超声引导下冲击波及振动训练治疗脑卒中后肌痉挛的研究

目的 探讨超声引导下冲击波及振动训练治疗脑卒中后肌痉挛的效果。方法 选取2018年1月-2019年5月本院康复医学科收治的脑卒中后肌痉挛患者120例,并按随机数字表法分为2组,即对照组和观察组,每组各60例; 对照组采用肌松药类治疗,观察组在此基础上采用超声引导下冲击波及振动训练治疗; 比较2组康复治疗前和治疗4周后肌张力变化、Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)、电生理指标肱二头肌和腓肠肌休息状态下均方根值(RMS)]、被动踝关节活动度(踝背屈、外翻)、超声肌肉结构参数肌肉羽状角度(PA)、肌纤维长度(FL)和肌纤维厚度(MT)]、治疗满意度。结果 治疗4周后观察组MAS分级优于对照组(P<0.05); 治疗4周后观察组FMA、MBI评分高于对照组(P<0.05); 治疗4周后观察组肱二头肌、腓肠肌肌腹RMS低于对照组(P<0.05); 治疗4周后观察组被动踝关节活动度背屈、外翻高于对照组(P<0.05); 治疗4周后观察组PA、FL低于对照组,MT高于对照组(P<0.05); 观察组治疗满意度(93.33%)高于对照组(75.00%)(P<0.05)。结论 超声引导下冲击波及振动训练治疗脑卒中后肌痉挛,能改善患者肌张力、肌肉结构参数与神经肌肉活动,抑制肌痉挛,增加患者踝关节被动活动度,改善患者肢体运动功能和日常生活能力,提高治疗满意度。

Ultrasound-guided shock wave and vibration training for the treatment of muscle spasm after brain stroke

ObjectiveTo explore the effect of ultrasound-guided shock wave and vibration training on muscle spasm after brain stroke.Methods A total of 120 patients with post-stroke muscle spasm who were admitted to the department of rehabilitation medicine in our hospital from January 2018 to May 2019 were selected. They were divided into two groups according to the random number table method, 60 cases in each group. The control group was treated with muscle relaxants, and the observation group was treated with ultrasound-guided shock wave and vibration training on the basis of the control group. The muscle tone changes, Fugl-Meyer rating scale(FMA), modified Barthel index(MBI), electrophysiological paramaters root mean square value(RMS)of biceps and gastrocnemius muscles at rest], passive ankle joint mobility(ankle dorsiflexion, valgus), and ultrasound muscle structure parameters muscle pinnate angle(PA), muscle fiber length(FL)and muscle fiber thickness(MT)] before rehabilitation treatment and after four weeks of rehabilitation treatment and treatment satisfaction were compared between the two groups.Results The MAS grade of the observation group after four weeks of treatment was better than that of the control group(P<0.05), the FMA and MBI scores of the observation group after four weeks of treatment were higher than those of the control group(P<0.05). After four weeks of treatment, the RMS of the biceps and gastrocnemius muscles of the observation group was lower than that of the control group(P<0.05). After four weeks of treatment, the passive ankle joint dorsiflexion and valgus in the observation group were higher than those in the control group(P<0.05). After four weeks of treatment, the PA and FL of the observation group were lower than those of the control group, and the MT of the observation group was higher than that of the control group(P<0.05). The treatment satisfaction of the observation group(93.33%)was higher than that of the control group(75.00%)(P<0.05).Conclusion Ultrasound-guided shock wave and vibration training to treat muscle spasm after brain stroke could improve patients’ muscle tone, muscle structure parameters and neuromuscular activity, and inhibit muscle spasm, increase the patient’s ankle joint passive activity, improve the patient’s limb motor function and daily living ability, and improve treatment satisfaction.