腦性麻痺兒童接受下肢軟組織鬆動手術之文獻及病歷回顧

Retrospective Literature and Chart Review of Children with Cerebral Palsy after Soft Tissue Releases in Lower Extremities

陳玉瑩(Yu-Ying Chen) ； 劉文瑜(Wen-Yu Liu) ； 張嘉獻(Chia-Hsieh Chang) ； 黃美涓(Alice MK Wong) ； 陳嘉玲(Chia-Ling Chen) ； 黃維彬(Wei-Bin Hwang)

《物理治療》 30卷3期 (2005/06) Pp. 139-147

摘要

目的：本篇研究透過（實證(Evidence-based practice)分析以及病歷回顧來瞭解國內外對於腦性麻痺兒童接受下肢軟組織鬆動術處理與成效。方法：在實證分析部份，搜尋文獻年代為1966至2004間，以英國國家健康服務(the National Health service in united Kingdom)的實證分類系統分析。在病歷回顧部份，以描述性統計分析林口長庚醫院在2002年11月到2003年11月間部分接受過下肢軟組織鬆動術之腦性麻痺兒童的病歷記錄。結果：實證醫學回顧共蒐集到17篇國外相關研究報告，7篇的實證等級屬於2+，10篇為2-。病歷回顧部分共蒐集到12位兒童的病歷記錄，比較手術前後病歷顯示多數的個案有可追溯到描述性的關節活動度及動作功能改善，但這些量化性評估常缺乏系統性追蹤。結論：國內單一醫療機構臨床常使用的軟組織鬆動術方式，接受手術年齡及成效評估與國外研究報告相似，但因個案人數少，缺乏有計劃性的系統追蹤，因此未來研究應強調系統化的動作功能評估及其它影響因子的追蹤，以瞭解如何提供最佳的手術形態及相關復健治療方式。

關鍵字

軟組織鬆動術 ； 腦性麻痺 ； 粗動作功能 ； 實證醫學

並列摘要

Purposes: The purpose of this study is to review the management and outcome of soft tissue releases in lower extremities for children with cerebral palsy (CP) through evidence-based practice (EBP) review and chart review. Methods: In EBP review, a systematic extensive search of literature published between 1966 and 2004 was performed. The evidence of each paper was determined by the National Health Service in United Kingdom (NHS) system. In chart review, the relevant records of children with CP who underwent soft tissue releases of lower extremities between November 2002 and November 2003 were reviewed. Descriptive analyses were used to report the operational (op) procedures and changes between the pre-op and the post-op conditions. Results: Seventeen publications were identified. Of those, there were seven at level 2+ and ten at level 2-. The review of the records identified 12 children (age from 3 to 9.1 years). Their gains after surgery were documented in their medical records by the brief descriptive comments. However, their measures were not performed regularly. Conclusions: The procedures, population, and outcome measures of soft tissue releases in this Taiwan hospital were similar to the other countries. However, limited to small case number and no regular follow-up, the current available documentation was not solid enough to provide a fundament of evidence-based practice. Future research may need to systematically investigate the changes of their gross motor outcomes, as well as other influencing factors, to provide the fundament of optimizing the effects of those procedures.

並列關鍵字

Soft tissue release ； Cerebral palsy ； Gross Motor Function ； Evidence-based practice