| 体外冲击波联合镜像疗法治疗脑卒中后上肢痉挛的临床疗效 |
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| 引用本文： | 郭君怡,徐爱华,叶小聪,李菊芳,王亦素.体外冲击波联合镜像疗法治疗脑卒中后上肢痉挛的临床疗效[J].中华全科医学,2019,17(12):1989. |
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| 作者姓名： | 郭君怡 徐爱华 叶小聪 李菊芳 王亦素 |
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| 作者单位： | 温州医科大学附属第二医院神经康复科, 浙江 温州 325027 |
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| 基金项目： | 国家自然科学基金项目(71804134)；浙江省医药卫生科技计划项目(2018PY033)；温州市基础性科研项目(Y20190372) |
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| 摘 要： | 目的 探讨体外冲击波联合镜像疗法治疗脑卒中后上肢痉挛患者的康复疗效，阐述其可能机制。 方法 选取2015年1月—2018年6月温州医科大学附属第二医院神经康复科收治的脑卒中后存在上肢痉挛的132例患者，排除12例失访患者，按随机数字表法分为治疗组和对照组，对照组在综合康复治疗基础上运用了体外冲击波治疗，治疗组在综合康复治疗基础上，增加了体外冲击波联合镜像疗法。2组患者采用改良的痉挛评估量表 (Modified Ashworth scale，MAS)评估患者的痉挛程度，采用简式Fugl-Meyer运动功能评定量表(FMA)评定患者的上肢运动功能，日常生活活动能力量表(Barthel Index，BI)评定日常生活活动能力，运动功能恢复(Signe Brunnstrom创建 ，Brunnstrom)分期评定患者的上肢运动功能恢复疗效。 结果 与治疗前相比，2组患者偏瘫侧Ashworth评分、FMA评分及Barthel指数均有明显改善(均P<0.01)；同时治疗组的Ashworth评分、FMA评分及Barthel指数优于对照组(均P<0.01)。治疗后2组患者上肢及手Brunnstrom分期比较差异有统计学意义(均P<0.05)，治疗组上肢功能恢复明显优于对照组。 结论 体外冲击波联合镜像疗法，能部分改善脑卒中后患者上肢关节痉挛状态，改善患者上肢肢体功能，促进上肢肢体功能康复，提高患者日常生活活动能力，有利于患者脑卒中的康复。
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| 关 键 词： | 体外冲击波 镜像疗法 脑卒中 上肢痉挛 |
| 收稿时间： | 2019-03-20 |
The clinical study and mechanism of mirror therapy combined with extracorporeal shock wave in the treatment of upper limb spasm after stroke |
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| Affiliation: | Department of Neurology Rehabilitation, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China |
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| Abstract: | Objective To explore the rehabilitation effect of extracorporeal shock wave combined with mirror image therapy in the treatment of patients with upper limb spasm after stroke and to expound its possible mechanism. Methods A selection of 132 cases of upper limb spasm after cerebral apoplexy, out of 12 cases which were lost to follow-up of patients during January 2015 to June 2018 from the Second affiliated hospital of Wenzhou medical university nerve rehabilitation, who were randomly divided into treatment group and control group. The control group used extracorporeal shock wave treatment on the basis of comprehensive rehabilitation treatment, and the treatment group added the joint mirror extracorporeal shock wave therapy. Two groups of patients were treated by modified Ashworth scale assessment of contracture, patients' upper limb motor function was assessed by the simplified Fugl-Meyer motor function rating scale (FMA), the curative effect was assessed by BI (Barthel Index), and the curative effect was assessed by Brunnstrom stages. Results Ashworth score, FMA score and Barthel index of hemiplegic patients in both groups were significantly improved (all P<0.01). Meanwhile, Ashworth score, FMA score and Barthel index were significantly higher in the treatment group than in the control group (all P<0.01). The upper limb and hand Brunnstrom stages of the patients before and after treatment indicated significant difference before and after treatment (all P<0.05), and the upper limb function recovery of the treatment group was significantly better than that of the control group. Conclusion Extracorporeal shockwave combined with mirror image therapy can partially improve the contracture state of the upper limb after stroke, improve the function of the upper limb, promote the recovery of the upper limb function, improve the ability of the patients' daily life activities, and contribute to the recovery of stroke. |
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