早期伸肌康复治疗策略对脑梗死恢复期偏瘫上肢功能恢复的影响  

Effect of early extensor rehabilitation treatment on functional recovery in patients with cerebral infarction with upper limb hemiplegia

作　　者：陈少军 槐雅萍 杨伟伟 王宇轩 CHEN Shaojun;HUAI Yaping;YANG Weiwei;WANG Yuxuan(Department of Rehabilitation Medicine,Shenzhen Longhua District Central Hospital,Shenzhen,Guangdong 518110)

机构地区：[1]广东省深圳市龙华区中心医院康复医学科,广东深圳518110

出　　处：《河北中医》2023年第8期1314-1317,1322,共5页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察早期伸肌康复治疗策略对脑梗死恢复期偏瘫上肢功能恢复的影响。方法将92例脑梗死上肢偏瘫患者按照随机数字表法分为2组,2组均接受脑梗死的常规治疗和康复科常规康复治疗,治疗组46例予早期伸肌康复治疗策略,对照组46例予早期屈肌康复治疗策略。疗程均为6周。比较2组治疗前后患肢肌纤维长度(FL)、肌纤维厚度(MT)和回声强度(EI),并比较2组表面积肌电图均方根值(RMS)、协同收缩率(CR),应用Fugl-Meyer运动功能量表上肢部分(FMA-UE)评价2组上肢功能。结果2组治疗后患肢最大等长收缩状态下屈肘时肱二头肌、伸肘时肱三头肌RMS及患肢伸肘、屈肘时的CR均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。2组治疗后患肢肌肉FL、MT均较本组治疗前增加(P<0.05),EI均降低(P<0.05),且治疗组治疗后患肢肌肉FL、MT均高于对照组(P<0.05),EI低于对照组(P<0.05)。2组治疗后FMA-UE、FMA-肩肘评分(FMA-SE)、FMA腕手部评分(FMA-WH)评分均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。结论早期伸肌康复治疗策略可改善患肢肌痉挛程度,促进患肢功能的恢复,应用于脑梗死偏瘫上肢功能恢复效果显著。Objective To explore the effect of early extensor rehabilitation treatment on functional recovery in patients with cerebral infarction(CI)with upper limb hemiplegia.Methods A total of 92 CI patients with upper limb hemiplegia were randomly assigned into the treatment group(n=46)and the control group(n=46);in addition to conventional rehabilitation treatment,the treatment group and the control group received early extensor rehabilitation treatment and early flexor rehabilitation treatment,respectively.Treated for 6 weeks,the aim was to compare fascicle length(FL),muscular thickness(MT)and echo intensity(EI),root mean square(RMS)value and co-contraction ratio(CR)of electromyography(EMG)integral values.The upper limb function in the two groups was evaluated by the Fugl-Meyer assessment for upper extremity(FMA-UE).Results After treatment,the RMS values(biceps brachii of elbow flexion and triceps brachii of elbow extension)and the CR value of the affected limb of maximal voluntary isometric contraction(MVIC)in groups were significantly increased,which were significantly higher in the treatment group than in the control group(all P<0.05).Significantly increased FL and MT,and decreased EI were detected in the two groups(all P<0.05),and the treatment group was superior to the control group for FL,MT,EI(all P<0.05).FMA-UE,FMA for wrist and hand(FMA-WH),FMA for shoulder and elbow(FMA-SE)in groups were significantly higher after treatment(P<0.05),which were significantly higher in the treatment group than in the control group(P<0.05).Conclusion For CI patients with upper limb hemiplegia,early extensor rehabilitation treatment has a significant effect,which can improve the degree of muscle spasm in the affected limb,and promote the recovery of upper limb function.

关 键 词：脑梗死 偏瘫 上肢功能 康复治疗 

分 类 号：R743.330.9[医药卫生—神经病学与精神病学]