体外冲击波疗法对脑卒中后下肢肌肉张力过高的疗效观察

Effects of extracorporeal shock wave therapy on hypertonia in lower extremity after cerebral stroke

目的:观察体外冲击波疗法(ESWT)对脑卒中后下肢肌张力过高状态的疗效。方法:抽取2016年10月至2017年10月在郑州大学第一附属医院康复医学科住院的脑卒中恢复期患者40例,均伴有下肢肌肉张力过高,主要分布于股四头肌、小腿三头肌,肌张力均以2~3级为主。按随机数字表法分为常规治疗组(对照组)、常规治疗+ESWT治疗组(观察组),每组20例。对照组采用常规康复训练方法,每日1次,每周5次,共治疗4周;观察组除进行常规康复治疗外,还对患者股四头肌、小腿三头肌进行EWST治疗,每周2次,连续治疗4周。于治疗前和治疗1、2、4周后分别进行膝关节伸膝肌群肌张力、踝关节跖屈肌群肌张力、下肢运动功能评定。结果:治疗前及治疗1周后,两组肌张力运动功能评估量表(MAS)评分比较差异未见统计学意义(P>0.05);治疗2、4周后,观察组MAS评分(7.90、8.20分)小于对照组(12.33、12.00分),P<0.05。治疗前及治疗1、2周后,两组下肢Fugl-Meyer运动功能评定量表(FMA)评分比较差异未见统计学意义(P>0.05);治疗4周后,观察组下肢FMA评分[(16.00±1.41)分]大于对照组[(10.56±2.56)分],P<0.05。结论:体外冲击波疗法可以降低患者肌肉张力过高状态,有效提高患者的运动功能,对脑卒中后肌张力有明显的改善作用。

Objective To observe the effects of extracorporeal shock wave therapy(ESWT)on hypertonia in lower extremity after cerebral stroke.Methods A total of 40 stroke patients during recovery stages treated in the Department of Rehabilitation of the First Affiliated Hospital of Zhengzhou University from October 2016 to October 2017 were selected.All patients had hypertonia,mainly distributed in quadriceps femoris muscle and triceps muscle of the calves.The muscle tension was mainly 2 to 3 grades.Patients were divided into conventional treatment group(control group),conventional treatment+ESWT treatment group(observation group)by random number table method,with 20 cases in each group.The control group was treated by routine rehabilitation therapy,once a day,5 times a week for 4 weeks.In addition to the routine rehabilitation therapy,ESWT was also performed on quadriceps femoris muscle and triceps muscle of the calves of the patients in the observation group,twice a week for 4 weeks.Before treatment and 1,2,4 weeks after treatment,the extensor knee muscle group tension,ankle flexor metatarsal muscle group tension and lower extremity motor function were evaluated.Results Before and after 1 week of treatment,there was no significant difference in the scores of muscle tension and motor assessment scale(MAS)between the two groups(P>0.05);after 2 and 4 weeks of treament,the MAS scores of the observation group were 7.90 and 8.20,respectively,significantly lower than the 12.33 and 12.00 of the control group(P<0.05).Before treatment and after 1 and 2 weeks of treatment,there was no significant difference in the scores of lower limb Fugl-Meyer assessment(FMA)between the two groups(P>0.05).After 4 weeks of treatment,the FMA score of the observation group was significantly higher than that of the control group(16.00±1.41 vs.10.56±2.56),P<0.05.Conclusions ESWT can alleviate hypertonia,improve motor function effectively and have significant improvements in treating muscle tone after cerebral stroke.