表面肌电技术指导下督脉电针治疗脑卒中下肢痉挛的临床价值

Value of electroacupuncture of Du meridian under the guidance of surface electromyography in the treatment of stroke lower limb spasm

目的探讨表面肌电技术指导下督脉电针治疗脑卒中下肢痉挛的临床价值。方法回顾性分析2017年10月至2019年4月解放军联勤保障部队第九一○医院收治的缺血性脑卒中后下肢痉挛80例患者的临床资料,按照治疗方法不同分为对照组和肌电组各40例。对照组实施常规督脉电针治疗,肌电组则在对照组基础上应用表面肌电技术指导下督脉电针治疗。比较2组干预后肌张力、足背屈角度及粗大运动功能评分变化;比较2组患者治疗过程中下肢腓肠肌与比目鱼肌肌电图均方根振幅(RMS)值协同收缩率变化情况;比较2组随访半年下肢关节功能及欧洲脑卒中评分(ESS)和整体生活质量Barthel指数变化;统计2组干预后痉挛改善情况。结果肌电组干预后肌张力为(2.4±0.2)级,显著低于对照组的(3.7±0.4)级;足背屈角度为(49.7±2.5)°,显著大于对照组的(43.4±1.6)°;粗大运动功能评分为(2.6±0.2)分,显著高于对照组的(2.0±0.1)分,以上差异均有统计学意义(P<0.01)。干预后1周和干预后1个月,肌电组下肢腓肠肌与比目鱼肌肌电图RMS值协同收缩率[(35.6±3.3)%和(40.5±3.9)%]均较同期对照组[(32.1±2.0)%和(34.5±2.6)%]显著增高(P<0.01)。随访半年,肌电组出现下肢关节半脱位、下肢关节挛缩、下肢关节僵硬等比例分别为7.5%、5.0%和5.0%,均显著低于对照组的40.0%、40.0%和32.5%(P<0.01);肌电组神经功能ESS得分为(86.6±4.6)分,生活质量Barthel指数得分为(80.1±3.8)分,均显著高于对照组的(73.4±3.8)分和(67.6±1.4)分,差异均有统计学意义(P<0.01)。肌电组痉挛改善率达到90.0%(36例),显著高于对照组的50.0%(20例),差异有统计学意义(P<0.01)。结论针对脑卒中下肢痉挛患者,运用表面肌电技术下进行督脉电针治疗,可有效降低下肢肌张力,促进关节功能恢复与运动功能协调,减少骨骼肌肉相关并发症发生率,最终达到促进下肢痉挛改善的目的。

Objective To explore the clinical value of electroacupuncture of Du meridian under the guidance of surface electromyography in the treatment of stroke lower limb spasm.Methods 80 cases with spasticity of lower limbs after ischemic stroke admitted in the 910th Hospital of the Joint Logistics Support Force from October 2017 to April 2019 were selected as research objects were randomly divided into two groups with 40 cases each.The control group was treated with conventional Du meridian electroacupuncture,while the electromyography(EMG)group was treated with Du meridian electroacupuncture under the guidance of surface electromyography technology on the basis of the control group.The changes of muscle tension,dorsiflexion angle of foot and gross motor function scores after intervention were compared between the two groups.Then the changes of RMS value of electromyogram of lower limb gastrocnemius and soleus muscle and the change of synergic contraction rate during treatment were comparable between the two groups.Following up for half a year,the changes of lower limb joint function,the European stroke score(ESS)and the Barthel index of overall life quality were compared between the two groups.The improvement of spasticity after intervention in the two groups was recorded.Results After intervention,the muscle tension in EMG group was(2.4±0.2),which was significantly lower than that in control group(3.7±0.4),the dorsiflexion angle of foot was(49.7±2.5),which was significantly higher than that in control group(43.4±1.6),and the gross motor function score was(2.6±0.2),which was significantly higher than that in control group(2.0±0.1);The differences were statistically significant(P<0.01).One week after intervention and one month after intervention,the synergetic contraction rates of RMS values of gastrocnemius and soleus muscles in EMG group[(35.6±3.3)%and(40.5±3.9)%]were significantly higher than those in control group[(32.1±2.0)%and(34.5±2.6)%,P<0.01].After half a year's follow-up,the rates of subluxation,contracture and stiffness of lower limb joints in EMG group were 7.5%,5.0%and 5.0%,respectively,which were significantly higher than those in control group(40.0%,40.0%and 32.5%,P<0.01).After half a year's follow-up,the ESS score of nerve function and Barthel index score of quality of life in EMG group were(86.6±4.6)and(80.1±3.8),which were significantly higher than those in control group[(73.4±3.8)and(67.6±1.4),P<0.01].The improvement rate of spasm in EMG group was 90.0%(36 cases),which was significantly higher than that in control group(50.0%,20 cases),and the difference was statistically significant(P<0.01).Conclusion For stroke patients with lower limb spasms,electroacupuncture of Du meridian under surface electromyography technology can effectively reduce lower limb muscle tension,promote joint function recovery and coordination of motor function,reduce the incidence of skeletal muscle-related complications,and finally achieve the purpose of improving lower limb spasms.