目的：观察调肾通督健脑法推拿联合3D矫形鞋垫对痉挛型双瘫患儿下肢生物力学及三维步态时-空参数的影响。方法：将162例痉挛型双瘫患儿按随机数字表法分为对照组、观察1组和观察2组各54例。对照组采用常规康复治疗，观察1组在对照组基础上加用3D矫形鞋垫，观察2组在观察1组基础上加用调肾通督健脑法推拿。治疗前和治疗8周后，对三组患儿进行Berg平衡量表（BBS）评分、粗大运动功能评定量表（GMFM）中的D功能区、E功能区评分和下肢生物力学评估[包括立姿跟骨休息位（RCSP）角度、腓肠肌平均肌电信号均方根值（RMS）和超声剪切波弹性成像（SWE）]，检测三组患儿三维步态时-空参数（包括步行周期、步速、步长、单支撑时间及髋、膝、踝关节最大屈曲度）。结果：量表评分方面，观察2组GMFM的D功能区和E功能区评分均高于其他两组（P<0.05）；观察2组BBS评分高于对照组（P<0.05）。生物力学方面，观察2组左、右侧RCSP角度、腓肠肌RMS以及SWE腓肠肌Emean值均低于其他两组（P<0.05）。三维步态时-空参数方面，观察2组步长以及髋关节、膝关节、踝关节最大屈曲度均大于其他两组（P<0.05），单支撑时间短于其他两组（P<0.05）；步速高于对照组（P<0.05）。结论：调肾通督健脑法推拿联合3D矫形鞋垫可以通过纠正下肢力学分布、缓解痉挛改善痉挛型双瘫患儿的平衡功能和下肢运动功能。

Objective:To observe the effects of kidney-regulating,governor vessel-dredging,and brainstrengthening massage combined with 3D orthopedic insoles on the biomechanics and three-dimensional gait time-space parameters of lower limbs in children with spastic diplegia. Methods:A total of 162 children with spastic diplegia were divided into a control group,observation group 1,and observation group 2 by the random number table method,with 54 cases in each group. The control group received conventional rehabilitation treatment,the observation group 1 received 3D orthopedic insoles in addition to the control group's treatment,and the observation group 2 received kidney-regulating,governor vessel-dredging,and brainstrengthening massage in addition to the observation group 1's treatment. Before the treatment and after 8weeks of the treatment,the Berg balance scale(BBS) scores,gross motor function measure(GMFM) scores of sections D and E,and lower limb biomechanical assessments [including resting calcaneal stance position(RCSP) angles,average root mean square values of gastrocnemius muscle electromyography signals(RMS),and shear wave elastography(SWE)] were conducted for the children in all the three groups,along with the measurement of three-dimensional gait time-space parameters(including walking cycle,walking speed,stride length,single-limb support time,and maximum flexion angles of the hip,knee,and ankle joints). Results:In terms of scale scores,observation group 2 scored higher in the D and E sections of the GMFM than the other two groups(P<0.05). The BBS score of the observation group 2 was higher than that of the control group(P<0.05). In terms of biomechanics,the RCSP angles on the left and right sides,gastrocnemius RMS,and SWE gastrocnemius Emean values of the observation group 2 were lower than those of the other two groups(P<0.05). In terms of three-dimensional gait time-space parameters,the observation group 2 had greater stride length and maximum flexion angles of the hip,knee,and ankle joints than the other two groups(P<0.05) and shorter single-limb support times(P<0.05). The walking speed of the observation group 2was higher than that of the control group(P<0.05). Conclusions:Kidney-regulating,governor vessel-dredging,and brain-strengthening massage combined with 3D orthopedic insoles can improve the balance function and lower limb motor function of children with spastic diplegia by correcting lower limb mechanical distribution and alleviating spasms.