电动深层肌肉刺激对脑卒中患者肱二头肌张力、弹性及硬度的影响

Effect of electrical deep muscle stimulate on muscle tone,elasticity,and stiffness of biceps brachii in stroke patients

背景:电动深层肌肉刺激作为一种局部振动疗法可缓解因劳累或牵拉导致的损伤、乳酸堆积,或者筋膜间粘连导致的疼痛与功能受限,但其对抗痉挛作用的研究报道较少。目的:探讨电动深层肌肉刺激对脑卒中患者肱二头肌张力、弹性及硬度的影响。方法:选择2019年5至12月广东药科大学附属第一医院收治的脑卒中偏瘫患者60例,按随机数字表法分3组治疗,每组20例:对照组接受常规的康复训练和药物治疗;牵伸组在常规康复训练和药物治疗的基础上进行肱二头肌牵伸训练,每次10 min,1次/d,每周5次,连续治疗3周;试验组在常规康复训练和药物治疗的基础上进行牵伸状态下的电动深层肌肉刺激,每次10 min,1次/d,每周5次,连续治疗3周。治疗前、首次治疗后及全部治疗结束后测试肱二头肌阻尼振动频率(F值,反映肌张力)、对数衰减值(D值,反映肌肉弹性)及动态刚度(S值,反映肌肉硬度),并进行改良Tardieu量表(肘关节屈曲起始角度R值、快速牵伸肘关节卡住角度R1值与肌肉反应质量X值)及上肢肩肘部分Fugl-Meyer量表(FMA评分)评定。研究经广东药科大学附属第一医院伦理委员会批准,审批号:医伦审[2019]第(181)号。结果与结论:①首次治疗后,牵伸组和试验组的F、S、D、R1、X值低于治疗前(P<0.05),试验组的R值低于治疗前(P<0.05)、FMA评分高于治疗前(P<0.05);治疗结束后,3组的F、S、D、R、R1、X值均低于治疗前(P<0.05),FMA评分高于治疗前(P<0.05);②牵伸组首次治疗后的F、S值低于对照组(P<0.05),两组治疗结束后的所有参数比较无差异(P>0.05);牵伸组和试验组间首次治疗后的所有参数比较无差异(P﹥0.05),试验组治疗结束后的F、S、D、R1和X值低于牵伸组(P<0.05),FMA评分高于牵伸组(P<0.05);试验组首次治疗后的F、S值低于对照组(P<0.05),治疗结束后的所有参数均优于对照组(P<0.05);③结果表明,电动深层肌肉刺激治疗仪联合常规康复治疗能显著降低脑卒中患者肱二头肌的肌张力及硬度,改善弹性,并提高上肢运动功能。

BACKGROUND:Electrical deep muscle stimulate as a local vibration therapy can relieve pain and functional limitation due to injury,lactic acid buildup,or interfascial adhesions caused by exertion or pulling,but few studies have reported on its anti-spasticity effects.OBJECTIVE:To observe the effect of electrical deep muscle stimulate(DMS)on muscle tone,stiffness,and elasticity of biceps brachii in stroke patients.METHODS:A total of 60 stroke patients with hemiplegia,who met the inclusion criteria,were randomly divided into control group(n=20),stretch group(n=20)and DMS group(n=20).All of the three groups were given routine rehabilitation and drug treatments.Biceps brachii of the hemiplegic side was stretched for 10 minutes,once a day,five times per week,for 3 continuous weeks in the stretch group.The DMS group was given DMS in the state of biceps brachii stretched,10 minutes once,five times per week,for 3 continuous weeks.The Modified Tardieu Scale scores,the content of shoulder and elbow of Fugl-Meyer Assessment Scale(FMA)scores and the Myoton-3 parameters were recorded before,immediately after the first intervention and after 3 weeks of treatment.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University(approval No.[2019]181).RESULTS AND CONCLUSION:Immediately after the first intervention,the oscillation frequency(F),logarithmic decrement(D),and dynamic stiffness(S)of biceps brachii,the angle of catch following a fast velocity stretch biceps brachii(R1)and the quality of biceps brachii reaction(X)in both stretch group and DMS group were significantly lower than those before treatment(P<0.05).The start angle of elbow flexion(R)in the DMS group was significantly lower than that before treatment and the FMA scores of the upper limb in the DMS group were significantly higher than those before treatment(P<0.05).After 3 weeks of treatment,the oscillation frequency,logarithmic decrement,and dynamic stiffness of biceps brachii,the start angle of elbow flexion(R),the angle of catch following a fast velocity stretch biceps brachii(R1)and the quality of biceps brachii reaction(X)in all groups were significantly lower than those before treatment(P<0.05),while the FMA scores of the upper limb in all groups were significantly higher than those before treatment(P<0.05).Immediately after the first intervention,the oscillation frequency and dynamic stiffness of biceps brachii were lower in the stretch group than in the control group(P<0.05),but after 3 weeks of treatment,all parameters did not show significant difference between the stretch group and control group(P>0.05).Immediately after the first intervention,all parameters did not show significant difference between the stretch group and the DMS group(P>0.05),but after 3 weeks of treatment,the oscillation frequency,logarithmic decrement,dynamic stiffness of biceps brachii,the angle of catch following a fast velocity stretch biceps brachii(R1)and the quality of biceps brachii reaction(X)were lower in the DMS group than the stretch group,while the FMA scores of the upper limb were significantly higher in the DMS group than the stretch group(P<0.05).Immediately after the first intervention,the oscillation frequency and dynamic stiffness of biceps brachii were lower in the DMS group than the control group(P<0.05),and after 3 weeks of treatment,all parameters were significantly improved in the DMS group compared to the control group(P<0.05).To conclude,electrical DMS combined with routine rehabilitation treatment can effectively reduce muscle tone and stiffness,promote elasticity of biceps brachii and improve the motor function of the upper limb in stroke patients.