偏瘫患者膝关节等速评定与训练的临床研究

Evaluation of the effect of Isokinetic Training on Knee in Stoke Patients

目的研究偏瘫患者膝关节等速训练的临床效果。方法首次发病脑卒中后偏瘫患者90例,按照等速训练时膝关节屈曲范围分为0-30°组、30°-60°组和60°-90°组,应用德国ISOMED2000型等速肌力训练系统进行股四头肌和腘绳肌向心性收缩训练。评定股四头肌痉挛指标;膝关节屈/伸膝肌力比值(Flexor/Extensor,F/E)变化;应用Fugl-Meyer法评定下肢运动功能。结果各组表示痉挛程度的被动阻力力矩在治疗前后差异无统计学意义(P>0.05),显示锻炼并没有增加肌张力;治疗前后F/E值差异在0-30°和30°-60°组有统计学意义(P<0.05),此两组膝关节稳定性均有好转,60°-90°组差异无统计学意义(P>0.05);0-30°组Fugl-Meyer评定中下肢运动积分、下肢平衡计分在治疗前、后差异有统计学意义(P<0.05),在30°-60°组和60°-90°组差异无统计学意义(P>0.05)。结论本研究显示在膝关节屈曲0-30°股四头肌及腘绳肌的向心性肌力锻炼可有效增加偏瘫患者患侧膝关节的功能,提高日常生活能力。

Objective To evaluate the effect of isokinetic quadriceps and hamstring training in different range of motion in stroke patients.Methods Isokinetic quadriceps and hamstring training of affected side were performed in 90 stroke cases,which were categorized in three groups of isokinetic training with 0-30°,30-60°or 60-90°range of motion of knee,using ISOMED2000.The quadriceps spastity,the ratio of flexor on extensor（F/E）the lower limb function of Fugl-Meyer scale and Barthal Index（BI）were compared before and after the training.Results The F/E score,the Fugl-Meyer scale and the BI in the 0-30°training group were statistically different before and after training（P〈0.05）.Whereas there were no statistical differences for the Fugl-Meyer scale and the BI in the 30-60°and 60-90°training groups（P〉0.05）,though there was statistical difference for F/E in the 30-60°training group.Conclusion The isokinetic quadriceps and hamstring training in knee range of motion 0-30°in stroke patients could increase the knee stability,improve lower limb function of the affected side and improve the capability of daily activity in stroke patients.