摘要
目的:探讨经络刮疗结合康复训练对脑卒中偏瘫患者上肢肱二头肌、肱三头肌表面肌电图及动力学的影响。方法:将80例脑卒中后偏瘫上肢肌张力增高患者按照随机数字表法分为综合组和西药组,每组各40例。西药组口服巴氯芬片治疗,综合组在口服巴氯芬片基础上对上肢阴经及阳经进行经络刮疗,治疗期间2组均接受相同的康复训练。经络刮疗和康复训练均每日1次,每周5次,连续4周。治疗前及治疗4周后,2组在患侧肘关节屈曲、伸展最大等长收缩时记录肱二头肌、肱三头肌肌肉收缩的积分肌电值,计算肘关节屈伸力矩及相应的协同收缩率。采用改良Ashworth量表、肘关节活动度及Fugl-Meyer测评法评价患侧屈肘痉挛上肢肱二头肌肌张力改善程度、肘关节活动度变化及运动功能恢复情况。结果:2组治疗后患肘屈曲、伸展力矩均高于治疗前(P<0.05),肱二头肌、肱三头肌的协同收缩率低于治疗前(P<0.05)。治疗后综合组患侧肘关节伸展力矩增加幅度大于西药组(P<0.05),肱二头肌协同收缩率降低幅度大于西药组(P<0.05)。治疗后2组患侧肱二头肌痉挛程度、肘关节自主活动度、上肢运动功能较治疗前明显改善(P<0.05),且综合组患侧肱二头肌痉挛程度、肘关节自主活动度、上肢运动功能改善优于西药组(P<0.05)。结论:经络刮疗结合康复训练能增强脑卒中偏瘫痉挛上肢伸肘力量,改善肘关节屈伸运动的协调性,降低患侧肱二头肌肌张力,增大患侧肘关节主动活动度和改善患侧上肢运动功能。
Objective：To investigate the effects of meridian scraping therapy combined with rehabilitation training on the dynamics and surface electromyography（s EMG） of the biceps brachii and triceps brachii muscle in hemiplegic stroke patients. Methods：A total of 80 patients with hemiplegic upper limb muscle tension after stroke were randomly assigned to the comprehensive therapy group and baclofen group, with 40 patients in each group. The baclofen group received baclofen tablets, and the comprehensive therapy group received both baclofen tablets and meridian scraping therapy on Yin and Yang channels of upper limb. Both groups also received same rehabilitation training once a day, five times each week for four weeks. The biceps and triceps s EMG values of IEMG in the ipsilateral elbow flexion and extension of the maximum isometric contraction were recorded, and the elbow flexion and extension moment and the corresponding co-contraction ratio were calculated before and after the treatment. Modified Ashworth scale, range of elbow joint motion and Fugl-Meyer assessment were applied to evaluate biceps brachii muscle tonus changes of spastic upper limb when the affected elbow flexion, range changes of elbow joint motion and recovery of motor function. Results：After the treatment, the elbow flexion and extension torque of both groups were higher than those before（P0.05）, and the co-contraction ratio was lower than that before（P0.05）. After the treatment, the increasing amplitude of affected elbow extension torque of comprehensive therapy group was higher than that of baclofen group, the decreasing amplitude of biceps brachii co-contraction ratio was higher than that of baclofen group（P0.05）. After the treatment, the spastic degree of affected biceps brachii muscle, elbow autonomic activity and upper limb motor function of both groups were improved（P0.05）, and the improvement of comprehensive therapy group was better than that of baclofen group（P0.05）. Conclusion：Meridian scraping therapy combined with rehabilitation training can strengthen the elbow extension strength of spastic upper limb of hemiplegic stroke patients, improve the coordination of elbow flexion and extension movement, reduce the affected biceps brachii tension, increase the affected elbow joint activity and improve the motor function of upper limbs.
出处
《康复学报》
2017年第6期9-14,共6页
Rehabilitation Medicine
基金
国家自然科学基金项目(81373720)
广东省科技计划项目(2014A020212046)
广东省中医药管理局项目(20151082)
福建省泉州市卫计委项目(20131030)
关键词
脑卒中
痉挛上肢
经络刮疗
康复训练
表面肌电图
动力学
stroke, spastic upper limb, meridian scraping therapy, rehabilitation training, sEMG, dynamics
