骨盆、髋关节周围肌群等长收缩训练对脑卒中后遗症期患者步行功能的影响

Effect of isometric exercise of muscle groups around pelvic and hip on walking function in patients with stroke in sequelae period

目的观察骨盆、髋关节周围肌群等长收缩训练对脑卒中后遗症期患者步行功能的影响。方法根据康复方法将脑卒中后遗症期患者21例分为收缩训练组(11例)和对照组(10例)。两组均予常规脑卒中药物治疗和常规康复治疗;收缩训练组在此基础上,采用仰卧位、侧卧位和俯卧位下的多组骨盆、髋关节周围肌群的等长收缩训练。两组均接受治疗6个月。治疗前后采用下肢Fugl-Meyer量表(FMA)、Berg平衡功能量表(BBS)、步态评估量表(TGA)和10 m最大步行速度(MWS)评价患者的步行功能。结果与治疗前比较,收缩训练组及对照组治疗后下肢FMA、BBS及TGA评分均显著升高,MWS速度显著加快(P<0.05~0.01)。两组患者治疗前下肢FMA、BBS、TGA评分及MWS速度差异无统计学意义(均P>0.05)。与对照组比较,收缩训练组治疗前后下肢FMA、TGA评分及MWS速度差值显著升高(t=2.28,P=0.04;t=3.85,P=0.00;Z=2.17,P=0.03),治疗前后BBS评分差值无统计学意义(t=-0.08,P=0.94)。结论仰、侧、俯卧位下骨盆、髋关节周围肌群等长收缩可提高脑卒中后遗症期患者下肢运动和步行能力。

Objective To observe the effect of isometric exercise （IE） of muscle groups around pelvic and hip on walking function in patients with stroke in sequelae period. Methods According to different rehabilitation therapies, 21 patients with stroke in sequelae period were divided into IE group （11 eases） and control group （10 eases）. Both groups were accepted routine medication and rehabilitation therapies. IE group patients, based on treatments above-mentioned, were received isometric exercise of muscle groups around pelvic and hip in three positions including supine, unaffected side-lying and prone position at same time. Both groups were treated for 6 months. Before and after treatment, both groups were evaluated walking function by lower limb Fugl-Meyer assessment （FMA） scale, Berg balance scale （BBS） , tinetti gait analysis （TGA） scale and 10 m maximum walking speed （MWS）. Results Compared with pre-treatment, the scores of FMA, BBS and TGA of lower limb in IE group and control group were significantly higher, and MWS in IE group and control group were significantly increased （ P 〈 0. 05 - 0.01 ）. There was no statistical significance in scores of FMA, BBS and TGA of lower limb and MWS between IE group and control group before treatment （ all P 〉 0. 05 ）. Compared with control group, difference values between pre and post treatment of scores of lower limb FMA, TGA and MWS of IE group were significantly increased （t =2.28, P = O. 04; t = 3.85, P = 0.00; Z = 2. 17, P = 0. 03 ）, while difference values between pre and post treatment of score of BBS of IE group had no statistical significance （ t = - 0.08, P = 0.94 ）. Conclusion Isometric exercises of muscle groups around pelvic and hip in three positions including supine, unaffected side-lying and prone position are effective to enhance affected lower limbs＇ motor function and walking ability of patients with stroke in sequelae period.