复合式腕手矫形器辅助疗法对脑卒中后腕手功能障碍的效果

doi:10.3969/j.issn.1006-9771.2020.12.013

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (12): 1446-1452.doi: 10.3969/j.issn.1006-9771.2020.12.013

复合式腕手矫形器辅助疗法对脑卒中后腕手功能障碍的效果

黄楚红¹,曾庆¹,陈欢¹,李宇淇¹,黄国志^1,²()

1.南方医科大学珠江医院康复医学科,广东广州市 510280
2.南方医科大学康复医学院,广东广州市 510280

收稿日期:2020-07-01 修回日期:2020-09-21 出版日期:2020-12-25 发布日期:2020-12-30
通讯作者: 黄国志 E-mail:drhuang66@163.com
作者简介:黄楚红(1992-),女,汉族,广东揭阳市人,硕士研究生,主要研究方向：神经康复、康复工程。|黄国志(1963-),男,汉族,博士,主任医师,博士研究生导师,主要研究方向：神经康复、康复工程。
基金资助:
1.国家自然科学基金项目(81874032);1.国家自然科学基金项目(82072528);1.国家自然科学基金项目(82002380);2.广东省医学科学技术研究基金项目(A2017610)

Efficacy of Compound Wrist-hand Orthosis-assisted Therapy on Wrist-hand Dysfunction after Stroke

HUANG Chu-hong¹,ZENG Qing¹,CHEN Huan¹,LI Yu-qi¹,HUANG Guo-zhi^1,²()

1. Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
2. School of Rehabilitation Medicine, Southern Medical University, Guangzhou, Guangdong 510280, China

Received:2020-07-01 Revised:2020-09-21 Published:2020-12-25 Online:2020-12-30
Contact: HUANG Guo-zhi E-mail:drhuang66@163.com
Supported by:
National Natural Science Foundation of China(81874032);National Natural Science Foundation of China(82072528);National Natural Science Foundation of China(82002380);Guangdong Medical Development and Research Fund(A2017610)

摘要/Abstract

摘要：

目的观察复合式腕手矫形器辅助下训练对脑卒中恢复期腕手功能障碍患者的效果。方法 2018年6月至2019年12月,本院脑卒中患者34例随机分为对照组(n = 17)和试验组(n = 17)。两组均接受基础治疗和常规手工作业治疗,试验组在每天手工作业治疗时及休息时佩戴复合式腕手矫形器。常规手工作业治疗每次30 min,每天2次,共14 d;非训练时间佩戴矫形器每天累计5 h,共14 d。治疗前后分别采用Brunnstrom分期(上肢和手)、Fugl-Meyer评定量表(FMA)(腕手)评定上肢和手的运动功能,采用改良Ashworth量表(MAS)评定腕关节肌张力,采用改良Barthel指数(MBI)评定日常生活活动能力。结果对照组脱落2例。治疗前,两组Brunnstrom分期、FMA评分、MAS分级、MBI评分均无显著性差异(P> 0.05)。治疗后,两组FMA和MBI评分较治疗前均明显提高(|Z| > 3.420, P< 0.01),且试验组FMA和MBI评分改善程度明显优于对照组(Z = -2.895, t = 4.331, P< 0.01);两组Brunnstrom分期、MAS分级在治疗前后均无改变(P> 0.05)。结论佩戴复合式腕手矫形器进行康复训练可进一步促进脑卒中恢复期患者腕手运动功能和日常生活活动能力的改善。

关键词: 脑卒中, 腕手功能障碍, 复合式腕手矫形器, 手工作业治疗, 日常生活活动能力

Abstract:

Objective To observe the efficacy of compound wrist-hand orthosis-assisted training on wrist-hand dysfunction in patients with convalescent stroke.Methods From June, 2018 to December, 2019, 34 stroke patients in our hospital were randomly divided into control group (n = 17) and experimental group (n = 17). Both groups received basic treatment and routine occupational therapy, while the experimental group wore a compound wrist-hand orthosis during and after the daily occupational therapy. The occupational therapy was carried out 30 minutes a time, twice a day for 14 days, and the non-training time orthosis wearing was carried out cumulative five hours a day for 14 days. Before and after treatment, the Brunnstrom stage (upper limb and hand) and Fugl-Meyer Assessment (FMA) (wrist and hand) were used to assess the motor function of the upper limbs and hands, while the modified Ashworth Scale (MAS) and modified Barthel Index (MBI) were separately used to assess the wrist tension and activities of daily living.Results Two cases dropped out in the control group. There was no significant difference in Brunnstrom stage, FMA score, MAS score, and MBI score between two groups before treatment (P> 0.05). After treatment, the scores of FMA and MBI significantly improved in both groups (|Z| > 3.420, P< 0.01), and the improvement was higher in the experimental group than in the control group (Z = -2.895, t = 4.331, P< 0.01); while, no significant difference was found in Brunnstrom stages and MAS score in both groups (P> 0.05).Conclusion The compound wrist-hand orthosis-assisted therapy could improve the wrist-hand motor function and activities of daily living in patients with convalescent stroke.

