本体感觉神经肌肉促进技术改善卒中后偏瘫患者下肢肌痉挛及步行功能研究

Clinical study of PNF technology in relieving lower limb muscle spasm and improving walking ability in patients with hemiplegia after stroke

目的:研究本体感觉神经肌肉促进技术(proprioceptive neuromuscular facilitation,PNF)缓解卒中后偏瘫患者下肢肌痉挛,促进步行能力提高的临床疗效。方法:选择2017年3月至2018年12月郴州市第一人民医院收治的102例卒中后偏瘫患者为研究对象,按就诊顺序分为对照组和观察组,各51例,均给予内科对症基础治疗和针刺治疗;此外,对照组进行常规康复训练;观察组采用PNF技术对患肢进行训练。分别于治疗前后采用改良的Ashworth肌张力分级(MAS分级)标准评价股四头肌、内侧腓肠肌、外侧腓肠肌、股二头肌和腘绳肌的肌张力;使用量角器测量膝过伸角度;Berg平衡量表(BBS)和计时起立行走测试(TUG)评价平衡能力;步态分析系统评价步态。结果:治疗后,观察组的股四头肌、外侧腓肠肌、股二头肌的MAS分级评分显著低于同组治疗前(P<0.05);2组患者膝过伸角度较同组治疗前均有显著降低,且观察组显著低于对照组(P<0.05);观察组BBS和TUG评分较同组治疗前及对照组均有改善(P<0.05);2组患者的步频均较同组治疗前显著增加,观察组患者的跨步长和双支撑相百分比均较同组治疗前显著增加,且步速、跨步长均显著高于对照组(P<0.05)。结论:PNF技术相较于常规康复能更好地改善卒中后偏瘫患者下肢功能,降低患肢的肌张力,改善关节活动度,提高平衡能力,从而改善步行功能,降低跌倒风险。

Objective:To investigate the clinical efficacy of proprioceptive neuromuscular facilitation(PNF)in relieving lower limb spasm and improving walking ability in patients with hemiplegia after stroke.Methods:A total of 102 patients with hemiplegia after stroke were divided into the control group and PNF group with 51 patients in each group in order of visits,all of which were given symptomatic basic treatment and acupuncture treatment.In addition,the control group received routine rehabilitation training,and PNF group was given PNF training for affected limbs.The muscle tension of quadriceps femoris,medial gastrocnemius,lateral gastrocnemius,biceps femoris and hamstring muscles were evaluated by modified Ashworth scale(MAS)before and after treatment respectively.The knee overextension angle was measured by protractor,the balance abilities were evaluated by Berg balance scale(BBS)and time up and go test(TUG),and gait analysis system was used to evaluate gait.Results:Compared with that before treatment,the MAS grading of quadriceps femoris,lateral gastrocnemius and biceps femoris in the PNF group decreased significantly after treatment(P<0.05).The knee overextension angle of both groups decreased,and the decrease of PNF group was more significant than that of control group(P<0.05).The improvement of the balance and motor ability of PNF group was more significant than that of before treatment and the control group(P<0.05).The percentage of stride frequency in the control group increased compared with that before treatment,the percentage of stride frequency,stride length and double support phase in PNF group increased compared with that before treatment,and the improvement of stride speed and stride length in PNF group was more obvious than those in the control group(P<0.05).Conclusions:PNF technology is an effective method to improve the lower limb function of hemiplegic patients after stroke.It can reduce the muscle tension of affected limbs,improve the range of motion of joints,improve balance ability,thus improve walking function and reduce the risk of falling.