肌电生物反馈联合任务导向性训练对桡神经损伤患者手功能的影响

Effect of electromyographic biofeedback and task oriented training on hand function of patients with radial nerve injury

目的观察肌电生物反馈联合任务导向性训练对桡神经损伤患者手功能的影响,为临床提供一种新的综合康复治疗手段。方法采用随机数字表法将2018年1月—2020年1月石家庄市人民医院收治的60例桡神经损伤导致手功能障碍患者随机分为3组,每组20例。治疗后常规组脱落4例余16例,任务导向性训练组脱落3例余17例,联合组脱落1例余19例。3组均给予常规药物治疗,常规组辅以针对性的手功能康复治疗,任务导向性训练组在常规组治疗基础上附加任务导向性训练,联合组在常规组治疗基础上附加肌电生物反馈及任务导向性训练。于治疗前及治疗12周后检测腕关节背伸主动活动度(AROM)评估手功能,通过肌电图检测桡神经的运动神经传导速度(MCV)、潜伏期(LAT)及波幅(AMP)评估神经功能,治疗12周后通过手功能评定法评估手实用功能。结果治疗12周后,任务导向性训练组和联合组腕关节背伸AROM差值均明显高于常规组(P均<0.05),且联合组明显高于任务导向性训练组(P<0.05)。治疗12周后,3组桡神经MCV均明显快于治疗前(P均<0.05),且联合组和任务导向性训练组明显快于常规组(P均<0.05),联合组明显快于任务导向性训练组(P<0.05);3组桡神经LAT均明显短于治疗前(P均<0.05),且联合组LAT明显短于常规组(P<0.05),但任务导向性训练组与常规组和联合组比较差异均无统计学意义(P均>0.05);3组桡神经AMP均明显高于治疗前(P均<0.05),但3组间治疗后比较差异均无统计学意义(P均>0.05)。治疗12周后,常规组、任务导向性训练组、联合组总有效率分别为68.8%(11/16)、88.2%(15/17)、94.7%(18/19),联合组明显高于常规组(P<0.05),但任务导向性训练组与常规组和联合组比较差异均无统计学意义(P均>0.05)。结论肌电生物反馈联合任务导向性训练较常规康复治疗和任务导向性训练能够更明显提高桡神经损伤后手功能障碍患者的神经肌肉兴奋度,增加腕关节主动活动度,改善手功能。

Objective It is to investigate the effect of electromyographic biofeedback(EMGBF)and task oriented training(TOT)on the hand functional disorders of patients after radial nerve injury,in order to offer a new kind of rehabilitation treatment for this disease.Methods 60 patients with hand dysfunction caused by radial nerve injury admitted to the People’s Hospital of Shijiazhuang from January 2018 to January 2020 were randomly divided into 3 groups according to a random number table method,with 20 cases in each group.After 12 weeks intervention,the conventional rehabilitation group lost 4 patients,the TOT group lost 3 patients and the EMGBF+TOT group lost 1 patients.All patients received conventional drug therapy,the conventional rehabilitation group was treated with the hand function rehabilitation,the TOT group was treated with task orientation training on the basis of the conventional rehabilitation group,the EMGBF+TOT group was treated with electromyographic biofeedback and task oriented training on the basis of the conventional rehabilitation group.Before treatment and 12 weeks after treatment,the wrist joint dorsal extension active range of motion(AROM)was measured to assess hand function,and the motor nerve conduction velocity(MCV),latency(LAT)and amplitude(AMP)of the radial nerve function were assessed by electromyography.After 12 weeks of treatment,the hand function was evaluated by hand function assessment method.Results After 12 weeks of treatment,the difference in wrist dorsiflexion AROM between the task-oriented training group and the combined group was significantly higher than that of the conventional group(P<0.05),and the combined group was significantly higher than the task-oriented training group(P<0.05).After 12 weeks of treatment,the radial nerve MCV in the three groups was significantly faster than that before treatment(all P<0.05),and the combined group and task-oriented training group were significantly faster than the conventional group(all P<0.05),and the combined group was significantly faster than the task oriented training group(P<0.05);the radial nerve LAT of the three groups was significantly shorter than that before treatment(P<0.05),and the LAT of the combined group was significantly shorter than the conventional group(P<0.05),but there was no statistically significant difference in the task-oriented training group compared with the conventional group and the combined group(all P>0.05);the radial nerve AMP of the three groups was significantly higher than that before treatment(all P<0.05),but there was no statistically significant difference between the three groups after treatment(P>0.05).After 12 weeks of treatment,the total effective rates of the conventional group,task-oriented training group,and combined group were 68.8%(11/16),88.2%(15/17),and 94.7%(18/19),respectively.The combined group was significantly higher than the conventional group(P<0.05),but the task-oriented training group was not statistically different from the routine group and the combined group(P>0.05).Conclusion EMG biofeedback combined with task-oriented training can significantly improve the neuromuscular excitability of patients with hand dysfunction after radial nerve injury,increase the active range of wrist joints,and improve hand function compared with conventional rehabilitation and task-oriented training.