基于步态分析和sEMG评价的合谷刺法治疗中风后踝背屈障碍:随机对照研究

Evaluation of Triple Directional Needling in Treating Ankle Dorsiflexion Disorder After Stroke by Gait Analysis and Surface Electromyography: A Randomized Controlled Trial

目的观察合谷刺法对中风后踝背屈障碍患者的步态和表面肌电(surface electromyography,s EMG)的影响。方法选择符合纳入标准的脑卒中患者40例,采用随机数字表法随机分为两组,对照组20例,采用常规针刺法,治疗组20例,采用合谷刺法。在治疗前,采集并提取两组患者双侧下肢的步长、踝关节最大主动背屈角度、腓肠肌和胫前肌在踝关节屈伸最大等长收缩(MIVC)状态下的s EMG,评价中风后患者双侧下肢步行能力及肌肉功能状态。治疗后,应用三维步态参数、踝关节最大主动背屈角度、腓肠肌和胫前肌在MIVC状态下的s EMG特征值来评价两组中风患者患侧下肢步行能力和肌肉状态。结果两组患者治疗前双侧下肢参数比较,患侧下肢步长和踝关节最大主动背屈角度均小于健侧,患侧腓肠肌和胫前肌在MIVC状态下的IEMG和RMS均低于健侧,患侧CR大于健侧,差异均具有统计学意义(P<0.05)。治疗后,两组患者患侧下肢的步速、步频、步长、支撑相、双支撑相、踝关节最大主动背屈角度、腓肠肌和胫前肌在MIVC状态下的IEMG、RMS和CR均较同组治疗前有明显改善(P<0.05),且治疗组的参数明显优于对照组(P<0.05)。结论合谷刺法对中风后踝背屈障碍患者步行能力恢复具有促进作用。

Objective To observe the effect of triple directional needling on gait and surface electromyography(sEMG)in patients with ankle dorsiflexion disorder after stroke.Method Forty eligible patients were randomized into two groups.Twenty patients in the control group were intervened by conventional acupuncture;20 patients in the treatment group were intervened by triple directional needling.Before the treatment,the bilateral step length,maximum angle of active ankle dorsiflexion,and sEMG of gastrocnemius muscle and anterior tibial muscle under the maximum isometric voluntary contraction(MIVC)during ankle flexion and extension were collected from the two groups,to evaluate the walking ability and muscle function of bilateral limbs in stroke patients.After the treatment,threedimensional gait parameters,the maximum angle of active ankle dorsiflexion,the sEMG eigenvalues of gastrocnemius muscle and anterior tibial muscle under MIVC were used to evaluate the stroke patients’walking ability and muscle state of the lower limbs on the affected side in the two groups.Result Before the treatment,the parameters of the bilateral lower limbs of the two groups were compared,showing that the step length and the maximum angle of active ankle dorsiflexion of the affected limb were smaller than those of the healthy side,the integrated electromyogram(IEMG)and root mean square(RMS)of gastrocnemius muscle and anterior tibial muscle under MIVC of the affected side were lower than those of the healthy side,and the co-contraction ratio(CR)of the affected side was larger than that of the healthy side,with significant differences(P<0.05).After the treatment,the walking speed,cadence,step length,stance phase,double stance phase,the maximum angle of active ankle dorsiflexion,the IEMG,RMS and CR of gastrocnemius muscle and anterior tibial muscle under MIVC of the affected side were significantly improved in the two groups(P<0.05);the parameters in the treatment group were significantly superior to those in the control group(P<0.05).Conclusion Triple directional needling can promote the recovery of walking ability in patients with ankle dorsiflexion disorder after stroke.