60 Hz-2 mm与60 Hz-4 mm振动刺激下的悬吊训练治疗脑卒中患者躯干核心肌群肌力及运动功能研究

Study of suspension training under 60 Hz-2 mm and 60 Hz-4 mm vibration stimulation in the treatment of trunk core muscle strength and motor function in stroke patients

目的探讨60 Hz-2 mm与60 Hz-4 mm振动刺激下的悬吊训练治疗对脑卒中患者躯干核心肌群肌力和运动功能改善情况的影响。方法本研究为前瞻性随机对照研究,选取2021年5月至2023年10月西安高新医院康复医学科收治的80例脑卒中患者,男45例,女35例,年龄(59.0±6.4)岁,年龄范围为40~65岁,采用随机数表法将患者随机分为对照组与观察组,每组40例。对照组在悬吊训练的基础上给予60 Hz-2 mm的振动刺激,观察组在悬吊训练的基础上给予60 Hz-4 mm的振动刺激,均持续训练6周。比较两组患者临床治疗效果、躯干核心肌群激活率、步态时空参数(步长、步频、步宽、步行周期)、躯干控制测试量表(TCT)评分、Berg平衡量表(BBS)评分、简化版下肢Fugl-Meyer运动功能量表(FMA-LE)评分及改良Barthel指数(MBI)评分情况。结果训练6周后,观察组患者治疗有效率[92.5%(37/40)]高于对照组[75.0%(30/40)];观察组健侧腹直肌[(104.4±5.2)μV%]、患侧腹直肌[(87.3±5.7)μV%]、健侧腹横肌[(110.5±7.6)μV%]、患侧腹横肌[(90.5±7.0)μV%]、健侧竖脊肌[(108.4±5.7)μV%]、患侧竖脊肌[(94.3±6.0)μV%]、健侧多裂肌[(98.4±5.9)μV%]、患侧多裂肌[(84.6±6.4)μV%]的激活率均高于对照组[(89.3±6.0)μV%、(73.4±5.4)μV%、(96.4±7.1)μV%、(77.3±6.4)μV%、(97.6±6.3)μV%、(80.1±5.9)μV%、(89.8±6.0)μV%、(73.3±6.2)μV%];观察组患者步长[(40.3±5.2)cm]、步频[(53.4±7.8)步/分]大于对照组[(36.4±4.9)cm、(48.7±6.5)步/分],步宽[(15.4±4.2)cm]及步行周期[(1.4±0.4)s]小于对照组[(17.5±4.6)cm、(1.6±0.2)s];观察组患者TCT评分[(55.7±6.2)分]、BBS评分[(43.2±4.7)分]、FMA-LE评分[(27.2±3.3)分]及MBI评分[(76.8±7.5)分]均高于对照组[(48.6±5.8)分、(37.4±5.0)分、(24.4±3.2)分、(65.7±7.2)分],差异有统计学意义(P<0.05)。结论60 Hz-4 mm振幅的振动参数能显著激活患者躯干核心肌群,改善躯干控制能力、平衡能力、下肢运动功能及步态,利于患者康复。

Objective To investigate the effect of suspension training under 60 Hz-2 mm and 60 Hz-4 mm vibration stimulation on the improvement of muscle strength and motor function of trunk core muscle in stroke patients.Methods This study was a prospective randomized controlled study,a total of 80 stroke patients who received Rehabilitation Medicine department of Xi'an Hi-tech Hospital from May 2021 to October 2023,including 45 males and 35 females,aged(59.0±6.4)years old,ranging from 40 to 65 years old.Patients were randomly divided into control group and observation group by random number table method,with 40 cases in each group.The control group was given 60 Hz-2 mm vibration stimulation on the basis of suspension training,and the observation group was given 60 Hz-4 mm vibration stimulation on the basis of suspension training,and the training lasted for 6 weeks.The clinical therapeutic effect,activation rate of trunk core muscle group,temporal and spatial parameters of gait(step length,step frequency,step width,walking cycle),trunk control test(TCT)score,berg balance scale(BBS)score,simplified lower limb Fugl-Meyer motor function scale(FMA-LE)score and modified Barthel index(MBI)score were compared between the two groups.Results After 6 weeks of training,the effective rate of observation group[92.5%(37/40)]was higher than that of control group[75.0%(30/40)];the activation rates of healthy abdominus[(104.4±5.2)μV%],affected abdominus[(87.3±5.7)μV%],healthy abdominus transversalis[(110.5±7.6)μV%],affected abdominus transversalis[(90.5±7.0)μV%],healthy erector ridge[(108.4±5.7)μV%],affected erector ridge[(94.3±6.0)μV%],healthy multifidus[(98.4±5.9)μV%]and affected multifidus[(84.6±6.4)μV%]in observation group were higher than those of control group[(89.3±6.0)μV%,(73.4±5.4)μV%,(96.4±7.1)μV%,(77.3±6.4)μV%,(97.6±6.3)μV%,(80.1±5.9)μV%,(89.8±6.0)μV%,(73.3±6.2)μV%];the step length[(40.3±5.2)cm]and step frequency[(53.4±7.8)steps/min]in observation group were higher than those in control group[(36.4±4.9)cm,(48.7±6.5)steps/min],the step width[(15.4±4.2)cm]and the walking cycle[(1.4±0.4)s]were lower than those of the control group[(17.5±4.6)cm,(1.6±0.2)s];Observation group TCT score[(55.7±6.2)points],BBS score[(43.2±4.7)points],FMA-LE score[(27.2±3.3)points]and MBI score[(76.8±7.5)points]were higher than that of control group[(48.6±5.8)points,(37.4±5.0)points,(24.4±3.2)points,(65.7±7.2)points],and the differences were statistically significant(P<0.05).Conclusions The vibration parameter of 60 Hz-4 mm amplitude can significantly activate the trunk core muscle group of the patient,improve the trunk control ability,balance ability,lower limb motor function and gait,which were conducive to the rehabilitation of the patient.