早期分离与抗阻运动训练对脑卒中膝过伸和偏瘫步态的防治作用

Preventive and therapeutic effect of early isolated and resisted movement training on stroke genu recurvatum and hemiplegic gait

目的:观察早期分离与抗阻运动训练对脑卒中患者膝过伸和偏瘫步态的预防和治疗作用。方法:选择2001-11-27/2005-02-28在安徽医科大学神经内科治疗的急性脑卒中初次发病患者100例,年龄40～80岁,病程不超过3周,均自愿签署知情同意书。按入组顺序随机分成2组,即康复组和对照组,每组50例。两组患者均接受常规的神经内科治疗,对照组不进行康复训练。康复组还需接受早期分离和抗阻运动训练,训练强度为1次/d,45～60min/次,5次/周,总疗程为6个月。观察患者站立和运动过程中有无膝过伸和偏瘫步态,进行计数,显效率用百分数表示。显效即为膝过伸症状和偏瘫步态显著改善。结果:康复组、对照组分别死亡1例和2例,康复组失访1例,进入结果分析康复组与对照组均为48例。康复组患者的膝过伸发生率显著低于对照组[20.8%,45.8%(χ2=6.75,P<0.01)],显效率显著高于对照组[60.0%,31.8%(P<0.05)];康复组偏瘫步态发病率显著低于对照组[27.1%,54.2%(χ2=7.29,P<0.01)],显效率显著高于对照组[61.5%,26.9%(P<0.05)]。结论:早期分离与抗阻运动训练有助于预防和治疗脑卒中偏瘫患者的膝过伸和偏瘫步态。

AIM： To study preventive and therapeutic effect of early isolated and resisted movement training on stroke patients with genu recurvatum and hemiplegic gait. METHODS： Totally 100 first-onset patients with acute stroke aged between 40 and 80 admitted in the Department of Neurology, Anhui Medical University between November 27^th, 2001 and February 28^th, 2005 were chosen. The course was no more than three weeks. They all agreed to sign the informed consent. One hundred patients were randomly divided into two groups according to sequence of entering the group： rehabilitative group and control group, with 50 cases in each group. Conventional neurology therapies were given to all patients of the two groups. The patients in the control group were not treated with rehabilitative group. Those in the rehabilitative group received isolated and resisted movement training, once a day, 45-60 minutes every time, 5 times a week, totally for 6 months. In addition, the amounts of stroke patients with genu recurvatum and hemiplegic gait were calculated at both .groups. Effective rate was expressed with percentage. Efficiency referred to significant improvement of genu recurvatum and hemiplegic gait. RESULTS： One case and two cases were dead in the rehabilitative group and the control group, respectively. One case in the rehabilitative group was dropped-out, so, 48 cases in the rehabilitative group and the control group, respectively were involved in the result analysis. The incidence rate of genu recurvatum in patients of the rehabilitative group was obviously lower than that of the control group [20.8%,45.8%（χ^2=-6.75, P 〈 0.01 ）], and the effective rate was markedly higher than that of the control group [60.0%,31.8% （P 〈 0.05）]. The incidence rate of hemiplegic gait in patients of the rehabilitative group was remarkably lower than that of the control group [27.1%, 54.2%（χ^2=7.29, P 〈 0.01 ）], and the effective rate was distinctly higher than that of the control group [61.5%,26.9%（P 〈 0.05）]. CONCLUSION： Early isolated and resisted movement training is helpful for preventing and curing genu recurvatum and hemiplegic gait in patients with stroke and hemiparalysis.