针刺联合肌电生物反馈疗法治疗脑卒中偏瘫患者足下垂的临床研究

Acupuncture combined with electromyographic biofeedback therapy for foot drop in stroke patients with hemiplegia

目的:探讨针刺联合肌电生物反馈疗法治疗脑卒中偏瘫患者足下垂的效果。方法:选取90例恢复期脑卒中偏瘫足下垂患者,按随机数字表法分为针刺治疗组、肌电生物反馈治疗组、联合治疗组,每组患者30例。针刺治疗组进行针刺治疗,肌电生物反馈治疗组进行肌电生物反馈治疗,联合治疗组进行针刺联合肌电生物反馈治疗。治疗前及治疗4周后分别采用踝关节背屈主动关节活动度(AROM)、下肢Fugl-Meyer运动功能量表(FMA-LE)、Berg平衡量表(BBS)及改良Barthel指数(MBI)分别评估患者的踝关节背屈能力、下肢运动功能、平衡功能及日常生活活动能力,并对3组患者的胫前肌和腓骨长短肌进行表面肌电图(iEMG)检测。结果:治疗4周后,3组患者的踝关节背屈AROM、下肢FMA评分、BBS评分、MBI、iEMG、均方根值(RMS)均较治疗前明显提高(P<0.05);治疗4周后组间比较,联合治疗组的各评分值改善程度均优于针刺组和肌电生物反馈治疗组(P<0.05);针刺组与肌电生物反馈治疗组的各评分值差异无统计学意义。结论:针刺联合肌电生物反馈疗法能显著改善脑卒中偏瘫患者的足下垂。

Objective:To investigate the effect of acupuncture combined with electromyographic biofeedback therapy on foot drop in stroke patients with hemiplegia.Methods:A total of 90 patients with hemiplegic foot drop in convalescent stroke were randomly divided into acupuncture treatment group,electromyographic biofeedback treatment group and combined treatment group,with 30 patients in each group.The acupuncture treatment group received acupuncture treatment,the electromyographic biofeedback treatment group received electromyographic biofeedback treatment,and the combined treatment group received acupuncture combined with electromyographic biofeedback treatment.Ankle dorsiflexion ability,lower limb motor function,activities of daily living and ankle dorsiflexion ability were evaluated by active range of motion(AROM),Fugl-Meyer assessment of lower extremity(FMA-LE),Modified Barthel index(MBI)and Berg balance scale(BBS)before and 4 weeks after treatment,respectively.Balance function,and the tibialis anterior muscle and fibula longus muscle were measured by surface electromyography(iEMG).Results:After 4 weeks of treatment,AROM,FMA,MBI,BBS,iEMG and RMS in 3 groups were significantly improved as compared with those before treatment(P<0.05).After 4 weeks of treatment,the improvement degree of each score in the combined treatment group was better than that in the acupuncture group and the electromyographic biofeedback group(P<0.05).There was no significant difference between acupuncture group and electromyographic biofeedback group.Conclusion:Acupuncture combined with electromyographic biofeedback therapy can significantly improve foot drop in stroke patients with hemiplegia.