改良腕手关节矫形器对脑卒中偏瘫患者腕手关节屈肌痉挛及运动功能的疗效

Effect of Modified Wrist- hand Orthosis on Spasm and Motor Function of Wrist and Hand in Hemiplegics post Stroke

目的：探讨改良腕手关节矫形器对偏瘫患者腕手关节屈肌痉挛及运动功能的疗效。方法脑卒中后偏瘫患者56例分为观察组与对照组各28例。两组均接受常规康复训练，包括运动疗法、作业疗法、痉挛肌电刺激疗法，观察组加用改良腕手关节矫形器，于每天训练结束后累计穿戴4～8 h，每次30～60 min，休息15 min。分别于治疗前、治疗4周、治疗8周及治疗12周对两组患者采用改良Ashworth量表（MAS）、简式Fugl-Meyer评定（FMA）进行评定，采用量角器测量患侧腕关节主动掌屈、背伸、桡偏、尺偏关节活动度（AROM）。结果治疗4周时，两组均未见明显改善，两组间也无显著性差异。治疗8周时，两组MAS和FMA评分较治疗前和治疗4周时改善（P〈0.05），观察组明显优于对照组（P〈0.01）；观察组腕关节各方向AROM与治疗前比较均有提高（P〈0.05），其中背伸AROM较对照组明显提高（P〈0.01）。治疗12周时，观察组MAS和FMA评分较治疗8周时进一步明显改善（P〈0.01），且明显优于对照组（P〈0.01）；观察组背伸、掌曲、桡偏AROM优于对照组（P〈0.05）。结论改良腕手关节矫形器可明显缓解脑卒中后偏瘫患者腕手关节屈肌痉挛，促进腕手关节运动功能恢复。

Objective To investigate the effect of the modified wrist-hand orthosis on the spasm and function of wrist-hand in hemiple-gic patients. Methods 56 patients with hemiplegia after stroke were divided into observation group （n=28） and control group （n=28）. All the patients received routine rehabilitation, including physical therapy, occupational therapy, and Hufschmidt therapy. The observation group wore modified wrist-hand orthosis 4-8 hours a day after the treatment, with interval of 15 min per 30-60 min. All the patients were assessed with modified Ashworth Scale （MAS）, simple Fugl-Meyer Assessment （FMA） and active range of motion （AROM） of flexion, extension, ra-dial deviation and ulnar deviation of wrist before and 4 weeks, 8 weeks and 12 weeks after treatment. Results There was no significant im-provement in both groups 4 weeks after treatment, nor difference between groups. The scores of MAS and FMA improved 8 weeks after treatment in both groups （P〈0.05）, and improved more in the observation group than in the control group （P〈0.01）. While the AROMs im-proved in the observation groups （P〈0.05）, and the AROM of extension was more than that of the control group （P〈0.01）. 12 weeks after treatment, the scores of MAS and FMA improved further in the observation group （P〈0.01）, and improved more than those of the control group （P〈0.01）. The AROMs of flexion, extension and radial deviation improved more in the observation group than in the control group （P〈0.05）. Conclusion The modified wrist-hand orthosis can obviously relieve the spasm of wrist-hand flexor in patients with hemiplegia af-ter stroke, and promote the motor function.