夹脊电针和下肢康复机器人联合肌内效贴在ISCI患者中的应用

Application of electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping in patients with ISCI

目的探讨夹脊电针和下肢康复机器人联合肌内效贴在不完全性脊髓损伤(incomplete spinal cord injury,ISCI)康复中的应用效果。方法选取陕西省康复医院运动疗法科2022年4月至2023年4月收治的ISCI患者104例进行随机对照试验,按照随机数字表法分为对照组(52例,实施常规步态康复联合肌内效贴治疗)和联合组(52例,实施夹脊电针和下肢康复机器人联合肌内效贴治疗)。治疗周期12周。对照组男30例、女22例,年龄(41.29±9.19)岁,美国脊髓损伤协会(ASIA)分级:C级24例、D级28例;联合组男28例、女24例,年龄(42.40±8.29)岁,ASIA分级:C级26例、D级26例。比较两组患者步态参数(跨步长、步频、舒适步速)、步行功能[Holden步行功能评定(Functional Ambulation Category Scale,FAC)]、下肢肌力(股四头肌、臀大肌、腘绳肌、胫前肌、腓肠肌)、下肢痉挛状态[改良Ashworth量表(modified Ashworth Scale,MAS)]、下肢功能[美国脊髓损伤协会下肢肌功能(ASIA-Lower Extremity Muscle Function Scale,ASIA-LEMS)评分]、平衡功能[Berg平衡量表(Berg Balance Scale,BBS)评分]及日常生活活动能力[改良Barthel指数(Barthel index,BI)]。采用t检验、χ^(2)检验。结果治疗后,联合组步长[(0.49±0.13)m比(0.43±0.11)m]、步速[(0.37±0.07)m/s比(0.29±0.06)m/s]、步频[(1.04±0.34)步/s比(0.86±0.22)步/s],股四头肌[(3.05±0.75)分比(2.44±0.59)分]、臀大肌[(3.09±0.81)分比(2.64±0.58)分]、腘绳肌[(1.79±0.48)分比(1.41±0.34)分]、胫前肌[(1.37±0.24)分比(1.26±0.22)分]、腓肠肌肌力评分[(0.42±0.07)分比(0.38±0.07)分],FAC[(3.78±0.48)分比(2.42±0.51)分]、ASIA-LEMS[(37.95±9.22)分比(29.13±8.90)分]、BBS[(35.22±5.46)分比(28.43±7.08)分]、BI评分[(88.20±2.65)分比(74.34±5.48)分]均高于对照组,MAS评分[(1.49±0.52)分比(1.97±0.73)分]低于对照组(均P<0.05)。结论夹脊电针和下肢康复机器人联合肌内效贴能有效改善ISCI患者的步态参数、下肢肌力、步行与平衡功能,减少肌肉痉挛,增强患者日常生活自理能力。

Objective To explore the application effect of electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping in the rehabilitation of incomplete spinal cord injury(ISCI).Methods A total of 104 ISCI patients treated in the Department of Exercise Therapy,Shaanxi Provincial Rehabilitation Hospital from April 2022 to April 2023 were selected for a randomized controlled trial.The patients were divided into a control group(52 cases,receiving conventional gait rehabilitation combined with kinesio taping treatment)and a combined group(52 cases,receiving electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping treatment)according to the random number table method.The treatment period was 12 weeks.In the control group,there were 30 males and 22 females,aged(41.29±9.19)years,and the American Spinal Cord Injury Association(ASIA)classification was grade C in 24 cases and grade D in 28 cases.In the combined group,there were 28 males and 24 females,aged(42.40±8.29)years,and the ASIA classification was grade C in 26 cases and grade D in 26 cases.The gait parameters(stride length,step frequency,and comfortable walking speed),walking function[Functional Ambulation Category Scale(FAC)],lower extremity muscle strength(quadriceps femoris,gluteus maximus,hamstrings,tibialis anterior,and gastrocnemius),spasticity of lower extremity[modified Ashworth Scale(MAS)],lower limb function[American Spinal Cord Injury Association-Lower Extremity Muscle Function Scale(ASIA-LEMS)score],balance function[Berg Balance Scale(BBS)score],and daily living activities[modified Barthel index(BI)]were compared between the two groups.t test andχ^(2)test were used.Results After treatment,the stride length[(0.49±0.13)m vs.(0.43±0.11)m],step speed[(0.37±0.07)m/s vs.(0.29±0.06)m/s],step frequency[(1.04±0.34)steps/s vs.(0.86±0.22)steps/s],muscle strength score of quadriceps femoris[(3.05±0.75)points vs.(2.44±0.59)points],gluteus maximus[(3.09±0.81)points vs.(2.64±0.58)points],hamstrings[(1.79±0.48)points vs.(1.41±0.34)points],tibialis anterior[(1.37±0.24)points vs.(1.26±0.22)points],and gastrocnemius[(0.42±0.07)points vs.(0.38±0.07)points],and scores of FAC[(3.78±0.48)points vs.(2.42±0.51)points],ASIA-LEMS[(37.95±9.22)points vs.(29.13±8.90)points],BBS[(35.22±5.46)points vs.(28.43±7.08)points],and BI[(88.20±2.65)points vs.(74.34±5.48)points]in the combined group were higher than those in the control group,and the MAS score[(1.49±0.52)points vs.(1.97±0.73)points]was lower than that in the control group(all P<0.05).Conclusion Electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping effectively improves the gait parameters,lower limb muscle strength,walking and balance functions,reduces the muscle spasms,and enhances the patients'ability to perform daily living activities independently.