不同屈膝肌群和伸膝肌群肌力比值的等速肌力训练治疗脑卒中后膝过伸的疗效评价

Effect evaluation of isokinetic muscle strength training with different flexor and extensor muscle strength ratios in treatment of hyperextension of knee after stroke

目的:设置不同的屈膝肌群与伸膝肌群肌力比值参数,观察应用等速肌力训练纠正脑卒中后膝过伸患者的疗效,为该病的治疗提供依据。方法:自2019年7月起,选取符合纳入标准的脑卒中后膝过伸患者64例,64例患者按区组随机法(区组长度为8)分为低比值组、中间比值组、高比值组和随机比值组,每组16例。治疗过程中,共有4例患者(低比值组1例、高比值组1例和随机比值组2例)因提前出院退出研究。共60例患者(低比值组15例、中间比值组16例、高比值组15例和随机比值组14例)完成了本研究。各组患者在常规康复训练的基础上均接受等速肌力训练,低比值组患者的屈膝肌群与伸膝肌群肌力比值控制在0.5~0.7,中间比值组患者的屈膝肌群与伸膝肌群肌力比值控制在0.7~0.9,高比值组患者的屈膝肌群与伸膝肌群肌力比值控制在0.9~1.1,随机比值组患者的屈膝肌群与伸膝肌群肌力比值随机,控制在0.5~1.1。于治疗前和治疗4周时采用膝过伸纠正率和简化Fugl-Meyer运动功能量表(FMA)分别评估各组患者的纠正膝过伸的有效率和下肢运动功能,采用CON-TREX多关节等速肌力测试与训练系统比较各组患者屈膝肌群与伸膝肌群平均力矩的比值。结果:治疗4周时,各组患者FMA评分高于治疗前(P<0.05),中间比值组患者膝过伸的有效率明显高于其他各组(P<0.0083),FMA评分亦明显高于其他各组(P<0.05)。治疗4周时,与低比值组比较,中间比值组和高比值组患者屈膝肌群与伸膝肌群肌力比值升高(P<0.05),随机比值组患者屈膝肌群与伸膝肌群肌力比值降低(P<0.05);与中间比值组比较,高比值组患者屈膝肌群与伸膝肌群肌力比值升高(P<0.05),随机比值组患者屈膝肌群与伸膝肌群肌力比值降低(P<0.05);与高比值组比较,随机比值组患者屈膝肌群与伸膝肌群肌力比值降低(P<0.05)。结论:将屈膝肌群和伸膝肌群肌力比值设置在0.7~0.9并进行等速肌力训练,可更加有效地纠正脑卒中后膝过伸。

Objective:To set the different parameters of muscle strength ratio of flexor and extensor knee muscles to observe the efficacy of isokinetic muscle strength training in the patients with correcting knee hyperextension after stroke,and to provide the basis for treatment of the disease.Methods:Since July2019,64 patients with knee hyperextension after stroke were selected and randomly divided into low ratio group,middle ratio group,high ratio group,and random ratio group according to the block random method(the length of block was 8).During the treatment,a total of 4 patients(1 in low ratio group,1 in high ratio group and 2 in random ratio group)were withdrew from the study because of early discharge.A total of60 patients(15 in low ratio group,16 in middle ratio group,15 in high ratio group,and 14 in random ratio group)completed the study.On the basis of routine rehabilitation training,all the patients in various groups received isokinetic muscle strength training.The muscle strength ratio of knee flexors and extensors in low ratio group was controlled at 0.5-0.7,in middle ratio group it was controlled at 0.7-0.9,and in high ratio group it was controlled at 0.9-1.1.The ratio of flexor muscle to extensor muscles was 0.5-1.1 in random ratio group.Before treatment and 4 weeks after treatment,the knee hyperextension correction rate and simplified Fugl Meyer Assessment(FMA)scale were used to evaluate the effective rate of knee hyperextension and lower limb motor function of the patients in various groups.CON-TREX multi joint isokinetic muscle strength test and training system was used to compare the average torque of knee flexors and extensors of the patients in various groups.Results:Four weeks after treatment,the FMA scores of the patients in various groups were higher than those before treatment(P<0.05),the effective rate of knee hyperextension of the patients in middle ratio group was significantly higher than that in the other groups(P<0.0083),and the FMA score was also significantly higher than that in the other groups(P<0.05).Four weeks after treatment,compared with low ratio group,the ratios of knee flexor to knee extensor of the patients in middle ratio group and high ratio group were increased(P<0.05),and the ratio of knee flexor to knee extensor of the patients in random ratio group was decreased(P<0.05);compared with middle ratio group,the ratio of knee flexor to knee extensor of the patients in high ratio group was increased(P<0.05),and the ratio of knee flexor to knee extensor of the patients in random ratio group was decreased(P<0.05);compared with high ratio group,the ratio of knee flexor to knee extensor of the patients in random ratio group was decreased(P<0.05).Conclusion:The isokinetic muscle strength training with the muscle strength ratio of knee flexor and knee extensor between 0.7 and 0.9 can more effectively correct the knee hyperextension after stroke.