头针治疗联合下肢机器人辅助步行训练改善脑卒中偏瘫患者步态的疗效观察

Scalp acupuncture combined with robot-assisted walking training improves the gait of stroke patients

目的通过三维步态分析观察头针治疗联合下肢机器人辅助步行训练对改善脑卒中患者异常步态的临床疗效。方法选取2018年1月至2019年12月绍兴市人民医院康复医学科收治的脑卒中偏瘫患者90例,采用随机数字表法分为试验组、机器人对照组和头针对照组,每组30例。3组患者均接受脑卒中后的常规运动康复治疗及头针治疗,其中试验组及机器人对照组患者在常规运动康复治疗及头针治疗的基础上增加下肢机器人辅助步行训练,而头针对照组不增加;试验组患者头针治疗与下肢机器人辅助步行训练同时进行,机器人对照组及头针对照组患者的头针治疗与常规运动康复治疗中的步行训练及步态矫正训练同步进行。3组患者分别在治疗前及治疗8周后测定Fugl-Meyer评定量表的下肢部分(FMA-LE)评分、改良Barthel指数(MBI)评分、步行时的步幅、步速、步宽、双足支撑百分比及患侧支撑相期髋关节伸展、膝关节伸展、踝关节跖屈的峰值力矩等三维步态参数。结果3组患者治疗前FMA-LE、MBI评分、步幅、步速、步宽、双足支撑百分比、髋、膝、踝关节峰值力矩比较差异均无统计学意义(均P>0.05)。3组患者治疗后FMA-LE、MBI评分较治疗前均明显升高(均P<0.05),试验组与机器人对照组患者MBI评分较头针对照组患者均明显为高(均P<0.05)。3组患者治疗后步幅、步速、步宽、双足支撑百分比较治疗前均有显著改善(均P<0.05),试验组与机器人对照组患者步幅、步速较头针对照组患者均有显著改善(均P<0.05),试验组患者步速较机器人对照组明显加快(P<0.05)。3组患者治疗后髋、膝、踝关节峰值力矩较治疗前均明显升高(均P<0.05),试验组与机器人对照组患者髋、膝、踝关节峰值力矩较头针对照组均明显为高(均P<0.05),试验组患者膝关节峰值力矩较机器人对照组明显为高(P<0.05)。结论应用头针治疗联合下肢机器人辅助步行训练可改善脑卒中后偏瘫患者的步态,头针治疗的同时进行下肢机器人辅助步行训练具有更佳的治疗效果。

Objective To assess the clinical effects of scalp acupuncture combined with robot-assisted walking training on improving the gait of stroke patients.Methods Ninety stroke patients with abnormal gait were randomly divided into three groups with 30 cases in each group.All patients received conventional motor function training and scalp acupuncture therapy after stroke.The patients in group A and group B received scalp acupuncture when gait training,patients in group B received the robot-assisted gait training,while the patients in group C received the scalp acupuncture and the robot-assisted gait training at the same time.The motor function of lower-extremity was evaluated by the Fugl-Meyer assessment(FMA-LE),the activity of daily living(ADL)was evaluated by the modified Barthel index(MBI),and the gait of patients was evaluated by three-dimensional(3D)gait analysis before and eight weeks after treatment.Results After eight weeks of treatment,the scores of the FMA-LE and MBI,and the parameters of 3D gait analysis in the three groups were improved significantly(all P<0.05).The scores of MBI and the step length of the affected side and the gait speed and the peak joint movements for hip extension,knee extension and ankle plantar flexion at affected side in group B and C were improved more markedly than those in group A after eight weeks of treatment(all P<0.05),while the gait speed and the peak torque for the knee extension at affected side in group C were improved more significantly than those in group B(all P<0.05).Conclusion The scalp acupuncture com-bined with robot-assisted walking training can improve the gait of stroke patients,while using two methods at the same time shows a better effect.