| 宋娟,胡子木,刘奔,陈和木.体外冲击波联合神经肌肉电刺激治疗脑卒中后小腿三头肌痉挛的疗效观察[J].中国康复,2025,40(4):207-211 |
| 体外冲击波联合神经肌肉电刺激治疗脑卒中后小腿三头肌痉挛的疗效观察 |
| Efficacy of extracorporeal shock wave therapy combined with neuromuscular electrical stimulation for triceps surae spasticity of stroke patients |
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| DOI：10.3870/zgkf.2025.04.003 |
| 中文关键词: 脑卒中 神经肌肉电刺激 痉挛 体外冲击波 表面肌电图 |
| 英文关键词: stroke neuromuscular electrical stimulation spasticity extracorporeal shock wave therapy surface electromyography |
| 基金项目:安徽省高校科研项目（2022AH051160） |
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| 中文摘要: |
| 目的：探讨体外冲击波(ESWT)联合神经肌肉电刺激（NMES）治疗脑卒中后小腿三头肌痉挛的疗效，并分析其表面肌电的特征。方法：选取2022年1月~2024年6月我科收治的脑卒中偏瘫患者40例，随机分成NMES组和联合组，每组20例。2组患者均给予基础药物治疗和常规康复训练，在此基础上，NMES组予以胫骨前肌NMES治疗，联合组予以胫骨前肌NMES和小腿三头肌ESWT治疗，共治疗4周。治疗前后均采用改良Ashworth痉挛评定量表（MAS）评估患者小腿三头肌的肌张力，采用量角器测量踝背伸主动关节活动度（AROM），采用Fugl-Meyer运动功能量表下肢部分（FMA-LE）评估患者下肢运动功能，采用表面肌电图（sEMG）采集腓肠肌内侧头和胫骨前肌的肌电信号，并应用积分肌电值（iEMG）和协同收缩率（CR）进行分析。结果：治疗前，2组患者MAS评分、踝关节背伸AROM、FMA-LE评分、腓肠肌内侧头和胫骨前肌iEMG值及踝背伸时CR值比较差异均无统计学意义。治疗4周后，2组患者的MAS评分均较治疗前降低（P＜0.05），联合组低于NMES组 (P＜0.01)；2组患者踝关节背伸AROM及FMA-LE评分均较治疗前升高（P＜0.05），联合组高于NMES组(P＜0.05)；2组患者腓肠肌内侧头iEMG均较治疗前降低(P＜0.05)，且联合组低于NMES组(P＜0.01)，胫骨前肌iEMG均较治疗前升高(P＜0.05)，且联合组高于NMES组(P＜0.01)；2组患者踝背伸时CR值均较治疗前降低，且联合组低于NMES组(均P＜0.01)。结论：ESWT联合NMES治疗可以缓解脑卒中患者小腿三头肌的痉挛，提高胫骨前肌的肌力，改善踝关节活动度，纠正异常痉挛模式，从而提高下肢运动功能。 |
| 英文摘要: |
| Objective：To investigate the effectiveness of combining extracorporeal shock wave therapy (ESWT) with neuromuscular electrical stimulation (NMES) for the treatment of triceps surae spasticity in stroke patients, and to analyze the surface electromyographic characteristics of this treatment. Methods：A total of 40 patients with hemiplegia who were hospitalized from January 2022 to June 2024 were randomly assigned to NMES group and the combined group, with 20 patients in each group. Both groups received basic medication and conventional rehabilitation training, with the NMES group additionally receiving NMES of the anterior tibial muscle and the combined group receiving both NMES of the anterior tibial muscle and ESWT of the triceps surae muscle for a period of 4 weeks. Before and after the treatment, the muscle tone and motor function of lower extremities were assessed using the modified Ashworth scale (MAS ) and the Fugl-Meyer assessment lower extremities scale (FMA-LE). Besides, the active range of motion (AROM) of the ankle joint was measured. Additionally, the integrated electromyography (iEMG) and co-contraction ratio (CR) were used to analyze the electromyographic changes of the medial head of gastrocnemius and the tibialis anterior muscle. Results：There were no statistically significant differences in the MAS scores, the AROM of the ankle joint, the FMA-LE scores, the iEMG values of medial head of gastrocnemius and tibialis anterior muscle, and the CR values of ankle dorsiflexion between the two groups before treatment. After 4 weeks of treatment, the MAS score in the two groups was lower than that before treatment (P<0.05), and the MAS score in the combined group was significantly lower than that in the NMES group (P<0.01). The ankle AROM and FMA-LE scores in the two groups were higher than those before treatment (P<0.01), and those in the combined group were significantly higher than those in the NMES group (P<0.01). The iEMG of medial head of gastrocnemius in the two groups was significantly lower than that before treatment (P<0.01), the iEMG of the tibial anterior muscle was significantly higher than that before treatment (P<0.01), the iEMG of medial head of gastrocnemius in the combined group was significantly lower than that in the NMES group (P<0.05), and the iEMG of tibialis anterior muscle was significantly higher than that in the NMES group (P<0.01). Additionally, the CR values of ankle dorsiflexion were significantly decreased in both groups as compared with those before treatment (P<0.01), the CR value in the combined group was significantly lower than that in the NMES group (P<0.01). Conclusion: ESWT combined with NMES can effectively alleviate triceps surae spasticity, improve the muscle strength of tibialis anterior muscle and the AROM of the ankle joint, correct the abnormal spasticity pattern, and ultimately improve lower extremities motor function in stroke patients. |
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