BTE系统对颈脊髓损伤后上肢肌力强化训练的效果

doi:10.3969/j.issn.1006-9771.2020.05.021

摘要/Abstract

摘要：

目的研究BTE系统对不同病程颈脊髓损伤患者进行上肢肌力强化训练的有效性。方法 2019年6月至2020年1月,创伤性完全性C_6-7脊髓损伤住院患者60例按病程分为亚急性期组(术后1~2个月,n = 15)和恢复期组(术后3~6个月,n = 15),术后6个月以上者分为稳定期组和对照组,各15例。对照组行常规综合康复,其余三组每天采用BTE系统行上肢肌力强化训练,共4周。治疗前后,采用上肢运动评分(UEMS)和功能独立性测量(FIM)进行评定,并测量双侧伸肘肌群等长峰值力矩(IPT)和等张极限肌耐力(IEE)。结果治疗后,每组各项评分均明显提高(t > 3.500, P < 0.01);各组间均有非常高度显著性差异( F > 9.257, P < 0.001),其中亚急性期组UEMS、IPT最高,恢复期组IEE、FIM最高,稳定期组较差。结论采用BTE系统对颈脊髓损伤患者进行上肢肌力强化训练疗效明显,亚急性期患者上肢运动功能、爆发力恢复更快,恢复期患者耐力和日常生活活动能力进步更快;稳定期患者各项功能也有不同程度提高。

关键词: 脊髓损伤, 上肢, 肌力, BTE系统, 等长峰值力矩, 等张极限肌耐力

Abstract:

Objective To investigate the effect of BTE system intensive training on upper limbs for cervical spinal cord injured patients in various courses.Methods From June, 2019 to January, 2020, 60 inpatients with traumatic C_6-7 spinal cord injury were selected into sub-acute group (one to two months after surgery, n = 15), recovery group (three to six months after surgery, n = 15), stable group (over six months after surgery, n = 15) according to the course of disease, and control group (over six months after surgery, n = 15). The control group received comprehensive rehabilitation, while the other groups received upper limbs intensive training on BTE system in addition, for four weeks. They were assessed with Upper Extremity Motor Score (UEMS) and Functional Independence Measure (FIM), meassured isometric peak torque (IPT) and isotonic extreme muscle endurance (IEE) of bilateral elbow extensors before and after treatment.Results All the indexes improved after treatment (t > 3.500, P < 0.01), and they were significantly different among the groups ( F > 9.257, P < 0.001), in which, it was the most of UEMS and IPT in the sub-acute group, and IEE and FIM in the recovery group. Conclusion BTE system intensive training is effective on upper limbs after cervical spinal cord injury. Sub-acute patients may improve more in motor function and explosive power, while patients at recovery stage do better in endurance and activities of daily living. Even stable patients can benefit from it somehow.

Key words: spinal cord injury, upper limbs, muscle strength, BTE system, isometric peak torque, isotonic extreme muscle endurance

中图分类号:

R651.2

冯晓娟, 李建军. BTE系统对颈脊髓损伤后上肢肌力强化训练的效果[J]. 《中国康复理论与实践》, 2020, 26(5): 597-602.

FENG Xiao-juan, LI Jian-jun. Effects of BTE System Intensive Training on Upper Limbs after Cervical Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(5): 597-602.

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组别	n	性别(n)		年龄(岁)	病程(d)	ASIA运动平面(n)
组别	n	男	女	年龄(岁)	病程(d)	C₆	C₇
对照组	15	8	7	40.27±8.88	263.13±37.91	7	8
亚急性期	15	8	7	45.47±14.39	46.93±14.10	8	7
恢复期	15	7	8	40.20±14.59	117.93±18.84	9	6
稳定期	15	6	9	38.87±11.53	293.73±81.64	9	6
χ²/F值		0.734		0.808	49.543	0.741
P值		0.865		0.495	< 0.001	0.864

组别	治疗前	治疗后	t值	P值
对照组	20.07±2.05	20.53±0.05	3.500	0.004
亚急性期组	19.47±2.64	24.87±3.68	5.807	< 0.001
恢复期组	19.27±2.55	22.07±2.02	10.583	< 0.001
稳定期组	19.47±2.10	20.80±2.21	11.523	< 0.001
F值	0.326	9.257
P值	0.807	< 0.001

组别	治疗前	治疗后	t值	P值
对照组	70.03±3.86	73.60±3.78	8.911	< 0.001
亚急性期组	68.07±3.73	80.93±4.08	14.941	< 0.001
恢复期组	69.53±5.02	86.00±5.39	7.726	< 0.001
稳定期组	71.20±3.67	78.27±4.43	15.675	< 0.001
F值	3.104	20.237
P值	0.169	< 0.001

组别	治疗前	治疗后	t值	P值
对照组	81.29±43.26	87.33±17.15	14.182	< 0.001
亚急性期组	90.43±43.76	197.09±56.15	10.695	< 0.001
恢复期组	81.05±33.85	145.48±32.94	17.275	< 0.001
稳定期组	93.96±60.06	130.31±62.59	7.782	< 0.001
F值	1.994	14.574
P值	0.125	< 0.001

组别	治疗前	治疗后	t值	P值
对照组	425.87±149.25	510.90±152.59	16.433	< 0.001
亚急性期组	432.87±287.45	939.07±350.20	6.397	< 0.001
恢复期组	418.39±204.96	1415.38±460.41	6.324	< 0.001
稳定期组	428.63±272.15	694.56±384.66	8.843	< 0.001
F值	0.695	21.494
P值	0.559	< 0.001