放散式体外冲击波对脑卒中患者下肢痉挛及三维步态参数的效果研究

The effects of radial extracorporeal shock wave therapy on gait parameters and spasticity in the patients of stroke with hemiplegia

目的:观察放散式体外冲击波对脑卒中偏瘫患者下肢痉挛,步态时空、对称性参数以及运动学参数的影响。方法:选取40例符合入选标准的脑卒中偏瘫患者,将其随机分为试验组及对照组,每组20例。试验组进行常规康复治疗和患侧下肢放散式体外冲击波治疗(每周2次),连续3周,对照组进行常规治疗和安慰性冲击波治疗。分别于治疗前、第三周全部治疗结束后使用三维步态分析仪器检测并获得两组患者的步态参数。同时比较两组患者治疗前后腘绳肌、股四头肌、小腿三头肌改良Ashworth分级(MAS)评分,以及患侧下肢的Fugl-Meyer(FMA)评分。结果:在第三周治疗结束后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相、踝关节最大背屈角度、踝关节最大跖屈角度均较治疗前明显提高(P<0.05),步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、患侧健侧摆动相比值均较治疗前明显减小(P<0.05)。组间对比显示,治疗后试验组患者步幅、步频、步速、步态周期、步长偏差、踝关节最大背屈角度、踝关节最大跖屈角度均优于对照组(P<0.05)。治疗后试验组腘绳肌、股四头肌、小腿三头肌MAS评分及患侧下肢FMA评分均较治疗前改善(P<0.05),并优于对照组(P<0.01,P<0.05)。结论:放散式体外冲击波能有效改善脑卒中偏瘫患者步态时空、运动学、对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。同时可以降低患侧下肢的痉挛,提高下肢运动功能。

Objective:To observe the effects of radial extracorporeal shock wave therapy(rESWT)on gait parameters and spasticity in the patients of stroke with hemiplegia.Method:Forty stroke patients with hemiplegia who met the inclusion criteria were randomly divided into the experimental group(n=20)and control group(n=20).The experimental group was given routine rehabilitation treatment and the r ESWT(twice a week for three weeks).The control group was given routine rehabilitation treatment and the placebo r ESWT.The gait parameters of the two groups were detected and obtained using a three-dimensional gait analysis instrument before treatment and after three-weeks treatment.At the same time,the modify Ashworth scale(MAS)scores of the hamstring,quadriceps,calf triceps and the Fugl-Meyer(FMA)scores of the lower limb were used before and after treatment.Result:After three-weeks treatment,the cadence,stride length,walking velocity,nonparetic leg swing phase,paretic leg swing phase,the maximum range of motion of dorsiflexion,and the maximum range of motion of plantar flexion were significantly higher than those before treatment(P<0.05),the gait cycle,double limbs stance phase,nonparetic leg stance phase,paretic leg stance phase,foot length deviation,and the ratio of paretic to nonparetic swing phase were significantly lower than before treatment(P<0.05).The parameters were better in the experimental group than those in control group after treatment(P<0.05),such as stride length,cadence,walking velocity,gait cycle,foot length deviation,the maximum range of motion of dorsiflexion,and the maximum range of motion of plantar flexion.The MAS scores of the hamstring,quadriceps and calf triceps and the FMA scores of the lower limb in the experimental group were significantly better than those before treatment(P<0.05),and were superior to the control group(P<0.01,P<0.05).Conclusion:Radial extracorporeal shock wave therapy can effectively improve the gait time-spatial parameters,kinematic parameters and symmetry parameters in the patients of stroke with hemiplegia.And it can also reduce the spasticity of the lower limb and improve the motor function of the lower limb.