肌电生物反馈疗法配合踝足支具治疗脊髓损伤患者术后踝背屈功能障碍的疗效

Curative effects of electromyographic biofeedback therapy combined with ankle-foot orthosis brace for ankle dorsiflexion dysfunction after spinal cord injury

目的：观察肌电生物反馈疗法配合踝足支具治疗脊髓损伤术后患者踝背屈功能障碍的疗效。方法2011年7月至2013年1月，我科收治的脊髓损伤术后患者30例，其中男22例，女8例，年龄18～65岁，平均35岁。将30例分为观察组15例和对照组15例。两组均接受被动关节活动度手法训练、Bobath技术、作业治疗等康复治疗，在治疗开始之前配予患者踝足支具（直角90°的位置）。观察组在此基础上应用肌电生物反馈电刺激疗法。分别在康复治疗前后测定表面肌电（ surface electromyogram，sEMG ）信号和肌力分级数据进行功能评定。结果治疗后3个月进行随访，两组患者胫前肌的sEMG信号及肌力有显著提高（ P＜0.05）：观察组sEMG信号和肌力分别由治疗前（5.57±2.31）μV、（1.04±1.38）级提高到治疗后（120.38±68.20）μV、（4.20±0.82）级；对照组sEMG信号和肌力分别由治疗前（7.35±4.30）μV、（1.64±1.47）级提高到治疗后（62.34±4.29）μV、（3.10±0.40）级，治疗后观察组sEMG信号和肌力均高于对照组（ P＜0.05）。结论肌电生物反馈疗法配合踝足支具治疗脊髓损伤术后患者，对其踝背屈功能障碍恢复有促进作用，能明显提高患者的胫前肌自主肌电信号及肌力。

Objective To observe the curative effects of electromyogram （ EMG ） biofeedback therapy combined with ankle-foot orthosis brace in the treatment of ankle dorsilfexion dysfunction in the patients with spinal cord injury （ SCI ）.Methods From July 2011 to January 2013, 30 SCI patients were adopted. There were 22 males and 8 females, whose average age was 35 years old （ range： 18-65 years ）. They were randomly divided into observation group （n=15 ） and control group （n=15 ）. All the patients received ankle-foot orthosis brace （ in the position of a right angle of 90° ） before the routine rehabilitation of ankle intensive training, Bobath technique and occupational therapy. The patients in the observation group received extra EMG biofeedback electrostimulation （ ES ） therapy. They were assessed with sEMG signal and muscle strength grading data before and after the rehabilitation.Results All the patients were followed up from the 3rd month after the treatment. The sEMG signal and strength of the tibialis anterior muscle were obviously improved in both groups after the treatment （P〈0.05 ）. The sEMG signal and muscle strength in the observation group were （ 5.57±2.31 ） μV and （ 1.04±1.38 ） grade before the treatment, which were improved to （ 120.38±68.20 ） μV and （ 4.20±0.82 ） grade after the treatment. The sEMG signal and muscle strength in the control group were （ 7.35±4.30 ） μV and （ 1.64＋1.47 ） grade before the treatment, which were improved to （ 62.34±4.29 ） μV and （ 3.10±0.40 ） grade after the treatment. Both the sEMG signal and muscle strength were improved more obviously in the observation group after the treatment （P〈0.05 ）.Conclusions The EMG biofeedback therapy combined with ankle-foot orthosis brace is effective in the treatment of ankle dorsilfexion dysfunction in the patients with SCI, which can signiifcantly improve the voluntary EMG signal and muscle strength of the tibialis anterior muscle.