膝踝足矫形器训练联合外周磁刺激对重度偏瘫患者下肢功能恢复的影响

Peripheral magnetic stimulation and a knee-ankle-foot orthosis for stroke patients with severe hemiplegia

目的 观察膝踝足矫形器（KAFO）训练联合外周磁刺激对脑卒中重度偏瘫患者下肢功能恢复的影响.方法 采用随机数字表法将60例下肢严重瘫痪的脑卒中偏瘫患者分为治疗组（30例）及对照组（30例）.对照组给予常规康复治疗（基于运动再学习技术）及KAFO训练,治疗组则在对照组干预基础上针对偏瘫侧髂腰肌进行磁刺激治疗,2组患者均持续治疗8周.于治疗前、治疗8周后分别采用简化Fugl-Meyer下肢功能量表（FMA-LE）对患者下肢运动功能进行评定,采用Berg平衡量表（BBS）对患者平衡功能进行评定,采用功能性步行分级（FAC）对患者步行功能进行评定,采用改良Barthel指数量表（MBI）对患者日常生活活动能力进行评定.结果 经8周治疗后,发现治疗组患者FMA-LE、BBS、MBI评分分别由治疗前（7.50±2.16）分、（5.57±1.91）分和（21.77±5.50）分提高至（13.63±3.13）分、（19.63 ±2.91）分和（51.10 ±9.09）分;对照组上述指标则分别由治疗前（7.53 ±2.05）分、（5.87±1.43）分和（21.53 ±5.44）分提高至（11.30±2.49）分、（15.50±2.90）分和（42.97±6.24）分;并且治疗组患者上述疗效指标改善幅度均显著优于对照组（P＜0.05）.治疗后2组患者FAC分级亦较治疗前明显改善（P＜0.05）,并且治疗组FAC分级改善幅度亦显著优于对照组（P＜0.05）.结论 KAFO训练联合外周磁刺激能进一步改善脑卒中重度偏瘫患者下肢运动功能、平衡功能、步行能力及ADL能力,该联合疗法值得临床推广、应用.

Objective To study the effects of peripheral magnetic stimulation combined with a knee-anklefoot orthosis （KAFO） for improving lower limb function in severe hemiplegia after stroke.Methods Sixty stroke patients with severe hemiplegia were randomly divided into treatment group and a control group with 30 in each.The patients in the control group received a conventional rehabilitation program including a KAFO.The patients in the treatment group received in addition magnetic stimulation of the iliopsoas muscle on the hemiplegic side.The treat ment of both groups lasted for 8 weeks.Lower limb motor function,balance,walking and ability in the activities of daily living （ADL） were assessed with the Fugl-Meyer lower extremity assessment （FMA-LE）,the Berg balance scale （BBS）,functional ambulation classification （FAC） and the modified Barthel index （MBI） before and after treatment.Results After 8 weeks of treatment the FMA-LE,BBS,FAC and MBI scores had all improved signifi cantly in both groups,but the patients in the treatment group had improved significantly more than the controls.Conclusion Peripheral magnetic stimulation combined with a KAFO can improve motor function,balance,walking and ADL performance in stroke patients with severe hemiplegia better than a KAFO alone.