林少平,瞿代虎,黄玲,等.体外冲击波联合本体感觉神经肌肉促进技术对卒中后足下垂患者下肢运动功能的影响[J].中华物理医学与康复杂志,2023,45(3):216-221
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体外冲击波联合本体感觉神经肌肉促进技术对卒中后足下垂患者下肢运动功能的影响 |
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DOI:10.3760/cma.j.issn.0254-1424.2023.03.005 |
中文关键词: 体外冲击波 本体感觉神经肌肉促进技术 足下垂 下肢运动功能 |
英文关键词: Extracorporeal shock wave therapy Proprioceptive neuromuscular facilitation Foot drop Lower limb motor function |
基金项目:国家重点研发计划专项项目(2017YFB1303200);广州市卫生健康科技项目(20221A010004) |
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中文摘要: |
目的 观察体外冲击波联合本体感觉神经肌肉促进(PNF)技术对卒中后足下垂患者下肢运动功能的影响。 方法 将入选的36例脑卒中足下垂患者按随机数字表法分为冲击波组、PNF组和联合治疗组三组,每组12例。冲击波组只接受体外冲击波治疗,PNF组只接受PNF技术治疗,联合组同时接受体外冲击波和PNF技术治疗,体外冲击波冲击压力强度2.5 bar,频率10 Hz,每块肌肉冲击2000次,每周2次,共治疗4周;PNF技术治疗每周不少于3次,每次30 min,共治疗4周。分别于治疗前和治疗4周后(治疗后),采用改良Ashworth分级(MAS)、踝关节主动活动度、足偏角、10 m步行时间(10 MWT)和下肢Fugl-Meyer运动功能量表(FMA)对3组患者的肌张力及下肢运动功能等指标进行治疗效果评定。 结果 ①治疗后,PNF组和冲击波组分别出现8例和9例的小腿肌张力下降,联合治疗组12例患者张力均出现下降;PNF组、冲击波组和联合治疗组治疗后的肌张力评分分别为(1.25±0.62)、(1.17±0.58)和(0.33±0.49)分,均较组内治疗前[PNF组(1.92±0.67)分、冲击波组(1.83±0.83)分和联合治疗组(1.75±0.62)分]明显改善(P<0.05),且联合治疗组较另2组改善更为明显(P<0.05)。②PNF组和冲击波组治疗前后的踝关节主动活动度差异均无统计学意义(P>0.05),而联合治疗组治疗前后对比,差异有统计学意义(P<0.05)。③治疗后,3组患者的10 m步行时间及下肢FMA评分均有不同程度的改善,与组内治疗前比较,PNF组差异有统计学意义(P<0.05),冲击波组差异无统计学意义(P>0.05),联合治疗组差异有统计学意义(P<0.01)。④3组患者治疗后的足偏角[PNF组(32.4±5.7)°、冲击波组(29.9±4.6)°、联合治疗组(20.9±5.9)°]较组内治疗前[PNF组(40.3±6.4)°、冲击波组(39.0±5.6)°、联合治疗组(38.7±7.4)°]均有明显改善(P<0.01),且联合治疗组的改善程度明显优于PNF组和冲击波组(P<0.01)。 结论 体外冲击波联合PNF技术可有效改善脑卒中后足下垂患者的下肢运动功能。 |
英文摘要: |
Objective To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop. Methods Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed. Results After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups. Conclusion Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop. |
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