慢速牵伸训练联合体外冲击波对脑卒中患者肱二头肌痉挛状态的治疗作用

目的：探讨慢速牵伸训练联合体外冲击波治疗脑卒中患者肱二头肌痉挛状态的疗效，为该方法的推广提供临床依据。方法：选择56例脑卒中后肱二头肌痉挛状态患者为研究对象，按随机数字表法随机分为观察组和对照组，每组28例。2组患者均采用常规康复治疗（40min/次，2次·d^-1，每周6d）和慢速牵伸训练（15min/次，2次·d^-1，每周6d）。在上述治疗的基础上，观察组患者给予体外冲击波治疗，对照组给予假性体外冲击波治疗。2组患者在治疗前、治疗2周和4周后分别采用简化的上肢Fugl-Meyer评分法（FMA）、改良的Barthel指数（MBI）和改良Ashworth量表（MAS）对疗效进行评估。结果：与治疗前比较，治疗2周后2组患者MAS评分明显降低（P<0.05），FMA和MBI评分明显升高（P<0.05）；观察组患者MAS评分明显低于对照组（P=0.036），但FMA和MBI评分2组比较差异无统计学意义（P>0.05）。与治疗2周后比较，治疗4周后2组患者MAS评分明显降低（P<0.05），FMA和MBI评分明显升高（P<0.05）；观察组患者FMA评分和MBI评分明显高于对照组（P<0.05或P<0.01），MAS评分明显低于对照组（P<0.01）。结论：慢速牵伸训练联合体外冲击波可有效改善脑卒中患者肱二头肌痉挛状态，且疗效明显优于单纯应用慢速牵伸训练。

Therapeutic effect of slow stretching training combined with extracorporeal shock wave on biceps brachii spasticity in stroke patients

Objective:To discuss the curative effect of slow stretching training combined with extracorporeal shock wave in the treatment of spasticity of biceps brachii in the stroke patients,and to provide the clinical evdiences for the application of this therapy.Methods:Fifty-six patients with post-stroke biceps bachii spasticity were randomly divided into observation group(n =28)and control group(n=28)according to random number table method.The patients in two groups received routine treatment(40 min/time,2 times·d-1,6 d per week)and slow stretching training(15 min/time,2 times·d-1,6 d per week).On the basis of the routine treatment,the patients in observation group were treated with extracorporeal shock wave,while the patients in control group were treated with pseudo-extracorporeal wave therapy.Modified Ashworth scale(MAS),simplified upper limb Fugl-Meyer score(FMA)and modified Barthel index(MBI)were used to evaluate the curative effects before treatment, 2 weeks and 4 weeks after treatment.Results:After 2 weeks of treatment,the FMA score of the patients in observation group was siginificantly increased compared with before treatment(P<0.05),and the MBI and MAS scores were decreased(P<0.05);the MAS score of the patients in observation group was significantly lower than that in control group(P=0.036),while there were no significant differences in the FMA and MBI scores between two groups(P>0.05).Compared with 2 weeks after treatment,the MAS score of the patients in observation group 4 weeks after treatment was significantly decreased(P<0.05),and the FMA and MBI scores were increased(P<0.05);the FMA score and the MBI score in observation group were significantly higher than those in control group (P<0.05 or P<0.01),and the MAS score was significantly lower than that in control group(P<0.01). Conclusion:Slow stretching training combined with extracorporeal shock wave could effectively improve the post-stroke biceps brachii spasticity,and its therapeutic effect is better than the simple application of slow stretching training.