平均得分为52.17分）（P<0.05）。另1例颈脊髓损伤患者入院为不完全损伤，经过治疗后感觉评分提高58分，运动评分提高14分，FIM评分中自理活动能力提高9分，转移能力提高14分，运动能力提高5分。结论：脊髓损伤合并截肢患者经过佩戴假肢并予综合康复后，患者丧失的部分功能可得到替代，生活自理能力可得到明显提高。

英文摘要:

  【Abstract】 Objectives: To study the effect of rehabilitation for patients of spinal cord injury with amputation. Methods: Six cases of spinal cord injury with amputation were selected from the patients admitted in China Rehabilitation Research Center from 1991 to 2011. 5 cases had the ASIA grade in A, 1 case in C. 3 cases were right lower limb amputees, 1 case was left lower limb amputee, 1 case was right upper limb amptutee, 1 case was right lower and upper limb amputee. Rehabilitation assessment was performed before treatment plan laid down. After overall condition and range of motion(ROM) improved, SCI cases with lower limb amputees were prescribed to wear prosthetics and orthotics to stand and walk. Cases with upper limb amputees were prescribed to wear functional prosthesis. American Spinal Injury Association(ASIA) scale was used to evaluate the patients′ neurological function and Functional Independence Measure(FIM) was used to evaluate the patients′ activity of daily living(ADL). Results: The mean hospitalization time for the cases was 126 days(from 58 to 236 days). After comprehensive treatment including PT, OT, prosthesis, orthosis and intensive exercise for the five paraplegia cases, ASIA scale was not improved(P>0.05), FIM scores improved significantly(the average score was 25.83 for admission and 52.17 for discharge)(P<0.05). Another cervical spinal injury patient was an incomplete injured one, whose sensory and motor function increased by 58 and 14 scores respectively. FIM score of self-care, transfer and mobility increased 9, 14 and 5 scores respectively. Conclusions: Spinal cord injury patients with amputation can improve their self-care ability significantly by substitution of the lost function after equipped with prosthesis and comprehensive rehabilitation.