脑梗死恢复期患者大腿前后肌群表面肌电特征的研究

The surface-electromyographic characteristics of the anterior and posterior thigh muscles in patients recovering from cerebral infarction

目的探讨脑梗死偏瘫患者大腿前、后肌群收缩功能及协调性的变化，为针对性康复治疗提供客观依据。方法选取18例脑梗死偏瘫患者作为病例组，另选18例年龄、性别与之相匹配的正常人作为正常对照组（对照组）。2组受试者均取俯卧位进行主动膝关节屈伸运动，采集股内侧肌、股直肌、股外侧肌、股二头肌及半腱半膜肌的表面肌电信号，病例组患者双大腿肌群均采集，对照组仅采集左侧大腿肌群。以标准化均方根值（stRMS）、协同收缩率（CR）作为观察指标进行比较分析。结果伸膝时，病例组患者偏瘫侧股直肌、股外侧肌、股内侧肌stRMS值明显大于健侧及对照组stRMS值（P〈0．05）；屈膝时，病例组患者健侧股二头肌、半腱半膜肌stRMS值明显大于偏瘫侧及对照组stRMS值（P〈0．05）。屈膝时，病例组偏瘫侧CR值明显大于健侧及对照组CR值（P〈0．05），结论脑梗死后偏瘫侧大腿前、后肌群功能均有受损，其中伸膝肌以股直股受损明显，屈膝肌群中半膜半腱肌及股二头肌受损程度相当，偏瘫侧膝伸屈肌群拮抗一收缩模式异常。康复治疗应加强偏瘫侧大腿前后肌群训练，改善异常收缩模式。

Objective To assess the contraction and coordination changes in the anterior and posterior thigh muscles of patients recovering from cerebral infarction, and to provide objective references for targeted rehabilitation programs. Methods Eighteen cerebral infarction patients with mild hcmiparesis （the patient group） and eighteen age- and sex-matched healthy volunteers （the healthy group） were investigated. The surface-electromyographic （sEMG） signals of their vastus medialis, rectus femoris, vastus lateralis, biceps femoris, semitendinosus and semi- membranosus were recorded during knee joint flexion and extension in the prone position. The sEMG signals from both legs were recorded for the patient group, but only from the left leg in the healthy group. The standardized root mean square （stRMS） signals and the co-contraction ratios （CRs） were compared and analysed. Results The stRMSs of the rectus femoris, vastus lateralis and vastus medialis on the patients＇ affected side during knee extension were significantly higher than those in the healthy group at baseline and follow-up. The stRMSs of the biceps femoris and semitendinosus-semimembranous on the patients＇ unaffected side were significantly higher than those of the affect- ed side and the healthy group during knee flexion at baseline. The CRs during knee flexion on the patients＇ affected side at baseline and follow-up were significantly higher than those of the unaffected side at baseline. Conclusions After cerebral infarction, the functioning of both the anterior and posterior thigh muscles on the affected side are im- paired. The rectus femoris are the most severely impaired knee extensors, and the biceps femoris, semitendinosus and semimembranous are impaired equally in knee flexion. The thigh flexors and extensors lose their normal antagonist-agonist contraction modes. The functions of both the anterior and posterior thigh muscles should be emphasized during rehabilitation to improve abnormal contraction.