两种不同针刺方法对脑卒中迟缓性瘫痪患者三维步态时空和表面肌电的影响

Effect of Two Acupuncture Methods on Three-dimensional Gait Time-space Parameters and Surface Electromyography of Post-stroke Patients with Flaccid Paralysis

【目的】比较电针和温针灸两种不同针刺方法对脑卒中迟缓性瘫痪患者三维步态时空和表面肌电的影响。【方法】将61例脑卒中迟缓性瘫痪患者随机分为电针治疗组(简称电针组)30例和温针灸治疗组(简称温针灸组)31例。2组均给予相应的基础治疗,电针组同时给予电针治疗,温针灸组同时给予温针灸治疗。治疗2个疗程后,分别检测2组治疗前后三维步态时空参数(步速、支撑相、摆动相、双支撑相、步长)及患肢腓肠肌和胫前肌在踝关节屈伸最大等长收缩(maximal isometric voluntary contraction,MIVC)状态下表面肌电均方根值(RMS)、肌电积分值(i EMG)、协同收缩率(CR)等指标。【结果】(1)治疗后,2组患者的三维步态参数步速、支撑相、摆动相、双支撑相和步长等均较治疗前有不同程度改善(P<0.05或P<0.01),且温针灸组在改善三维步态时空参数方面均优于电针组,差异均有统计学意义(P<0.05)。(2)治疗后,2组患者MIVC状态下的腓肠肌和胫前肌的i EMG、RMS和足背伸CR等均较治疗前有不同程度改善(P<0.05或P<0.01),且温针灸组在改善MIVC状态下的腓肠肌和胫前肌的i EMG、RMS和足背伸CR方面均优于电针组,差异均有统计学意义(P<0.05或P<0.01)。【结论】与电针相比,温针灸能更好地改善脑卒中迟缓性瘫痪患者三维步态时空和表面肌电的各项参数。

Objective To compare the effect of electro-acupuncture（EA）and warm-needle moxibustion（WNM）on the foot three-dimensional gait time-space parameters and surface electromyography of post-stroke patients with flaccid paralysis. Methods A total of 61 patients were randomly divided into EA group（N=30） and WNM group（N=31）. Both groups were given post-stroke conventional treatment,and additionally EA group received EA while WNM group was given WNM. Before treatment and after 2 treatment courses, we detected the foot three-dimensional gait time-space parameters of pace race,stance phase,swing phase,bilateral stance phase,and step length,and surface electromyography parameters of root mean square（RMS）,integrated electromyogram（i EMG）and co-contraction ratio（CR） of tibialis anterior muscle and gastrocnemius at the state of maximal isometric voluntary contraction（MIVC）. Results（1）After treatment, the foot three-dimensional gait time-space parameters of the two groups were improved in various degrees（P〈0.05 or P〈0.01 compared with those before treatment）, and the improvement of EA group was superior to that of WNM group（P〈0.05）.（2） After treatment,the RMS and i EMG of the gastrocnemius and tibialis anterior muscle as well as CR of dorsal extensor at MIVC state were improved in various degrees（P〈0.05 or P〈0.01 compared with those before treatment）,and the improvement of EA group was superior to that of WNM group（P〈0.05 or P〈0.01）. Conclusion WNM exerts better effect on improving the parameters of three-dimensional gait time-space parameters and surface electromyography of post-stroke patients with flaccid paralysis than EA.