放散式体外冲击波改善卒中患者下肢痉挛和功能效果的Meta分析  

Effect of Radial Extracorporeal Shock Wave Therapy on Lower Limb Spasticity and Motor Function in Stroke Patients:A Meta-Analysis

作　　者：赵慧 龙雨 于琼阁 余雨枫[1] ZHAO Hui(School of nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,Sichuan,China)

机构地区：[1]成都中医药大学护理学院,四川成都610075

出　　处：《牡丹江医科大学学报》2025年第2期121-127,110,共8页Journal of Mudanjiang Medical University

基　　金：黑龙江省青年科学基金项目(QC2009C45);黑龙江省大学生创新创(201310229026);牡丹江医学院大学生科研项目。

摘　　要：目的系统评价和分析放散式体外冲击波(rESWT)改善卒中患者下肢痉挛和功能的疗效。方法计算机检索Cochrane Library、PubMed、EMBASE、Web of Science、中国知网、万方、维普、中国生物医学文献数据库,检索时间从建库至2024年8月14日。纳入rESWT与常规康复或安慰冲击波相比较的随机对照试验(RCTs),采用RevMan 5.4软件进行Meta分析。结果共纳入14个RCTs,包含609例患者。Meta分析显示,rESWT改善下肢痉挛的治疗后效应优于对照组[MD=-0.46,95%CI(-0.66,-0.27),P<0.001];治疗后随访1周和4周,rESWT对下肢痉挛的改善效果均优于对照组[MD=-0.53,95%CI(-0.72,-0.34),P<0.001];rESWT改善下肢运动功能的效果也优于对照组[MD=4.95,95%CI(2.42,7.48),P<0.001];rESWT能显著改善脑卒中下肢痉挛患者的空间步态参数和运动学参数水平,提高患者的PROM[MD=2.49,95%CI(1.41,3.57),P<0.001],改善TUGT[MD=-5.48,95%CI(-9.54,-1.42),P=0.008],但对患者Hmax/Mmax比值无影响[MD=-0.34,95%CI(-1.34,0.66),P=0.50]。结论与对照组相比,rESWT能更为有效地缓解卒中患者下肢痉挛及相关运动功能,且痉挛缓解的效果能在短期内维持,可作为脑卒中下肢痉挛康复的有效技术。Objective To evaluate the efficacy of radial extracorporeal shock wave therapy(rESWT)in improving lower limb spasticity and function in stroke patients through a meta-analysis.Methods A systematic search was conducted in the Cochrane Library,PubMed,EMBASE,Web of Science,CNKI,Wanfang,VIP,and the Chinese Biomedical Literature Database from their inception to August 14,2024.Randomized controlled trials(RCTs)comparing rESWT with conventional rehabilitation or placebo shock wave treatment were included.Meta-analysis was performed using RevMan 5.4 software.Results total of 14 RCTs involving 609 patients were included.Meta-analysis showed that rESWT was more effective than the control intervention in reducing lower limb spasticity after treatment[MD=-0.46,95%CI(-0.66,-0.27),P<0.001].At both 1-week and 4-week follow-ups,rESWT continued to demonstrate superior effects on spasticity reduction compared with the control group[MD=-0.53,95%CI(-0.72,-0.34),P<0.001].Moreover,rESWT significantly improved lower limb motor function[MD=4.95,95%CI(2.42,7.48),P<0.001].In addition,rESWT significantly enhanced spatial gait parameters and kinematic outcomes in stroke patients with lower limb spasticity,increased passive range of motion(PROM)[MD=2.49,95%CI(1.41,3.57),P<0.001],and improved Timed Up and Go Test(TUGT)performance[MD=-5.48,95%CI(-9.54,-1.42),P=0.008].However,no significant effect was observed on the Hmax/Mmax ratio[MD=-0.34,95%CI(-1.34,0.66),P=0.50].Conclusion Compared with the control group,rESWT more effectively alleviates lower limb spasticity and improves related motor function in stroke patients.The antispastic effects can be sustained in the short term,suggesting that rESWT is a promising and effective modality for the rehabilitation of post-stroke lower limb spasticity.

关 键 词：脑卒中 rESWT 体外冲击波 下肢痉挛 随机对照试验 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]