脑卒中后痉挛性偏瘫患者膝关节控制能力障碍的sEMG特征研究

目的 观察脑卒中后痉挛性偏瘫患者在屈伸患者膝关节时双侧大腿各肌群的表面肌电信号特征，为脑卒中痉挛性偏瘫患者膝关节运动控制障碍的康复训练提供电生理依据。 方法 使用表面肌电图(surface electromyography,sEMG)检测正常对照组35例健康人和2013年7月—2014年12月在浙江省台州医院住院的脑卒中后偏瘫下肢痉挛状态的35例患者股外侧肌、股内侧肌、股直肌及股二头肌的肌电信号变化，观察在膝关节屈曲和伸展状态下均方根值(RMS)，协同拮抗率(CR)的变化对患者预后的影响。 结果 在膝关节伸展状态下时，健侧与患侧股外侧肌、股内侧肌、股直肌及股二头肌的RMS值显著小于正常对照组(P＜0.01)，而健侧与患侧CR显著大于正常对照组(P＜0.05)，但患侧的RMS值及CR均小于健侧(P＜0.05)。在膝关节屈曲状态下时，患侧股外侧肌、股内侧肌、股直肌及股二头肌的RMS值均小于正常对照组及健侧(P＜0.01)；患侧股外侧肌、股内侧肌、股直肌及股二头肌CR大于正常对照组，但差异无统计学意义(P＞0.05)；健侧股内侧肌及股二头肌的RMS值及CR均小于正常对照组，但差异无统计学意义(P＞0.05)。 结论 脑卒中后痉挛性偏瘫患者下肢健患侧屈伸肌都存在主动肌与拮抗肌协调性的异常，表面肌电图技术可以实时定量评价脑卒中后痉挛性偏瘫患者膝关节控制障碍主动肌与拮抗肌协调性，为制定康复方案及预后的评价提供有力的依据。 

The features of surface electromyography of knee joint control ability disorders in spastic hemiplegia patients

Objective To analyze the features of surface electromyography(sEMG) signal of the thigh muscle in convalescent stroke patients during knee voluntary extension and flexion. Methods Thirty-five stroke patients with who suffers spastic hemiplegia in Taizhou Hospital of Zhejiang Province from July,2013 to December,2014 and age-and sex-matched normal controls were involved in this study.The signals of sEMG of root mean square value(RMS) and co-contraction ratio(CR) from the patients and controls were compared. Results The knee extension in patients with bilateral quadriceps,biceps femoris RMS value were significantly decreased compared with normal control group(P<0.01),and health,ipsilateral RMS values significantly different(P<0.01);when knee,ipsilateral quadriceps and biceps femoris of RMS values are less than the normal control group,there was a significant difference(P<0.01),and health,ipsilateral RMS values significantly different(P<0.01);patients with contralateral medial femoral biceps muscle and the RMS value of the shares is less than the normal control group,but there was no significant difference(P>0.05);When knees,ipsilateral and contralateral CR greater than the normal control group,there was a significant difference(P<0.05);contralateral CR was less than normal control group showed no significant difference(P>0.05);knee extension,ipsilateral and contralateral CR were greater than the normal control group,there was a significant difference(P<0.05). Conclusion There are initiative antagonistic muscle coordination abnormal in the hemiplegic patients after stroke spastic muscle flexion ipsilateral healthy muscle.The SEMG technology in real-time quantitative evaluation of stroke patients after knee spastic muscle control disorders and active antagonistic muscle coordination,and provide a strong basis prognosis for the development and evaluation of rehabilitation programs.