体外冲击波治疗脑卒中患者肱二头肌痉挛状态的疗效
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摘要
目的:探讨体外冲击波治疗脑卒中患者肱二头肌痉挛状态的临床疗效,阐明其可能机制。方法:选择脑卒中后肱二头肌痉挛状态患者48例,按随机数字表法随机分为对照组和联合治疗组,每组24例。2组患者均接受常规康复治疗,联合治疗组患者在常规康复治疗的基础上联合体外冲击波治疗。于治疗前、治疗2周时采用改良Ashworth量表(MAS)和简化的Fugl-Meyer评分法(FMA)评定2组患者肱二头肌痉挛状态和上肢运动功能。结果:治疗前2组患者肱二头肌MAS和FMA评分组间比较差异无统计学意义(P>0.05);与治疗前比较,治疗2周时,联合治疗组患者肱二头肌MAS和FMA评分均明显改善(P<0.05),且联合治疗组患者肱二头肌MAS评分明显低于对照组(P=0.001),FMA评分明显高于对照组(P=0.023)。治疗过程中联合组患者均无不良反应发生。结论:应用体外冲击波治疗可有效改善脑卒中患者肱二头肌痉挛状态,且联合治疗组的有效率明显优于对照组。
Objective:To discuss the clinical efficacy of extracorporeal shock wave therapy(ESWT)in the treatment of spasticity of biceps brachii in the stroke patients,and to elucidate its possible mechanism.Methods:A total of 48 patients with spasticity of biceps brachii after stroke were selected divided into control group and combined treatment group according to the table of random number(n=24).All patients in two groups received routine rehabilitation treatment.Based on routine treatment,the patients in combined treatment group received ESWT.Modified Ashworth Scale(MAS)and simplified Fugl-Meyer(FMA)were used to evaluate the spasticity of biceps brachii and upper limb motor function of the patients in two groups before treatment and 2 weeks after treatment.Results:Before treatment,there was no significant difference in the MAS score and FMA score of biceps brachii of the patients between two groups(P>0.05).Compared with before treatment,the scores of MAS and FMA of biceps brachii of the patients in combined treatment group were significantly improved(P<0.05).The MAS score of biceps brachii of the patients in combined treatment group 2weeks after treatment was lower(P=0.001)while the FMA score was significantly higher than those in control group(P=0.023).There were no adverse reactions in the patients in combined treatment group.Conclusion:Aplication of ESWT can effectively relieve the spasticity of biceps brachii of the stroke patients,and the effective rate in combined treatment group was greatly superior to control group.
Objective:To discuss the clinical efficacy of extracorporeal shock wave therapy(ESWT)in the treatment of spasticity of biceps brachii in the stroke patients,and to elucidate its possible mechanism.Methods:A total of 48 patients with spasticity of biceps brachii after stroke were selected divided into control group and combined treatment group according to the table of random number(n=24).All patients in two groups received routine rehabilitation treatment.Based on routine treatment,the patients in combined treatment group received ESWT.Modified Ashworth Scale(MAS)and simplified Fugl-Meyer(FMA)were used to evaluate the spasticity of biceps brachii and upper limb motor function of the patients in two groups before treatment and 2 weeks after treatment.Results:Before treatment,there was no significant difference in the MAS score and FMA score of biceps brachii of the patients between two groups(P>0.05).Compared with before treatment,the scores of MAS and FMA of biceps brachii of the patients in combined treatment group were significantly improved(P<0.05).The MAS score of biceps brachii of the patients in combined treatment group 2weeks after treatment was lower(P=0.001)while the FMA score was significantly higher than those in control group(P=0.023).There were no adverse reactions in the patients in combined treatment group.Conclusion:Aplication of ESWT can effectively relieve the spasticity of biceps brachii of the stroke patients,and the effective rate in combined treatment group was greatly superior to control group.
引文
[1]卢柳梅,田帅,张圣浛.卒中后痉挛状态的评价和治疗[J].国际脑血管病杂志,2014,22(7):552-558.
[2]朱志芬,李萍.强化康复训练对脑卒中后偏瘫痉挛状态的影响[J].中国实用神经疾病杂志,2014,17(10):40-41.
[3]万新炉,叶正茂,潘翠环,等.运动反馈训练对脑卒中后偏瘫上肢痉挛状态的影响[J].中国康复,2013,28(2):109-111.
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[5]孟兆祥,尹正录,陈波,等.可调式肘关节固定器在脑卒中上肢屈肌痉挛患者中的应用[J].中华物理医学与康复杂志,2013,35(10):776-778.
[6]Sanford J,Moreland J,SwansonIR,et al.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke[J].Phys Ther,1993,73(7):447-454.
