早期主动性康复训练对卒中偏瘫患者上肢功能恢复的疗效观察

目的观察早期主动性康复训练对卒中偏瘫患者上肢功能恢复的疗效。方法将45例卒中后7-45d的偏瘫患者,按照入院病例号单双顺序分为康复组（25例）和对照组（20例）。所有患者均接受神经内科常规药物治疗、传统物理疗法、作业治疗和理疗等治疗;另外,康复组接受早期上肢主动性康复训练和应用腕关节背伸矫形支具,对照组仍进行传统康复训练。两组训练时间为30min/次,2次/d,5d/周,治疗时间均为4个月。分别在治疗前及治疗后4个月时进行偏瘫上肢功能评分（manual function examination,MFS）和运动评定量表评分（the motor assessment scale,MAS）。康复治疗4个月后,第3、6、12个月进行随访,评价MFS和MAS。对出院后继续自我练习2个月的患者进行功能磁共振成像检查。结果治疗后4个月,康复组MFS、MAS评分较治疗前分别增加10.8±1.1和5.3±1.5,对照组增加4.4±0.4和1.9±0.8,两组增加值比较,差异均有统计学意义（P〈0.01）。②康复组第3、6、12个月MFS、MAS随访评分均高于对照组,两组比较差异均有统计学意义（P〈0.01）③头部功能磁共振成像显示,康复组患者患侧第一运动区和辅助运动区均有高信号显示;对照组患侧和健侧第一运动区有高信号显示,而患侧辅助运动区无高信号显示。结论早期主动性康复训练对提高上肢功能的恢复和降低上肢致残率有显著疗效。

Observation on the efficacy of early active rehabilitation training for hemiplegic upper limb functional recovery in patients with stroke

Objective To observe the efficacy of early active rehabilitation training for hemiplegic upper limb functional recovery in patients with stroke. Methods Forty-five patients were divided into rehabilitation group （ n = 25 ） and control group （ n = 20 ） 7 to 45 days after stroke according to their odd and even numbers on admission. All patients received conventional neurological medication, traditional physiotherapy, occupational training, and physical therapy etc. At the same time, the rehabilitation group also received early active rehabilitation training of hemiplegic upper limb and dorsal wrist extension fulcrum splint. The time of active rehabilitation training was 30 minutes, twice a day for five days a week. The duration of treatment was four months for both groups. The hemiplegic upper limb was assessed by the motor function score （MFS） and the motor assessment scale （MAS） score before and 4 months after the treatment. The patients who had completed 4-months rehabilitation training were followed up at 3, 6, and 12 months, and their MFS and MAS were assessed. The patients who accomplished self- rehabilitation training for 2 months after discharge were examined by magnetic resonance imaging （MRI）. Results The MFS and MAS scores in the rehabilitation group four months after the treatment increased 10.8 ± 1.1 and 5.3 ± 1.5 respectively as compared with those before the treatment, and the control group increased 4.4± 0.4 and 1.9 ± 0.8 respectively. There were significant differences between the two groups （ P 〈0.01 ）. The follow-up scores of MFS and MAS in the rehabilitation group at 3, 6, and 8 months were higher than those in the control group. There were significant differences between the two groups （ P 〈 0. 01 ）. Brain functional MRI showed that the primary motor area and supplementary motor area on the af- fected sides in the rehabilitation group had hyperintensity ; the primary motor area at both sides of the brain in the control group had hyperintensity, but the supple