早期抗阻力训练在脊髓损伤患者康复治疗中的应用  

Application of early resistance training in rehabilitation of patients with spinal cord injuries

作　　者：王文科[1] 王方[1] 汤治中[1] 曾云[2] Wang Wenke;Wang Fang;Tang Zhizhong;Zeng Yun(Department of Rehabilitation Medicine,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan,Hubei 442008,China;Department of Spinal Surgery,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan,Hubei 442008,China)

机构地区：[1]湖北医药学院附属国药东风总医院康复医学科,湖北十堰442008 [2]湖北医药学院附属国药东风总医院脊柱外科,湖北十堰442008

出　　处：《创伤外科杂志》2023年第8期591-596,共6页Journal of Traumatic Surgery

基　　金：湖北省卫计委科研立项项目(WJ2017F081)。

摘　　要：目的运动康复训练能够在一定程度上帮助脊髓损伤(spinal cord injury,SCI)患者恢复正常运动功能,因此采取行之有效的康复训练手段至关重要。本研究旨在观察早期抗阻力训练在SCI患者康复治疗中的应用效果。方法前瞻性选择2022年3月—2023年1月笔者医院收治的SCI患者76例,根据美国脊髓损伤协会SCI分级,将其分为A~D 4类。按随机数字表法随机分为对照组(38例)和试验组(38例)。对照组男性26例,女性12例;年龄35~68岁,平均50.0岁;分级A、B、C、D类分别有9、7、8、14例;试验组男性30例,女性8例;年龄35~68岁,平均49.9岁;A、B、C、D类分别有7、9、8、14例。对照组仅进行传统的康复治疗,试验组在此基础上额外进行为期1个月的抗阻力训练。在进行康复治疗的前后对患者均进行体感诱发电位(somatosensory evoked potentials,SEPs)检查与修订的Barthel指数(modified Barthel index,MBI)评分,以此判断早期抗阻力训练的疗效。结果经过为期1个月的康复训练干预,发现相较于对照组,试验组在训练后的SCI恢复效果显著,其SEPs相关指标比较差异有统计学意义(P<0.05)。早期康复训练后,试验组患者胫骨前肌、腓肠肌的积分肌电值(integrated electromyography,IEMG)与对照组比较差异有统计学意义(P<0.05)。不同病程的SCI患者康复前后MBI评分比较,病程<1个月、1~3个月、4~6个月、7~12个月的SCI患者MBI评分均明显升高[(50.6±14.5)分vs.(64.4±20.1)分、(57.3±13.5)分vs.(73.9±17.0)分、(51.9±13.2)分vs.(65.7±16.6)分、(45.5±10.4)分vs.(55.4±10.2)分],差异有统计学意义(P<0.05)。随着训练时间的不断累积与延长,各组SCI患者的SEPs波形潜伏期显著缩短,差异有统计学意义(P<0.05)。结论将早期抗阻力训练应用于SCI患者的康复治疗,能够显著改善患者的运动功能和神经功能。Objective Exercise rehabilitation training can help the recovery of normal motor function in patients with spinal cord injuries(SCI)to a certain extent,and an effective rehabilitation training method is of vital sense.The purpose of this study is to observe the effect of early resistance training in the rehabilitation treatment of SCI patients.Methods Altogether 76 cases of SCI who were admitted into our hospital from Mar.2022 to Jan.2023 were prospectively selected and graded as A-D based on the criteria by the American Spinal Injury Association(ASIA).By using the random number table method,patients were randomly divided into control group and experimental group(n=38 for each).For the control group,there were 26 male and 12 female aged 35-68 years,mean 50.0 years;the injury severity was 9 grade A,7 grade B,8 grade C and 14 grade D,while for the experimental group,there were 30 male and 8 female aged 35-68 years,mean 49.9 years;the injury severity was 7 grade A,9 grade B,8 grade C and 14 grade D.Patients in control group only received traditional rehabilitation treatment,while those in experimental group additionally received one month of resistance training.Somatosensory evoked potentials(SEPs)were performed and modified Barthel index(MBI)score were calculated in all patients before and after rehabilitation treatment.Results The one month early training resulted in much better functional recovery in the experimental group,with all the SEPs related indicators showing significant difference,compared with control groups(all P<0.05);the integrated electromyography(IEMG)of the tibialis anterior muscle and the gastrocnemius muscle was also significantly different from the controls(both P<0.05).Compared with before rehabilitation,the MBI scores were all significantly improved after training for all the included SCI patients with different disease courses of<1 month(50.6±14.5 vs.64.4±20.1),1-3 months(57.3±13.5 vs.73.9±17.0),4-6 months(51.9±13.2 vs.65.7±16.6),and 7-12 months(45.5±10.4 vs.55.4±10.2),P<0.05.With th

关 键 词：脊髓损伤 抗阻力训练 康复治疗 体感诱发电位 

分 类 号：R683.2[医药卫生—骨科学]