肌筋膜松解手法治疗脑卒中后下肢痉挛  

Clinical therapeutic effect of myofascial release technique in the treatment of spasm of lower limb after stroke

作　　者：蒋惠瑜 刘海潮 陈燕青 李菊惠 王兆伟 JIANG Huiyu;LIU Haichao;CHEN Yanqing;LI Juhui;WANG Zhaowei(Department of Rehabilitation Therapy,the Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院康复治疗科,海口570311

出　　处：《长春中医药大学学报》2024年第8期901-905,共5页Journal of Changchun University of Chinese Medicine

基　　金：海南省自然科学基金项目(820MS145)。

摘　　要：目的探讨肌筋膜松解(MFR)手法对脑卒中后下肢痉挛的疗效及电生理机制。方法选择80名脑卒中后偏瘫患者作为研究对象,随机分为观察组和对照组,各40例。对照组进行常规Bobath康复技术治疗;观察组在对照组基础上进行肌筋膜松解手法治疗。对比2组康复治疗前后下肢屈肌群肌张力的改善情况,采用改良Ashworth量表(MAS)、临床痉挛指数(CSI)、下肢Fugl-Meyer运动功能量表(FMA-LE)以及改良Baethel指数(MBI)进行评估。分析2组表面肌电图(sEMG)并对比不同康复时间段下肢股直肌、腘绳肌、胫前肌及腓肠肌的均方根(RMS)值,分析RMS值变化与下肢痉挛及功能的相关性。结果康复治疗后,2组MAS得分及CSI均较康复前降低,且观察组均明显低于对照组(P<0.05);康复治疗后,2组FMA-LE评分和MBI均改善。观察组得分显著提升(P<0.05)。2组下肢肌RMS值均呈明显升高趋势(P<0.05),于康复后第2周即有明显下肢肌RMS值差异,观察组腘绳肌、胫前肌及腓肠肌的RMS值明显高于对照组(P<0.05),康复第4周及第6周,观察组股直肌、腘绳肌、胫前肌及腓肠肌RMS值均明显高于对照组(P<0.05);观察组下肢肌RMS值变化与MAS评分及CSI呈负相关(P<0.05),与FMA-LE评分及MBI呈正相关(P<0.05)。结论肌筋膜松解可以显著改善脑卒中后下肢痉挛患者的下肢张力,提高下肢功能,且功能性改变与下肢肌肌电信号的增强密切相关。Objective To explore the therapeutic eff ect and electrophysiological mechanism of myofascial release(MFR)technique in the treatment of lower limb spasm after stroke.Methods 80 patients with post-stroke hemiplegia were selected as the research subjects and randomly divided into the observation group and the control group,with 40 cases in each group.The control group receive routine Bobath rehabilitation therapy,and the observation group received MFR treatment on the basis of the treatment of the control group.The improvement of the muscular tension of lower limb fl exion muscle groups before and after rehabilitation treatment was compared between two groups,and evaluated by modifi ed Ashworth Scale(MAS),Clinical Spasm Index(CSI),Fugl-Meyer Assessment-Lower Extremity(FMA-LE)and modified Baethel index(MBI).The surface electromyography(sEMG)of two groups was analyzed,and the root mean square(RMS)values of the rectus femoris,hamstring,tibialis anterior and gastrocnemius muscles at different rehabilitation time periods were compared.The correlation between the changes of RMS values and spasticity and function of the lower limbs was analyzed.Results After rehabilitation treatment,compared with before rehabilitation,MAS scores and CSI decreased in both groups,and the observation group was signifi cantly lower than the control group(P<0.05).After rehabilitation treatment,FMA-LE scores and MBI of both groups improved.The score of the observation group signifi cantly improved(P<0.05).The RMS values of the lower limb muscles in both groups showed the signifi cant increase trend(P<0.05),and there was the statistically signifi cant diff erence in RMS values of the lower limb muscles in the second week after rehabilitation,and the RMS values of the hamstring,tibialis anterior,and gastrocnemius muscles in the observation group were signifi canly higher than those in the control group(P<0.05).At the 4th and 6th week of rehabilitation,the RMS values of the rectus femoris,hamstring,tibialis anterior,and gastrocnemius muscles in th

关 键 词：肌筋膜松解手法 脑卒中 下肢痉挛 电生理机制 

分 类 号：R743.33[医药卫生—神经病学与精神病学]