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[8]郑伟,王升强,张洁.电针运动终板体表投影治疗脑卒中后偏瘫痉挛状态的临床观察[J].中国康复医学杂志,2012,27(11):1070-1072.
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[10]张林果,李放.肉毒毒素治疗肢体痉挛状态的研究进展[J].中华物理医学与康复杂志,2015,37(6):475-477.
[11]陈晓伟,程士欢,李贺,等.A型肉毒毒素局部注射对脑卒中患者下肢肌痉挛和步行能力的改善作用[J].吉林大学学报:医学版,2016,42(3):582-586.
[12]宋小慧,谢青,崔立军,等.冲击波治疗痉挛的研究现状[J].中国医学前沿杂志:电子版,2015,7(5):116-119.
[13]刘金敏,李忠,赵建,等.体外冲击波配合针刺、康复治疗脑卒中后患肢肌张力增高临床观察[J].临床医学,2016,29(5):132-133.
[14]林歆,丛芳,吴琼.体外冲击波对偏瘫患者上肢痉挛的疗效观察[J].中国康复理论与实践,2013,19(8):755-758.
[15]贠国俊,刘青,杨雪.体外冲击波治疗脑瘫肌痉挛的疗效观察[J].中国康复,2015,30(3):198-200.
[16]Othman AMA,Ragab EM.Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis[J].Arch Orthop Trauma Surg,2010,130(7):1343-1347.
[17]姜雪,李纲,周禹鑫.体外单次冲击波对偏瘫患者肱二头肌肌张力的即时影响[J].中国康复,2013,28(4):295-296.
[18]鲍勇,包兴华,丁旭,等.气压弹道式体外冲击波对脑卒中腓肠肌痉挛的疗效观察[J].中国医学前沿杂志:电子版,2014,6(6):18-20.
[2]朱志芬,李萍.强化康复训练对脑卒中后偏瘫痉挛状态的影响[J].中国实用神经疾病杂志,2014,17(10):40-41.
[3]万新炉,叶正茂,潘翠环,等.运动反馈训练对脑卒中后偏瘫上肢痉挛状态的影响[J].中国康复,2013,28(2):109-111.
[4]中华神经科学会,中华神经外科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[5]孟兆祥,尹正录,陈波,等.可调式肘关节固定器在脑卒中上肢屈肌痉挛患者中的应用[J].中华物理医学与康复杂志,2013,35(10):776-778.
[6]Sanford J,Moreland J,SwansonIR,et al.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke[J].Phys Ther,1993,73(7):447-454.
[7]刘洪恩,陈建梅,陈汝伟,等.颅脑外伤后痉挛状态的治疗进展[J].中华创伤杂志,2012,28(8):765-768.
[8]郑伟,王升强,张洁.电针运动终板体表投影治疗脑卒中后偏瘫痉挛状态的临床观察[J].中国康复医学杂志,2012,27(11):1070-1072.
[9]孙媛,蔡春茜,赵建国.偏瘫痉挛状态治疗研究进展[J].中西医结合心脑血管病杂志,2014,12(5):613-617.
[10]张林果,李放.肉毒毒素治疗肢体痉挛状态的研究进展[J].中华物理医学与康复杂志,2015,37(6):475-477.
[11]陈晓伟,程士欢,李贺,等.A型肉毒毒素局部注射对脑卒中患者下肢肌痉挛和步行能力的改善作用[J].吉林大学学报:医学版,2016,42(3):582-586.
[12]宋小慧,谢青,崔立军,等.冲击波治疗痉挛的研究现状[J].中国医学前沿杂志:电子版,2015,7(5):116-119.
[13]刘金敏,李忠,赵建,等.体外冲击波配合针刺、康复治疗脑卒中后患肢肌张力增高临床观察[J].临床医学,2016,29(5):132-133.
[14]林歆,丛芳,吴琼.体外冲击波对偏瘫患者上肢痉挛的疗效观察[J].中国康复理论与实践,2013,19(8):755-758.
[15]贠国俊,刘青,杨雪.体外冲击波治疗脑瘫肌痉挛的疗效观察[J].中国康复,2015,30(3):198-200.
[16]Othman AMA,Ragab EM.Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis[J].Arch Orthop Trauma Surg,2010,130(7):1343-1347.
[17]姜雪,李纲,周禹鑫.体外单次冲击波对偏瘫患者肱二头肌肌张力的即时影响[J].中国康复,2013,28(4):295-296.
[18]鲍勇,包兴华,丁旭,等.气压弹道式体外冲击波对脑卒中腓肠肌痉挛的疗效观察[J].中国医学前沿杂志:电子版,2014,6(6):18-20.