持续静力性牵张状态下应用体外冲击波治疗脑卒中后小腿三头肌痉挛的疗效观察

The effect of combining extracorporeal shock waves with continuous static stretching in treating triceps spasticity after a stroke

目的观察持续静力性牵张(CSS)联合体外冲击波(ESWT)治疗脑卒中后小腿三头肌痉挛的疗效。方法选取符合标准的脑卒中小腿三头肌痉挛患者64例,根据患者所选治疗方法的不同,按随机数字表法随机分为常规康复组(21例)、冲击波治疗组(21例)、联合治疗组(22例)。常规康复组采用常规综合康复方法,,包括神经促通技术(30 min)、小腿三头肌泥蜡疗法(20 min)、下肢气压治疗(20 min)、步态训练(20 min),共治疗90 min,1次/日,6日/周,连续6周;在常规康复组治疗的基础上,冲击波治疗组实施体外冲击波治疗,联合治疗组则在持续静力性牵张状态下行体外冲击波治疗;冲击波参数设置均为压力强度1.4~2.5 bar(1 bar=100 kPa),频率6~10 Hz,均以小腿三头肌肌腹纵轴中线为中心,分别从外侧、中间、内侧匀速由近端向远端移动探头,经过3条线依次滑动探头,分别进行1000次冲击,共完成3000次冲击治疗,2组治疗频率均为2次/周,连续6周,共12次。分别于治疗前和治疗6周后(治疗后),采用改良Ashworth量表(MAS)、Fugl-Meyer运动功能评分(FMA)、Brunnstrom偏瘫功能恢复阶段分级对3组患者的治疗效果进行评定。结果治疗前,常规治疗组、冲击波治疗组、联合治疗组患者的MAS评分[(3.44±0.84)、(3.49±0.96)和(3.42±0.97)分]、下肢FMA评分[(9.23±3.85)、(8.42±4.61)和(10.04±3.71)分]以及Brunnstrom分级[(2.05±1.03)、(2.08±1.06)和(2.07±1.04)级]组间比较,差异均无统计学意义(P>0.05)。治疗后,3组患者小腿三头肌的肌张力明显下降,上述各项指标[MAS评分(2.57±0.61)、(2.12±0.47)和(1.53±0.59)分;下肢FMA评分(14.32±6.77)、(18.10±5.93)和(22.31±7.42)分;Brunnstrom分级(3.06±0.98)、(3.75±1.21)和(4.53±1.16)级]均较组内治疗前显著改善(P<0.05)。治疗后,冲击波治疗组和联合治疗组患者的MAS、FMA评分及Brunnstrom分级均优于常规治疗组(P<0.05),且联合治疗组各项指标的改善亦较冲击波治疗组更为明显(P<0.05)。结论持续静力性牵张状态下应用体外冲击波治疗脑卒中后小腿三头肌痉挛较常规放松体位下治疗更能明显减轻患者小腿三头肌的痉挛状态,从而改善患肢运动功能。

Objective To observe any effect of supplementing continuous static stretching(CSS)with extracorporeal shock wave therapy(ESWT)in treating triceps surae spasm after a stroke.Methods Sixty-four stroke survivors with triceps surae spasm were randomly divided into a conventional rehabilitation group,a shock wave group and a combined treatment group.In addition to conventional rehabilitation,the shock wave group received extracorporeal shock wave therapy twice a week and the combined treatment group received the shock waves during continuous static stretching.After 6 weeks of treatment all of the subjects were assessed using the Modified Ashworth Scale(MAS),the Fugl-Meyer Assessment(FMA)and Brunnstrom classification of their functional recovery stage.Results Before treatment there was no significant difference among the three groups.After the 6 weeks of treatment the average triceps surae tension in all three groups had eased significantly.At that point the average MAS and FMA scores of the shock wave group and the combined treatment group were significantly better than those of the conventional group.The combined treatment group then showed significantly better therapeutic effect than the shock wave group.Conclusions Applying extracorporeal shock waves during continuous static stretching can significantly improve the stretching′s ability to reduce spasticity and improve motor functioning,at least of the triceps surae.Combining shock waves with modern traction methods is recommended for clinical application.