体外冲击波联合肌电生物反馈疗法对慢性脑卒中患者腕手运动功能影响的研究

Effect of Extracorporeal Shock Wave Therapy Combined with Electromyoelectric Biofeedback in the Treatment of Motor Function of Wrist and Hand after Stroke

目的:探讨体外冲击波联合肌电生物反馈疗法对慢性脑卒中患者腕手运动功能的影响。方法:选择2020年10月至2021年12月广东药科大学附属第一医院康复科收治的脑卒中后合并腕手功能障碍患者64例,采用随机单盲对照试验设计,按随机数字表法分成对照组和试验组,每组各32例。两组均进行常规的康复治疗,对照组在常规治疗上增加肌电生物反馈疗法,试验组在对照组治疗的基础上增加体位冲击波治疗,隔天1次,每周3次,连续4周。统计分析两组治疗前、后患侧腕手运动功能状况(MSS-W/H)、腕屈肌张力硬度(F、S)、腕背伸肌最大收缩时的肌电信号幅度(EMG)、腕背伸主动关节活动度(AROM)以及患者日常生活活动能力(MBI)。结果:治疗前,两组患者MSS-W/H评分、F和S值、EMG、AROM和MBI评分无显著差异(P>0.05)。治疗后,两组MSS-W/H评分、EMG、AROM和MBI评分均较治疗前升高(P<0.01),F和S值较治疗前降低(P<0.05),且试验组MSS-W/H评分、EMG、AROM和MBI评分明显高于对照组(P<0.01),F和S值较对照组明显降低(P<0.05),有显著差异。结论:体外冲击波联合肌电生物反馈疗法能有效改善脑卒中后患者腕手运动功能,降低腕屈肌群张力和硬度,增大腕背伸主动关节活动度,提高患者日常生活能力。

Objective:To observe the efficacy of extracorporeal shock wave therapy(ESWT) combined with electromyoelectric biofeedback(EMG-BFB)in the treatment of motor function of wrist and hand after stroke.Methods:This was a single-blind randomized controlled trial.A total of 64 patients with wrist and hand dysfunction after stroke admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University from October 2020 to December 2021 were enrolled and randomly divided into two groups(n=32 per group): a control group and an experimental group.The MSS-W/H score,F and S values,EMG,AROM and MBI score were statistically analyzed in both groups before and after treatment. Results: Before rehabilitation treatment, there was no difference between the two groups in the MSS-W/H score,F and S values,EMG,AROM and MBI score(P>0.05).After treatment, the MSS-W/H scores, EMG, AROM and MBI scores were higher than before treatment(P<0.01), whlie F and S values were lower than before treatment(P<0.05).The MSS-W/H scores, EMG, AROM and MBI scores of the experimental group were significantly higher than the control group(P<0.01), whlie F and S values of the experimental group were significantly lower than the control group(P<0.05).Conclusion:The extracorporeal shock wave therapy combined with electromyoelectric biofeedback therapy can effectively improve the wrist-hand movement function, reduce muscle tone and stiffness of of wrist flexor muscles, increase active range of motion of wrist back stretch, and improve the daily life activity ability.