뇌성마비 아동에서 선택적 척수 신경 후근 절단술후의 운동능력 변화

Abstract

[영문]

[한글]

이 연구의 목적은 뇌성마비아동에 있어 GMFM(gross motor function measure) 평가도구

를 이용하여 선택적 척수 신경 후근 절단술 전·후의 운등능력의 변화를 알아보는데 있다

.

연구대상은 1990년 3월부터 1993년 4월까지 연세대학교 의과대학 부속 재활병원에 입원

하여 선택적 척수 신경 후근 절단술(selective posterior rhizotomy)을 시술받은 24명의

뇌성마비아동을 대상으로 수술전과 수술 6개월후의 전체 운동능력 점수와 각 영역별 운동

능력 점수의 변화를 관찰하였다.

이 연구의 결과는 다음과 같다.

첫째, 수술후 전체 운동능력 점수는 수술전에 비해 평균 7.91점이 향상되었다(P<0.01).

둘째, 각 영역별 운등능력 변화점수는 눕기와 뒤집기 영역은 수술전·후 모두 100점으

로 차이가 없었고, 앉기 영역은 평균 5.95점, 네발기기와 무릎서기 영역은 평균 6.75점,

서기 영역은 평균 14.79점, 걷기·달리기·뛰기 영역은 평균 12.33점의 향상이 있었으며

서기 영역에서 가장 큰 향상을 나타냈다(P<0.01).

세째, 운동능력 변화점수는 수술전 독립보행 불능군이 보행가능군 보다 5.75점 높았다(

p<0.05).

네째, 수술시기는 5세 이하의 연령군에서 가장 높은 운동능력 점수의 향상을 보였다(p<

0.05).

다섯째, 지능과 운동능력 점수 변화는 관련성이 없었다(p>0.05).

여섯째, 뇌성마비 분류에 따른 운동능력 점수의 변화는 경직성 양마비에서 증가를 보였

으나 통계적 유의성은 없었다.

이상의 결과로 미루어 볼때 선택적 척수 신경 후근 절단술은 수술의 적응증을 신중하게

적용하고 수술후 집중적인 재활치료를 하면 뇌성마비 아동에서 운동능력의 향상을 기대

할 수 있으며, 독립보행 불능군과 5세전에 수술한 경우 많은 향상을 기대할 수 있다.

Gross motor changes for lowing selective posterior rhizotomy in children with

cerebral palsy

Young Rok Kim

Graduate School of Health Science and Management Yonsei University

(Directed by Professor Chang Il Park, M.D., Ph.D.)

This study was designed to evaluate the change of gross motor function following

selective posterior rhizotomy in children with cerebral palsy. In this study, 24

children with cerebral palsy, ranging in age at surgery from 3 to 12 years(avg.

6.9), were selected. They had had surgery in which the selective posterior

rhizotomy was performed at Yonsei University Medical center. They were admitted for

rehabilitation in the Yonsei University Rehabilitation Hospital between March 1990

to April 1993.

This study measured the gross motor changes in subjects both one week prior to

surgery and 6 months after surgery. The measurement tool used was the GMFM(gross

motor function measure) scale. The data were analyzed by Wilcoxon signed rank test,

Mann-whitney test, Kruskal-Wallis test.

The results were as follows:

1. The total gross motor mean score difference between the pre-operative and 6

months post-operative score was 7.91 (P<0.01).

2. Gross motor scores were analysed in each of 88 conditions, lying, sitting,

crawling, walking etc. Lying & Rolling scores remained unchanged. Improvement was

seen in Sitting scores(5.95 p<0.01), Crawling & Kneeling (6.75 p<0.01),

Standing(14.79 p<0.01), Walking·Running·Jumping (12.33 p<0.01). The greatest

improvement was seen in standing scores.

3. The total mean change in GMFM scores before and after surgery showed a greater

increase (5.75 higher, p<0.05) in the non-ambulatory group than the ambulatory.

According to condition, the non-ambulatory/ambulatory total wean change (pre and 6

mos. post surgery) difference when compared were as for laws: Lying & Rolling : no

difference: non-ambulator improved over ambulators in Sitting, Crawling & Kneeling

and Standing by mean score difference of 11.65(p<0.01), 10.36(p<0.05), and

9.78(p<0.05) respectively. However, in Walking·Running·Jumping, the ambulatory

group mean scores were higher by a mean of 2.30.

4. The most improved outcome (regardless of ambulation status) was found in the

below 5 year age group(p<0.05).

5. IQ was not a relevant factor(p>0.05).

6. While there was a difference in the improvement between CP type scores, the

small number of subjects precludes statistical inference.

These results showed that selective posterior rhizotomy combind with intensive

post surgery rehabilitation for children with cerebral palsy had a significant

effect on gross motor function. However, further studies with long tern fort low-up

and larger sample size should be done to show more definitive results.