基于sEMG评价的股四头肌神经入肌点针刺法对脑卒中肌痉挛干预效应的研究  

Study on the interventional effect of acupuncture nerve entering points on musculi quadriceps femoris of cerebral apoplexy muscle spasm based on sEMG evaluation

作　　者：樊留博 刘宝华[2] FAN Liubo;LIU Baohua(Department of Rehabilitation of Medical,Taizhou Hospital of Zhejiang Province,Shaoxing University,Zhejiang Province,Taizhou317000,China;Department of Rehabilitation of Medical,the Second Affiliated Hospital of Wenzhou Medical University,Zhejiang Province,Wenzhou325035,China)

机构地区：[1]绍兴文理学院、浙江省台州医院康复医学科,浙江台州317000 [2]温州医科大学附属第二医院康复医学科,浙江温州325035

出　　处：《中国医药导报》2020年第26期13-16,29,共5页China Medical Herald

基　　金：浙江省自然科学基金项目(LSY19H170001);浙江省医药卫生科技计划项目(2017KY707、2014KYA224);浙江省台州市科技计划项目(14SF03)。

摘　　要：目的应用表面肌电图(sEMG)观察股四头肌神经入肌点针刺法对偏瘫患者痉挛下肢膝关节控制能力的影响并探求其作用机制。方法选取2016年1月—2017年12月在浙江省台州医院和温州医科大学附属第二医院确诊的脑卒中患者共52例,根据随机数字表法将其分为研究组和对照组,每组26例。两组均给予相同的基础治疗,对照组采用传统的循经取穴针刺治疗,研究组采用股四头肌神经入肌点针刺疗法。两组分别于治疗前与治疗4周后采用Holden步行功能分类、改良Ashworth分级(MAS)、临床痉挛指数(CSI)、下肢简化Fugl-Meyer运动量表、Berg平衡量表(BBS)评定及表面电极引导记录肌电信号并对所测得H波最大波幅(Hmax)、M波最大波幅(Mmax)及H波与M波最大波幅比值(Hmax/Mmax)的变化情况进行比较分析。结果治疗4周后,两组Holden功能步行能力、下肢简化Fugl-Meyer运动量表评分及BBS的评分均较治疗前提高,且研究组高于对照组,差异均有统计学意义(均P<0.05)。治疗4周后,两组下肢MAS及CSI评分均较治疗前降低,且研究组低于对照组,差异均有统计学意义(均P<0.05)。治疗4周后,两组Hmax、Mmax、H/Mmax均较治疗前降低,且研究组低于对照组,差异均有统计学意义(均P<0.05)。结论采用四头肌神经入肌点针刺疗法能够减轻痉挛性偏瘫患者患侧下肢的股四头肌的肌紧张,提高大腿前后肌群之间的协调性,改善痉挛性偏瘫患者患侧膝关节的控制能力,从而进一步提高患者的生活质量,其疗效优于传统针刺方法。Objective To observe the effect of surface electromyography(sEMG)on the control of the knee joint of the lower extremities with spasm in patients with hemiplegia by using acupuncture nerve entering points on musculi quadriceps.Methods A total of 52 cerebral apoplexy patients confirmed in Taizhou Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2017 were selected and divided into study group and control group according to the random number table method,with 26 patients in each group.The two groups were given the same basic treatment,the control group was treated with traditional acupuncture therapy with acupuncture points following the meridian,and the study group was treated with acupuncture nerve entering points on musculi quadriceps femoris.In both groups,the Holden walking functional classification,modified Ashworth scale(MAS),clinic spasticity index(CSI),the lower limb simplified Fugl-Meyer movement scale and Berg balance scale(BBS)were evaluated,electromyographic signals guided by the surface electrode were recorded and the changes of the measured maximum amplitude of H wave(Hmax),maximum amplitude of M wave(Mmax)and the ratio of the maximum amplitude of H wave to M wave(Hmax/Mmax)were analyzed and compared before and four weeks after treatment.Results After four weeks of treatment,the scores of Holden functional walking ability,lower limb simplified Fugl-Meyer movement scale and BBS in the two groups were all improved compared with those before treatment,and the study group was higher than the control group,with statistically significant differences(all P<0.05).After four weeks of treatment,lower limb MAS and CSI scores of both groups were lower than those before treatment,and the study group was lower than the control group,with statistically significant differences(all P<0.05).After four weeks of treatment,Hmax,Mmax and H/Mmax of the two groups were all lower than those before treatment,and the study group was lower than the contr

关 键 词：针刺神经入肌点 评价 痉挛 脑卒中 肌电图 

分 类 号：R246.6[医药卫生—针灸推拿学]