电针对脑卒中后下肢痉挛患者运动功能及步态的影响  

Effect of electroacupuncture on motor function and gait in patients with post-stroke spasticity in lower limbs

作　　者：黄慧[1] 陈健[1] 邱斐 林小梅[1] 林正坤 HUANG Hui;CHEN Jian;QIU Fei;LIN Xiao-mei;LIN Zheng-kun(Department of Rehabilitation Medicine,Zhongshan Hospital Xiamen University,Xiamen 361004,Fujian Province,China)

机构地区：[1]厦门大学附属中山医院康复医学科,福建厦门361004

出　　处：《中国针灸》2022年第1期23-27,共5页Chinese Acupuncture & Moxibustion

基　　金：福建省临床重点专科建设项目。

摘　　要：目的:观察基于康复治疗的电针联合肌电生物反馈疗法与单纯肌电生物反馈疗法对脑卒中后下肢痉挛患者运动功能、痉挛程度、肌力及三维步态分析参数的影响。方法:将60例脑卒中后下肢痉挛患者随机分为电针+生物反馈组、生物反馈组和康复治疗组,每组20例。康复治疗组予基础康复训练,每次45 min;生物反馈组在康复治疗组基础上予生物反馈疗法,每次30 min;电针+生物反馈组在生物反馈组基础上予电针治疗,针刺穴取伏兔、梁丘、足三里、丰隆等,足三里、太冲连接电针,连续波,频率5 Hz。3组均每天治疗1次,每周5次,共治疗6周。分别于治疗前后评定3组患者下肢Fugl-Meyer运动功能量表(FMA)评分、临床痉挛指数(CSI)评分、患侧胫前肌肌力,并测量3组患者三维步态分析时空参数(步频、步速)及运动学参数(患侧踝关节最大背屈及最大跖屈角度)。结果:治疗后,3组患者下肢FMA评分均较治疗前升高(P<0.05),电针+生物反馈组、生物反馈组患者下肢FMA评分高于康复治疗组(P<0.05);电针+生物反馈组、生物反馈组患者CSI评分较治疗前降低(P<0.05),且均低于康复治疗组(P<0.05)。治疗后,3组患者步频及步速较治疗前提高、患侧踝关节最大背屈角度及最大跖屈角度较治疗前增加(P<0.05);电针+生物反馈组、生物反馈组患者步频及步速、患侧踝关节最大背屈角度及最大跖屈角大于康复治疗组(P<0.05),电针+生物反馈组步速高于生物反馈组(P<0.05)。治疗后,3组患者患侧胫前肌肌力评级均较治疗前提高(P<0.05);电针+生物反馈组、生物反馈组患者患侧胫前肌肌力评级高于康复治疗组(P<0.05)。结论:在康复治疗的基础上,电针联合肌电生物反馈疗法与单纯生物反馈疗法均可有效改善脑卒中下肢痉挛患者运动功能、痉挛程度,提高步频、步速及踝关节活动度,在改善步态方面,电针联合肌电生物反馈疗法优Objective To observe the effect on motor function,spasticity degree,muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture(EA)and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine.Methods A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA+biofeedback group,a biofeedback group and a rehabilitation group,20 cases in each one.In the rehabilitation group,the basic rehabilitation training was provided,45 min each time.In the biofeedback group,on the base of the treatment as the rehabilitation group,the biofeedback therapy was added,30 min each time.In the EA+biofeedback group,besides the treatment as the biofeedback group,acupuncture was supplemented at Futu(ST 32),Liangqiu(ST 34),Zusanli(ST 36)and Fenglong(ST 40),etc,and EA was applid at Zusanli(ST 36)and Taichong(LR 3)with continuous wave and 5 Hz in frequency.In each group,the treatment was given once daily,5 times a week,for 6 weeks totally.Separately,before and after treatment,the score of Fugle-Meyer assessment(FMA),the score of clinical spasticity index(CSI)in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed,and the spatial-temporal parameters(step frequency and steep speed)in the three-dimensional gait analysis and the kinematic parameters(maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side)were measured in the patients of three groups.Results After treatment,FMA score was increased as compared with that before treatment in all of three groups(P<0.05).FMA score in the EA+biofeedback group and the biofeedback group was higher than the rehabilitation group respectively(P<0.05).CSI score in the EA+biofeedback group and the biofeedback group was lower than that before treatment respectively(P<0.05),and lower than the rehabil

关 键 词：脑卒中 下肢痉挛 电针 生物反馈 三维步态分析 

分 类 号：R246.1[医药卫生—针灸推拿学]