等速肌力训练联合常规康复治疗对偏瘫患者肩关节功能恢复的疗效分析

Effect analysis of isokinetic muscle strength training combined with routine rehabilitation on shoulder joint function recovery in hemiPlegic Patients

目的:通过对偏瘫患者在常规康复治疗的基础上联合肩部等速肌力训练,评估分析此治疗方法对偏瘫肩关节功能的恢复效果。方法:收集遵义医科大学附属医院2015年12月至2017年10月康复科收治的偏瘫患者60例作为研究对象,依据随机数字法分为2组,即观察组(30例)和对照组(30例)。对照组患者予以常规康复治疗,观察组患者在常规康复治疗的基础上联合偏瘫肩关节等速肌力训练,治疗前、治疗3周和治疗6周后分别用Constant-Murley肩关节功能评定量表(CMS)、改良Ashworth痉挛量表、简式Fugl-Meyer上肢运动功能评分量表(FMA-UE)比较两组患者的肩关节综合功能、肩屈肌群肌张力及偏瘫上肢综合运动功能。为减少差异,所有评定均由同一康复医师完成并记录。结果:①治疗3周时,两组的FMA-UE评分均显著高于治疗前(P<0.05),观察组的FMA-UE评分显著高于对照组(P<0.05);治疗6周时,两组的FMA-UE评分均显著高于治疗3周时(P<0.05),观察组的FMA-UE评分显著高于对照组(P<0.05);②治疗3周时,两组的CMS评分均显著高于治疗前(P<0.05),但观察组及对照组的CMS评分无明显差异(P>0.05);治疗6周时,两组的CMS评分均显著高于治疗3周时(P<0.05),观察组的CMS评分显著高于对照组(P<0.05);③治疗后两组患者改良Ashworth评分无显著差异(P>0.05);④治疗后两组患者疼痛指数无显著差异(P>0.05)。结论:①肩关节等速肌力训练能够明显的改善偏瘫侧肩关节及偏瘫上肢的功能;②等速肌力训练对脑卒中、脑外伤所致的偏瘫肩关节功能恢复均有效;③肩关节等速肌力训练不会明显增加患侧肩屈肌群肌张力及偏瘫肩痛。

Objective:Based on the routine rehabilitation of hemiPlegic Patients combined with shoulder isokinetic muscle strength training,the curative effect of this treatment method on the shoulder joint function of hemiPlegia Patients was evaluated and analyzed.Methods:Sixty Patients with hemiPlegia admitted to the Rehabilitation dePartment of affiliated HosPital of Zunyi Medical University from December 2015 to October 2017 were selected as research objects,and divided into two grouPs according to the method of random digital table,namely the observation grouP(30 cases)and control grouP(30 cases).The Patients in the control grouP were treated with routine rehabilitation,and the Patients in the observation grouP were treated with routine rehabilitation combined with isokinetic muscle strength training of hemiPlegic shoulder joint.Constant-Murley shoulder function rating scale,Modified Ashworth sPasticity scale,Fugl-Meyer SimPle UPPer Limb Motor Function Score were used to evaluate the function of the Patients at the beginning and after 3 and 6 weeks of treatment,the comPrehensive function of shoulder joint,muscle tension of shoulder flexor and hemiPlegic uPPer limb comPrehensive motor function between the two grouPs were comPared.To reduce differences,all assessments were Performed and recorded by the same rehabilitative Physician.Results:1.After 3 weeks of treatment,the FMA-UE score of the two grouPs was significantly higher than that before the treatment(P<0.05),but the FMA-UE score of the observation grouP was significantly higher than that of the control grouP(P<0.05);At 6 weeks,the FMA-UE score of the two grouPs was significantly higher than that at 3 weeks(P<0.05),and the FMAUE score of the observation grouP was significantly higher than that of the control grouP(P<0.05).2.After 3 weeks of treatment,the CMS score of the two grouPs was significantly higher than that before the treatment(P<0.05),but there was no significant difference in the CMS score between the observation grouP and the control grouP(P>0.05);At 6 weeks,the CMS score of the two grouPs was significantly higher than that at 3 weeks(P<0.05),and the CMS score of the observation grouP was significantly higher than that of the control grouP(P<0.05);3.There was no significant difference in the modified Ashworth score between the two grouPs before and after treatment(P>0.05);4.There was no significant difference in Pain index between the two grouPs after treatment.(P>0.05).Conclusion:1.The isokinetic muscle strength training of the shoulder joint could imProve the function of the hemiPlegia side shoulder joint and the hemiPlegic uPPer limb significantly.2.Isokinetic muscle strength training is effective in the recovery of shoulder joint function of hemiPlegia caused by stroke and brain injury.3.Shoulder joint isokinetic muscle strength training did not significantly increase the muscle tension of shoulder flexor and the shoulder Pain of the affected side.