综合康复治疗对脑卒中偏瘫患者动态肌电图及周围神经形态学的影响  

Effects of comprehensive rehabilitation therapy on dynamic electromyography and peripheral neuromorphology in stroke patients with hemiplegia

作　　者：郭丽云[1] 邢晓红[1] 刘红[1] 崔丽霞[1] 陈育英[1] 张沁丽[1] 谢道林[1] 王潞萍[1] 田泽丽[1] 张凤仙[1] Guo Liyun;Xing Xiaohong;Liu Hong;Cui Lixia;Chen Yuying;Zhang Qinli;Xie Daolin;Wang Luping;Tian Zeli;Zhang Fengxian(Department of Rehabilitation,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China)

机构地区：[1]长治医学院附属和平医院康复医学科,山西长治046000

出　　处：《中华生物医学工程杂志》2018年第4期261-265,共5页Chinese Journal of Biomedical Engineering

基　　金：山西省卫生计生委科研课题(2017161);长治医学院科研启动基金项目(QD201512)。

摘　　要：目的探究综合康复治疗对脑卒中偏瘫患者动态肌电图及周围神经形态学的影响。方法用计算机随机数字法将2015年6月至2017年6月长治医学院附属和平医院康复科收治的60例脑卒中偏瘫患者分为观察组和对照组各30例。对照组患者予以基础康复治疗,观察组患者在此基础上予以低频电刺激治疗。用Tecnnobody康复系统本体感觉评定模块对两组患者治疗前后本体感觉[平均轨迹误差(ATE)、测试所用时间]进行评估;应用Fugl-meyer运动功能评定量表(FMA)评价两组患者运动功能;应用改良Ashworth量表(MAS)评价肌张力,使用表面肌电图仪记录肱二头肌、腓肠肌收缩时的积分肌电值(IEMG),计算协同收缩率;利用表面电极测定神经传导速度[神经运动传导速度(MCV)、感觉神经传导速度(SCV)],用彩色多普勒超声诊断仪测量患者的周围神经形态学[宽度(W)、厚度(T)、横截面积(CSA)]。结果治疗4周后,两组患者ATE、时间值、肱二头肌、腓肠肌协同收缩率均较治疗前降低,且观察组低于对照组(均P<0.05);FMA评分、MAS评分以及腓总神经、胫神经MCV、SCV值均较治疗前升高,且观察组高于对照组(均P<0.05);观察组患者正中神经腕横纹处W值较治疗前升高(0.59±0.06比0.54±0.05,P<0.05),且高于对照组(0.59±0.06比0.56±0.05,P<0.05),两组患者治疗前后T、CSA值及组间比较,差异均无统计学意义(均P>0.05)。结论基础康复治疗辅以低频电刺激治疗脑卒中偏瘫可有效提高患者感觉、运动功能、肌张力水平,且可促进周围神经损伤的改善。Objective To investigate the effects of comprehensive rehabilitation therapy on dynamic electromyography and peripheral neuromorphology in stroke patients with hemiplegia.Methods Included in this study were 60 stroke patients with and hemiplegia admitted to the rehabilitation department of the Heping Hospital of Changzhi Medical College from June 2015 to June 2017,who were divided into observation group and control group by computer random number method(n=30 each).The patients in the control group were given basic rehabilitation treatment,and those in the observation group were treated additionally with low⁃frequency electrical stimulation.Before and after treatment in the two groups,the probabilistic assessment module of Tecnnobody rehabilitation system was used to evaluate the proprioception[average trajectory error(ATE)and test time];Fugl⁃meyer motor function assessment(FMA)was used to evaluate the motor function;muscle tension was evaluated using a modified Ashworth scale(MAS);the integral electromyogram(IEMG)at the time of contraction of the biceps brachii and gastrocnemius muscles was recorded using a surface electromyography,thereby the co⁃contraction rate was calculated;nerve conduction velocities[motor conduction velocity(MCV),sensory conduction velocity(SCV)]were measured by surface electrode;the peripheral neuromorphology[width(W),thickness(T),cross⁃sectional area(CSA)]was examined with a color Doppler ultrasound diagnostic device.Results After 4 weeks of treatment,the ATE,time value,co⁃contraction rate of biceps brachii and gastrocnemius muscle were lower than those at baseline in the both groups,and lower in the observation group than those in the control group(all P<0.05);the FMA score,MAS score,and the values of MCV and SCV of common peroneal nerve and tibial nerve were higher than those at baseline in the both groups,and before treatment,and were higher in the observation group than those in the control group(all P<0.05);the W value of the median nerve at the transverse wrist crease in t

关 键 词：康复治疗 电刺激 脑卒中 偏瘫 动态肌电图 周围神经形态学 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]