肌电生物反馈治疗卒中后肢体痉挛的Meta分析  

Electromyographic biofeedback for post-stroke limb spasticity:a Meta-analysis

作　　者：张田田 李甲民 欧梁 商燕 徐雅倩 胡国恒 Zhang Tiantian;Li Jiamin;Ou Liang;Shang Yan;Xu Yaqian;Hu Guoheng(Graduate School,Hunan University of Chinese Medicine,Changsha 410208,Hunan Province,China;Department of Orthopedics,the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,Guizhou Province,China;Department of Neurology,the First Hospital of Hunan University of Chinese Medicine,Changsha 410007,Hunan Province,China)

机构地区：[1]湖南中医药大学研究生院,湖南省长沙市410208 [2]贵州中医药大学第二附属医院骨伤科,贵州省贵阳市550001 [3]湖南中医药大学第一附属医院神经内科,湖南省长沙市410007

出　　处：《中国组织工程研究》2022年第29期4742-4748,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81573941),项目负责人:胡国恒。

摘　　要：目的:肌电生物反馈疗法现已广泛运用于脑卒中后患者的肌力康复训练,文章系统评价肌电生物反馈治疗脑卒中后肢体痉挛的临床疗效。方法:全面检索PubMed、Cochrane Library、Embase、中国知网、维普、中国生物医学文献数据库、万方数据库中有关肌电生物反馈治疗卒中后痉挛的临床随机对照试验,时间从各数据库建库至2021年6月。采用Cochrane风险偏倚评估工具和改良Jadad量表评价原始研究质量,使用RevMan 5.4软件进行Meta分析。结果:共纳入15篇临床随机对照研究,提取样本量878例。Meta分析结果提示,①肌电生物反馈治疗≤4周和4周以上的改良的Ashworth量表(MD=-0.32,95%CI:-0.45至-0.19,P<0.00001;MD=-0.27,95%CI:-0.37至-0.17,P<0.00001)和临床痉挛指数(MD=-2.05,95%CI:-2.27至-1.83,P<0.00001),试验组均优于对照组。②除腕关节主动活动度无改善外(P>0.05),肌电生物反馈对偏瘫运动功能(上肢≤4周:MD=3.39,95%CI:2.02-4.77,P<0.00001;上肢>4周:MD=2.53,95%CI:2.04-3.02,P<0.00001;下肢>4周:MD=3.36,95%CI:2.90-3.83,P<0.00001;总评分≤4周:MD=20.63,95%CI:19.38-21.88,P<0.00001;总评分>4周:MD=8.08,95%CI:3.38-12.78,P=0.0008)和踝关节主动活动度(≤4周:MD=4.87,95%CI:1.12-8.62,P=0.01;>4周:MD=3.69,95%CI:3.04-4.34,P<0.00001)的改善也优于对照组。③电生理参数(屈肌群:MD=-16.80,95%CI:-24.75至-8.85,P<0.0001;伸肌群:MD=17.88,95%CI:2.83-32.93,P=0.02)的改善试验组也优于对照组。结论:肌电生物反馈可以有效改善卒中后肢体的痉挛程度,促进肢体功能的康复,但仍需高质量的随机对照试验进一步验证。OBJECTIVE:Electromyographic biofeedback therapy has been widely used in post-stroke muscle rehabilitation training.The purpose of this paper is to systematically evaluate the efficacy of electromyographic biofeedback on treating post-stroke spasticity.METHODS:The randomized controlled trials addressing electromyographic biofeedback in the treatment of post-stroke spasticity were retrieved from PubMed,Cochrane Library,Embase,CNKI,VIP,Chinese BioMedical Literature Database,and WanFang Database.The retrieval time ranged from database inception to June 2021.The risk of bias was evaluated by the Cochrane Collaboration tool and modified Jadad scale.Meta-analysis was performed using RevMan 5.4 software.RESULTS:A total of 15 randomized controlled trials were included,and 878 samples were extracted.The results of Meta-analysis showed that treatment with electromyographic biofeedback≤4 weeks or over 4 weeks showed a significantly lower modified Ashworth scale score[mean difference(MD)=-0.32,95%confidence interval(CI):-0.45 to-0.19,P<0.00001;MD=-0.27,95%CI:-0.37 to-0.17,P<0.00001]and significantly lower clinical spasticity index(MD=-2.05,95%CI:-2.27 to-1.83,P<0.00001)compared with the control group.Compared with the control group,electromyographic biofeedback could significantly improve the motor function(upper limbs≤4 weeks:MD=3.39,95%CI:2.02-4.77,P<0.00001;upper limbs>4 weeks:MD=2.53,95%CI:2.04-3.02,P<0.00001;lower limbs>4 weeks:MD=3.36,95%CI:2.90-3.83,P<0.00001;total score≤4 weeks:MD=20.63,95%CI:19.38-21.88,P<0.00001;total score>4 weeks:MD=8.08,95%CI:3.38-12.78,P=0.0008),the active range of motion of the ankle joint(≤4 weeks:MD=4.87,95%CI:1.12-8.62,P=0.01;>4 weeks:MD=3.69,95%CI:3.04-4.34,P<0.00001)and electrophysiological parameters(flexor group:MD=-16.80,95%CI:-24.75 to-8.85,P<0.0001;extensor group:MD=17.88,95%CI:2.83-32.93,P=0.02)of the hemiplegic limbs.CONCLUSION:Electromyographic biofeedback can effectively improve post-stroke limb spasticity and function.However,more high-quality randomized controlled trials

关 键 词：脑卒中 痉挛 偏瘫 肌电生物反馈 功能 康复 随机对照试验 META分析 

分 类 号：R493[医药卫生—康复医学] R318[医药卫生—临床医学]