冲击波联合经皮神经电刺激治疗脑卒中后腓肠肌痉挛的比较研究

Comparative Study of Shock Wave Combined with Transcutaneous Electric Nerve Stimulation to Treat the Gastrocnemius Spasm After Stroke

观察冲击波联合经皮神经电刺激治疗在脑卒中后腓肠肌痉挛治疗中的疗效,并探讨其作用机制。42例脑卒中恢复期伴有腓肠肌痉挛患者,以随机数表法分为电刺激组、冲击波治疗组和联合治疗组,每组14例。三组均以接受脑卒中常规康复训练为基础,联合治疗组对患侧腓肠肌应用放散式体外冲击波(rESWT)并对患侧胫前肌应用经皮神经电刺激治疗(TENS);电刺激组给予患侧胫前肌TENS治疗;冲击波治疗组给予患侧腓肠肌rESWT治疗。比较治疗前、治疗4周后患者的踝关节被动活动度(PROM)、腓肠肌综合痉挛量表评分(CSS)和胫神经H反射H波峰值与M波峰值比值Hmax/Mmax。与治疗前相比,三组PROM、CSS均明显改善(P<0.05),且联合治疗组治疗后PROM、CSS均优于电刺激组及冲击波治疗组,差异有统计学意义(P<0.05),Hmax/Mmax比值仅联合治疗组和电刺激组较治疗前降低(P<0.05),且两组治疗后Hmax/Mmax差异不显著(P>0.05),冲击波治疗组治疗前后Hmax/Mmax则无明显变化(P>0.05)。冲击波联合经皮神经电刺激治疗较单一治疗对于痉挛的缓解效果更好。

To evaluate the effect of shock wave combined with transcutaneous electric nerve stimulation in the treatment of post-stroke with gastrocnemius spasm,and discuss its mechanism.42 patients with gastrocnemius spasm after stroke were divided into three groups:electrical stimulation group,shock wave group and combined treatment group,14 cases in each group.Three groups were all treated with conventional stroke rehabilitation training,combination group was given the radial extracorporeal shock wave(rESWT)to the gastrocnemius and the transcutaneous electric nerve stimulation(TENS)to the anterior tibial muscle.The shockwave treatment group was only treated with rESWT of the gastrocnemius.The electrical stimulation group was given the treatment of the TENS to the anterior tibial muscle.Compare the positive range of motion of ankle(PROM),composite spasticity scale of gastrocnemius(CSS)and ratio of H wave and M wave of tibial nerve H reflex(Hmax/Mmax)before and 4 weeks after treatment.Compared with before treatment,the PROM,CSS were all significantly improved(P<0.05)in 3 groups.Combined treatment group were better than electrical stimulation and shock wave treatment group.The difference was statistically significant(P<0.05).The Hmax/Mmax ratio was reduced only in combined treatment group and electrical stimulation group compared with that before treatment(P<0.05)and there are not significant differences between two groups(P>0.05).Hmax/Mmax before and after treatment was not significantly changed in shock wave treatment group(P>0.05).Shock wave combined with transcutaneous electric nerve stimulation is better than single treatment in the relief of spasm.