自制腕关节屈伸装置联合常规康复治疗对脑梗死后腕关节痉挛的干预效果分析

Therapeutic Effect of Self-made Wrist Joint Flexion and Extension Orthoses Combined with Routine Rehabilitation Training on Wrist Joint Spasm after Brain Infarction

目的:观察自制腕关节屈伸装置联合常规康复治疗对脑梗死后恢复期患者腕关节痉挛的干预效果。方法:将60例脑梗死后恢复期患者按照随机数字表法分为腕关节屈伸装置组和常规康复组,每组各30例。常规康复组给予痉挛电刺激、肌电生物反馈、电子生物反馈、作业训练、手功能训练、运动疗法、普通针刺等常规康复治疗,屈伸装置组在常规康复治疗基础上加用屈伸装置训练,首次治疗由治疗师为患者佩戴,教会患者自己使用,每次佩戴中角度固定,随着患者关节活动逐渐改善,每次治疗前慢慢调高屈伸装置的度数,每天调节的度数以患者感到肌肉紧张而没有明显疼痛为度。痉挛电刺激治疗每次15 min,其余常规康复治疗每次20 min,每天1次;自制腕关节屈伸装置每次佩戴30 min,每天2次;以上治疗均为每周6次,共治疗3周。治疗前后采用简化Fugl-Meyer运动功能量表上肢部分评定上肢运动功能,改良Ashworth量表(MAS)评估腕关节痉挛程度,改良Barthel指数(MBI)评价患者日常生活能力,量角器评定腕关节主动屈伸活动度之和,手功能量表评定患手功能。结果:治疗3周后,2组Fugl-Meyer运动功能量表评分均较治疗前有升高(P<0.05),且屈伸装置组升高幅度较常规康复组更明显,治疗后2组间上述指标比较,差异有统计学意义(P<0.05);治疗3周后,2组MAS评分均较治疗前降低(P<0.05),且屈伸装置组降低幅度较常规康复组更明显,治疗后2组间上述指标比较,差异有统计学意义(P<0.05);治疗3周后,2组MBI评分均较治疗前升高(P<0.05),且屈伸装置组升高幅度较常规康复组更明显,治疗后2组间上述指标比较,差异有统计学意义(P<0.05);治疗3周后,2组腕关节主动屈伸活动度之和较治疗前升高(P<0.05),且屈伸装置组升高幅度较常规康复组更明显,治疗后2组间上述指标比较,差异有统计学意义(P<0.05);治疗3周后,2组手功能评分均较治疗前升高(P<0.05),且屈伸装置组升高幅度较常规康复组更明显,治疗后2组间上述指标比较,差异有统计学意义(P<0.05)。结论:自制腕关节屈伸装置可缓解脑梗死后恢复期患者腕关节痉挛,增加其主动屈伸关节活动度,改善其上肢及手功能,提高其日常生活能力,且无明显副作用,值得临床推广。

Objective:To observe the effect of self-made wrist joint flexion and extension orthoses combined with conventional rehabilitation treatment on wrist joint spasm in convalescent patients after cerebral infarction.Methods:A total of 60 patients with cerebral infarction were randomly assigned to wrist flexion-extension orthoses group and routine rehabilitation group according to the random number table method,with 30 cases in each group.Routine rehabilitation group was given convulsive electrical stimulation,electromyographic biofeedback,electronic biofeedback,job training,hand function training,exercise therapy,ordinary acupuncture and so on.The flexion and extension orthoses group was trained with flexion and extension device on the basis of routine rehabilitation treatment.The first treatment was carried out by the therapist for the patient,and then the patient was taught to operate.The flexion and extension device was fixed at one angle at each time.As the patient’s joint activity gradually improved,the degree of the flexion and extension device was slowly raised before each treatment.The degree of adjustment per day was set up accoding to the patient’s feeling of muscle tension without apparent pain.Convulsive electric stimulation was given for 15 minutes each time,and the rest routine rehabilitation was given for 20 minutes,once a day.The self-made wrist joint flexion and extension device was worn for 30 minutes each time,twice a day,six days a week for a total of three weeks.Before and after treatment,the upper limb motor function was assessed by simplified Fugl-Meyer motor function scale,the degree of carpal spasm was evaluated by modified Ashworth scale(MAS),and the modified Barthel index(MBI)was used to evaluate the degree of carpal spasm.MBI was used to evaluate the patient ability of daily living(ADL)and the sum of active flexion and extension of wrist joint was evaluated by goniometer,the hand function scale was assessed by the hand function scale.Results:After three weeks of treatment,the scores of Fugl-Meyer motor function scale in both groups were higher than those before treatment(P<0.05),the increase of flexion and extension device group was more obvious than that of the routine rehabilitation group,the differences between the two groups were statistically significant after treatment(P<0.05).After three weeks of treatment,the MAS scores of the two groups after treatment were lower than those before treatment(P<0.05),and the decrease of the wrist flexion-extension orthoses group was more obvious than that of the routine rehabilitation group,the differences between the two groups were statistically significant after treatment(P<0.05).After three weeks of treatment,the MBI scores of the two groups increased after treatment compared with that before treatment(P<0.05),and the increase in the flexion and extension device group was more significant than that in the routine rehabilitation group,the differences between the two groups were statistically significant after treatment(P<0.05);after three weeks of treatment,the sum of range of motion of the active flexion and extension activities of the wrist after treatment in both groups were increased compared with that before treatment(P<0.05),and the increase in the flexion and extension device group was more significant than that in the conventional rehabilitation group,the differences between the two groups were statistically significant after treatment(P<0.05);after three weeks of treatment,the hand function scale of the two groups increased after treatment compared with that before treatment(P<0.05),and the increase in the wrist flexion-extension orthoses group was more significant than that in the routine rehabilitation group,the differences between the two groups were statistically significant after treatment(P<0.05).Conclusion:Self-made wrist joint flexion and extension orthoses can reduce wrist spasm in convalescent patients after cerebral infarction,increase their active flexion and extension range of motion,improve their upper limb and hand function,and improve their daily life ability,without obvious side effects.It is worthy of clinical application promotion.