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背景:15年前国内在江苏省与山东省交界地区大规模爆发脊髓灰质炎流行,15年后存活患儿日常生活能力以及功能概况如何?目的:明确残存患儿的功能状态,提出适合的康复医学建议。设计:以患者为对象的横断面的调查。单位:南京医科大学第一附属医院康复医学科。对象:1989年发病的邳州小儿麻痹后遗症患者共545例,以当地希望之家为中心随机化选取能够接受调查与评估的患儿333例小儿麻痹后遗症患者,采用集中方式在一周内完成评估。方法:邳州市进入康复项目的333例小儿麻痹后遗症患者集中至希望之家,由2位康复医师和1位治疗师为一个评估小组,共5组同时进行肢体功能与肌力、生活自理能力、手术矫治和辅助具配置的评定。肌力评定、肢体功能情况采用积分评定。关节活动检查用关节角度计方式。肢体长度测量采用皮尺测定髂前上棘至内踝和脐至内踝的距离,分别测定解剖长度和功能长度。肢体畸形分析主要采用目测和体检的方式。主要观察指标:主要结局包括足的形态、骨盆位置、髋关节、膝关节和踝关节的外形、肢体围度等。结果:按意向处理分析,333例小儿麻痹后遗症患者进入结果分析,年龄主要集中在15～17岁,占总例数的97%。独立行走135例(40.5%),使用双拐148例(44.4%)。双下肢功能长度差距最小值0.5cm,最大值13.0cm。双下肢累及(112例,33.6%)少于单下肢累及(211例,65.8%),四肢累及3例,上肢累及仅2例。另外已有46例患者已经行脊柱侧弯矫正术。使用矫形器的患者共计254例,其中双长腿矫形器110例,单腿131例。其中单左腿62例,单右腿79例。踝足矫形器3例。结论:除了肌力的因素外,导致步行能力障碍的重要原因是肢体畸形,多数肢体畸形可以通过手术、矫形器和康复训练得到显著改善,所有接受调查患儿存在进一步康复治疗的必要。建议成立多学科合作的团队,建立集体讨论制度,使这批小儿麻痹后遗症患者的康复功能达到最好的水平。
Background: 15 years ago, polio epidemic broke out on a large scale in the border areas between Jiangsu Province and Shandong Province. After 15 years, what are the daily living abilities and the functional profiles of surviving children? OBJECTIVE: To clarify the functional status of surviving children and to propose appropriate rehabilitation Medical advice. Design: A cross-sectional survey of patients. Unit: First Affiliated Hospital of Nanjing Medical University, Department of Rehabilitation Medicine. PARTICIPANTS: A total of 545 cases of post-polio sequelae in Danzhou in 1989 were randomly selected from 333 cases of children with poliomyelitis sequelae who were able to be surveyed and evaluated. The results were obtained within one week by a centralized method. Methods: 333 cases of poliomyelitis sequelae who entered rehabilitation project in Pizhou City were concentrated in Hope House. Two rehabilitation physicians and one therapist were included in the assessment group. A total of 5 groups were involved in limb function, strength and self-care ability at the same time. Surgical correction and assistive device configuration assessment. Muscle strength assessment, limb function using integral assessment. Joint activity check joint angle meter method. Body length measurement using a tape measure the anterior superior iliac spine to the medial malleolus and the umbilical to the medial malleolus distance were measured anatomical length and functional length. Physical deformity analysis using visual inspection and physical examination methods. MAIN OUTCOME MEASURES: The main outcomes include the morphology of the foot, the position of the pelvis, the hip shape, the shape of the knee and ankle joints, limb circumference, and more. Results: According to intention-to-treat analysis, 333 cases of poliomyelitis sequelae were included in the analysis of results. The age was mainly between 15 and 17 years old, accounting for 97% of the total cases. 135 cases (40.5%) walk independently and 148 cases (44.4%) use crutches. The minimum functional length of the lower limbs 0.5cm, the maximum 13.0cm. Lower extremity involvement (112 cases, 33.6%) was less than in the lower extremity (211 cases, 65.8%), limb involvement in 3 cases, upper extremity involvement in only 2 cases. In addition, 46 patients have been scoliosis correction surgery. A total of 254 patients with orthosis, of which 110 pairs of long-legged orthosis, 131 cases of single leg. Of which 62 cases of single left leg, 79 cases of single right leg. Ankle and foot orthosis in 3 cases. Conclusion: In addition to the factors of muscle strength, the most important reason for the impaired walking ability is limb deformity. Most limb deformities can be significantly improved by surgery, orthosis and rehabilitation training. All children under investigation have the need for further rehabilitation. It is proposed to set up a multidisciplinary team to establish a system of discussion so that the rehabilitation functions of these polio sequela patients will reach the best level.