脑卒中偏瘫患者肱二、三头肌表面肌电特征的研究

目的 观察和分析脑卒中偏瘫患者在最大等长收缩（MIVC）过程中肱二、三头肌表面肌电图的特征，为脑卒中后偏瘫上肢训练提供电生理依据。方法 选择18例轻偏瘫或处于恢复期的脑卒中患者，在进行肘关节屈、伸肌MIVC时，检测其力矩和肱二、三头肌表面肌电信号。结果 MIVC状态下，肘屈曲时肱二头肌健侧的积分肌电值（iEMG）明显大于患侧（P〈0．05），肱三头肌健、患侧iEMG比较，差异无统计学意义（P〉0．05）；肘伸展时肱三头肌健侧iEMG明显大于患侧（P〈0．01），肱二头肌患侧iEMG明显大于健侧（P〈0．05）。肱三头肌患侧协同收缩率明显大于健侧（P〈0．01），肱二头肌患侧协同收缩率有大于健侧的趋势，但差异无统计学意义（P〉0．05）。无论是屈肌收缩还是伸肌收缩，患侧的峰力矩均明显小于健侧（P〈0．01）。结论 脑卒中偏瘫患者肘关节痉挛以屈肌为主，提示脑卒中后偏瘫上肢的康复治疗应以训练伸肌侧肌力和抑制拮抗肌协同收缩为主。

Features of surface myoelectric signals taken from the triceps brachii and biceps brachii of stroke patients

Objective To provide scientific evidence for the effectiveness of upper limb training after stroke.Methods Surface electromyograms (sEMGs) of the triceps braehii and biceps brachii were recorded in stroke patients during maximum isometric voluntary contraction (MIVC).A total of 18 patients with hemiparesis were studied.During the elbow's MIVC,flexor and extensor peak torque were measured,and sEMGs of the biceps and tri- ceps brachii were recorded.Results During MIVC,the biceps braehius of the intact side registered a stronger EMG than that of the affected side when the elbow flexed,but the differenees in the triceps braehii readings were not significant.The triceps bracbius of the intact side gave a stronger iEMG than the affected side when the elbow extend- ed,but the iEMG form the biceps brachius of the affeeted side was higher than that of the intact side.The co-contrac- tion ratio (CCR) of the triceps brachius on the affected side was higher than that of the intact side.Though there was a tendency for the CCR of the biceps brachius on the affected side to be higher than the intact side,any difference was not statistically significant.For both flexor and extensor MIVC,the peak torque on the affected side was lower than that of the intact side.Conclusions Elbow spastieity in hemiplegic patients is mainly attributable to the flexor muscles.In the rehabilitation of the upper limb after stroke,it is important when training extensor strength to inhibit co-contraction of the antagonistic muscle.