床边徒手肢体运动训练联合新Bobath技术在脑卒中后肩手综合征患者中的治疗效果

Therapeutic effect of bedside unarmed limb movement training combined with the new Bobath technique in patients with post-stroke shoulder-hand syndrome

目的探讨床边徒手肢体运动训练联合新Bobath技术在脑卒中后肩手综合征患者中的治疗效果。方法选取2020年11月至2023年12月在西安医学院第一附属医院接受治疗的80例脑卒中后肩手综合征患者作为研究对象。采用随机数字表法,将患者分为观察组(40例)和对照组(40例)。观察组男23例,女17例;年龄53~75(64.18±5.27)岁;病程40~69(55.13±6.58)d;卒中类型:脑出血23例,脑梗死17例。对照组男19例,女21例;年龄52~75(63.59±5.43)岁;病程39~69(54.38±7.28)d;卒中类型:脑出血28例,脑梗死12例。对照组采用新Bobath技术,观察组在对照组基础上采用床边徒手运动训练。两组均治疗4周。比较两组临床疗效和治疗满意度,治疗前后疼痛程度[视觉模拟评分法(VAS)]、上肢运动功能[Fugl-Meyer运动功能评定量表(FMA)]、肩关节活动度(前屈、外展、外旋)、生活质量[改良Barthel指数(MBI)]。采用独立样本t检验、配对t检验和χ^(2)检验进行统计学分析。结果观察组治疗总有效率、总满意度均高于对照组[90.00%(36/40)比70.00%(28/40)、92.50%(37/40)比75.00%(30/40)](均P<0.05)。治疗后,观察组VAS评分低于对照组[(3.13±0.48)分比(3.41±0.53)分],FMA评分、MBI评分均高于对照组[(40.50±5.72)分比(37.77±5.68)分、(63.33±6.48)分比(59.66±5.12)分](均P<0.05);观察组前屈、外展、外旋活动度均大于对照组[(71.84±8.51)°比(67.32±8.19)°、(89.50±4.32)°比(84.77±4.68)°、(40.33±3.13)°比(36.52±3.07)°](均P<0.05)。结论床边徒手肢体运动训练联合新Bobath技术在脑卒中后肩手综合征患者中的治疗效果较好,可改善患者肩关节活动度以及日常生活能力,减轻疼痛,治疗满意度较高。

Objective To investigate the therapeutic effect of bedside unarmed limb movement training combined with the new Bobath technique in patients with post-stroke shoulder-hand syndrome.Methods A total of 80 patients with post-stroke shoulder-hand syndrome who received treatment in the First Affiliated Hospital of Xi'an Medical College from November 2020 to December 2023 were selected as the study objects.The patients were divided into an observation group(40 cases)and a control group(40 cases)by the random number table method.There were 23 males and 17 females in the observation group,aged 53-75(64.18±5.27)years,the course of disease was 40-69(55.13±6.58)days,and the type of stroke was cerebral hemorrhage in 23 cases and cerebral infarction in 17 cases.There were 19 males and 21 females in the control group,aged 52-75(63.59±5.43)years,the course of disease was 39-69(54.38±7.28)days,and the type of stroke was cerebral hemorrhage in 28 cases and cerebral infarction in 12 cases.The control group received the new Bobath technique,and the observation group received bedside unarmed limb movement training based on the control group.Both groups were treated for 4 weeks.The clinical efficacy and treatment satisfaction of the two groups were compared,as well as pain degree[Visual Analogue Scale(VAS)],upper limb motor function[Fugl-Meyer Motor Function Assessment(FMA)],shoulder motion(anterior flexion,abduction,and external rotation),and quality of life[modified Barthel index(MBI)]before and after treatment.Independent sample t test,paired t test,and χ^(2) test were used for statistical analysis.Results The total effective rate and total satisfaction of the observation group were higher than those of the control group[90.00%(36/40)vs.70.00%(28/40),92.50%(37/40)vs.75.00%(30/40)](both P<0.05).After treatment,the VAS score of the observation group was lower than that of the control group[(3.13±0.48)points vs.(3.41±0.53)points],and the FMA score and MBI score were higher than those of the control group[(40.50±5.72)points vs.(37.77±5.68)points,(63.33±6.48)points vs.(59.66±5.12)points](all P<0.05).The shoulder joint anterior flexion,abduction,and external rotation in the observation group were higher than those in the control group[(71.84±8.51)°vs.(67.32±8.19)°,(89.50±4.32)°vs.(84.77±4.68)°,(40.33±3.13)°vs.(36.52±3.07)°](all P<0.05).Conclusion Bedside unarmed limb movement training combined with the new Bobath technique has a good therapeutic effect in patients with post-stroke shoulder-hand syndrome,which can improve the patients'shoulder joint mobility and daily living ability,reduce the pain,and has a high treatment satisfaction degree.