Key words: stroke, wrist-hand dysfucntion, compound wrist-hand orthosis, occupational therapy, activities of daily living

中图分类号:

R743.3

黄楚红,曾庆,陈欢,李宇淇,黄国志. 复合式腕手矫形器辅助疗法对脑卒中后腕手功能障碍的效果[J]. 《中国康复理论与实践》, 2020, 26(12): 1446-1452.

HUANG Chu-hong,ZENG Qing,CHEN Huan,LI Yu-qi,HUANG Guo-zhi. Efficacy of Compound Wrist-hand Orthosis-assisted Therapy on Wrist-hand Dysfunction after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(12): 1446-1452.

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参考文献 31

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项目		对照组(n = 17)	试验组(n= 17)	t/Z/χ²值	P值
性别(n)	男	16	14		0.601^a
性别(n)	女	1	3		0.601^a
年龄(岁)		54.12±16.07	52.76±11.25	-0.284	0.778
病程(d)		30.00(30.00, 90.00)	60.00(30.00, 120.00)	-0.693	0.488
体质量指数(kg/m²)		20.57(19.87, 21.24)	21.00(20.21, 21.79)	-0.551	0.581
偏瘫侧(n)	左	8	10		0.732^a
偏瘫侧(n)	右	9	7		0.732^a
卒中类型(n)	脑梗死	11	8		0.491^a
卒中类型(n)	脑出血	6	9		0.491^a
基础疾病(n)
高血压	有	11	10		1.000^a
高血压	无	6	7		1.000^a
糖尿病	有	2	1		1.000^a
糖尿病	无	15	16		1.000^a
高血脂	有	3	2		1.000^a
高血脂	无	14	15		1.000^a

组别	n	治疗前			治疗后			Z值	P值
组别	n	Ⅲ期	Ⅳ期	V期	Ⅲ期	Ⅳ期	V期	Z值	P值
对照组	15	10	3	2	10	3	2	0.000	1.000
试验组	17	9	7	1	8	8	1	-1.000	0.317
Z值		-0.520			-0.790
P值		0.603			0.429

组别	n	治疗前			治疗后			Z值	P值
组别	n	Ⅲ期	Ⅳ期	V期	Ⅲ期	Ⅳ期	V期	Z值	P值
对照组	15	9	3	3	8	4	3	-1.000	0.317
试验组	17	9	6	2	7	7	3	-1.732	0.083
Z值		-0.127			-0.450
P值		0.899			0.652

组别	n	治疗前	治疗后	差值	Z值	P值
对照组	15	6.00(5.00, 8.00)	15.00(15.00, 16.00)	9.00(8.00, 10.00)	-3.420	0.001
试验组	17	7.00(5.00, 12.00)	22.00(15.00, 24.00)	12.00(9.50, 12.00)	-3.653	< 0.001
Z值		-0.852	-2.254	-2.895
P值		0.394	0.024	0.004

组别	n	治疗前				治疗后				Z值	P值
组别	n	0	1	1⁺	2	0	1	1⁺	2	Z值	P值
对照组	15	2	6	6	1	4	5	5	1	-1.127	0.260
试验组	17	3	8	6	0	5	9	2	1	-1.292	0.196
Z值		-0.753				-0.863
P值		0.451				0.388

复合式腕手矫形器辅助疗法对脑卒中后腕手功能障碍的效果

Efficacy of Compound Wrist-hand Orthosis-assisted Therapy on Wrist-hand Dysfunction after Stroke

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组别	n	治疗前	治疗后	差值	Z值	P值
对照组	15	35.00(30.00, 35.00)	45.00(40.00, 50.00)	15.00±9.45	-3.426	0.001
试验组	17	30.00(22.50, 35.00)	55.00(50.00, 65.00)	27.06±6.14	-3.652	< 0.001
Z/t值		-1.750	-2.714	4.331
P值		0.080	0.007	< 0.001

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