肌兴奋仪治疗成人下肢痉挛术后患者的肌力评估

背景采用选择性脊神经后根部分切断术、周围神经显微缩小术等神经外科手术方法治疗成人患者下肢痉挛状态,可取得满意疗效.但在手术后的康复训练中如何尽快提高相应肌肉的肌力是促进运动功能恢复的关键.目的观察肌兴奋仪在成人下肢痉挛患者术后康复中促进肌力恢复、运动功能改善的作用.设计病例分析.单位卫生部北京中日友好医院神经外科.对象选择2000-01/2002-05卫生部中日友好医院神经外科手术治疗成人下肢痉挛状态患者49例,男37例,女12例,年龄19～48岁.术后康复训练过程中采用肌兴奋治疗仪治疗的21例患者为治疗组,未接受肌兴奋治疗仪治疗的28例患者为对照组.方法术后第1天治疗组和对照组均开始进行常规康复训练.治疗组在术后第1天康复训练同时开始使用肌兴奋治疗仪治疗,30 min/次,3次/d,7 d为1个疗程,每疗程之间间隔3 d,坚持至少6个月.康复训练之前检查记录两组患者踝蹠屈肌、膝屈曲肌、大腿内收肌肌力,并分别于术后3个月和6个月时进行随访了解肌力改善情况.主要观察指标两组患者康复训练前和术后3个月和6个月时相应肌肉平均肌力.结果49例患者均进入结果分析.①治疗3个月和6个月后两组患者踝蹠屈、膝屈曲、大腿内收肌平均肌力均有不同程度的提高.②治疗组治疗3个月和6个月时踝蹠屈、膝屈曲、大腿内收肌平均肌力明显高于对照组[治疗3个月(4.2±0.8),(3.7±0.7)级;(4.3±0.7),(3.8±0.7)级;(4.0±0.7),(3.5±0.5)级;治疗6个月(4.5±0.6),(3.9±0.7)级;(4.6±0.7),(4.0±0.5)级;(4.4±0.7),(4.0±0.6)级,(P＜0.05或P＜0.01)].结论在成人下肢痉挛患者术后康复训练的同时应用肌兴奋仪可以加快肌力的恢复和运动功能的改善.

Effects of muscle stimulating instrument on adult patients with spasticity of lower limbs after microsurgical treatment

BACKGROUND: The curative effect is satisfactory for adult patients with spasticity of lower limbs treated with selective posterior rhizotomy and peripheral nerve micro diminution. But how to improve the strength of relevant muscle is the key factor to accelerate recovery of motor function during rehabilitation training.OBJECTIVE: To observe the effect of muscle stimulating instrument on the recovery of muscle strength and the improvement of motor function of adults with spasticity of lower limbs during rehabilitation training.DESIGN: Case analysis.SETTING: Department of Neurosurgery, China-Japan Friendship Hospital of Beijing Ministry of Public Health.PARTICIPANTS: Totally 49 adults with spasticity of lower limbs were selected from Department of Neurosurgery, China-Japan Friendship Hospital of Beijing Ministry of Public Health from January 2000 to May 2002.There were 37 males and 12 females aged from 19-48 years. Totally 21patients treated with muscle stimulating instrument were determined as treatment group and other 28 patients were determined as control group during rehabilitation training.METHODS: One day after operation, conventional rehabilitation training was performed on patients in the treatment group and the control group.Patients in the treatment group were also treated with muscle stimulating instrument three times a day with each for 30 minutes for totally 7 days as a course. There was a three-day interval between treating courses and the rehabilitative time lasted for 6 months. Before rehabilitation training, indexes of patients in the two groups, such as ankle extension, knee flexion and muscle strength of thigh adductor, were recorded and the improvement of muscle strength after 3 and 6 months was followed up.MAIN OUTCOME MEASURES: Average strength of relevant muscle before and after 3-month and 6-month rehabilitation training.RESULTS:Totally 49 patients entered the final analysis.①After 3-month and 6-month treatment, indexes of ankle extension, knee flexion and muscle strength of thigh adductor were increased at various degrees.②During 3-month and 6-month treatment,indexes of ankle extension,knee flexion and muscle strength of thigh adductor in the treatment group were obviously higher than those in the control group [3-month treatment:(4.2±0.8), (3.7±0.7) degrees; (4.3±0.7), (3.8±0.7) degrees; (4.0±0.7), (3.5±0.5)degrees; 6-month treatment: (4.5±0.6), (3.9±0.7) degrees; (4.6±0.7), (4.0±0.5)degrees; (4.4±0.7), (4.0±0.6) degrees, (P ＜ 0.05 or P ＜ 0.01)].CONCLUSION: The combination of rehabilitation training and muscle stimulating instrument can accelerate the recovery of muscle strength and motor function in adults with spasticity of lower limbs after microsurgical treatment.