不同上肢限制法对脑卒中偏侧肘屈肌活跃性和平衡的影响

doi:10.3969/j.issn.1006-9771.2021.05.015

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (5): 609-614.doi: 10.3969/j.issn.1006-9771.2021.05.015

不同上肢限制法对脑卒中偏侧肘屈肌活跃性和平衡的影响

陈昕¹,王盛²(),王彤³,吴勤峰²,李向哲²

^1.上海交通大学医学院附属瑞金医院，上海市 200020
^2.南京医科大学附属苏州科技城医院，江苏苏州市 215153
^3.南京医科大学第一附属医院，江苏南京市 210029

收稿日期:2019-09-16 修回日期:2020-01-16 出版日期:2021-05-25 发布日期:2021-05-26
通讯作者: 王盛 E-mail:wangshengkf@163.com
作者简介:陈昕(1993-)，女，汉族，江苏无锡市人，硕士，治疗师，主要研究方向：神经康复|王盛(1986-)，男，汉族，山东乳山市人，硕士，主治医师、主管技师，主要研究方向：脑卒中康复。
基金资助:
苏州高新区医疗卫生科技计划项目(2017Z003)

Effects of Different Upper Extremity Fixing Approaches on Elbow Flexor Activities and Balance for Stroke Patients

Xin CHEN¹,Sheng WANG²(),Tong WANG³,Qin-feng WU²,Xiang-zhe LI²

^1.Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200020, China
^2.Affiliated Suzhou Science ＆ Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, China
^3.First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

Received:2019-09-16 Revised:2020-01-16 Published:2021-05-25 Online:2021-05-26
Contact: Sheng WANG E-mail:wangshengkf@163.com
Supported by:
Medical and Health Science and Technology Projects of Suzhou New District(2017Z003)

摘要/Abstract

摘要： 目的

观察偏瘫上肢施加不同的限制方法，在站立位姿势维持及常速步行中，对偏瘫上肢肘屈肌活跃性和平衡稳定的即刻效应。

方法

2018年9月至12月，南京医科大学附属苏州科技城医院住院或门诊治疗的脑卒中患者14例，分别于无限制、肘伸直型支具固定、健手辅助患侧上肢伸直于身后、健手辅助患侧肩前屈90° 4种条件下，采用无线表面肌电设备观察站立和步行时偏瘫侧肘屈肌收缩率(屈肌的平均积分肌电值/伸肌的平均积分肌电值)，Biodex平衡系统观察站立20 s身体摆动指数。

结果

站立和步行时，支具固定下肘屈肌收缩率最大(F > 2.687, P < 0.05)。站立时，健手辅助患侧肩前屈90°下摆动指数最大(F = 21.091, P < 0.05)。

结论

支具固定限制会导致患侧肘屈肌收缩率增高，不是降低偏瘫上肢屈肌活跃性的有效方法；健手托举患手限制会导致平衡功能降低。

关键词: 脑卒中, 上肢限制, 平衡, 屈肌

Abstract: Objective

To observe the affected elbow flexor activities and balance of stroke patients in standing and walking as fixing the affected upper extremity with different methods.

Methods

From September to December, 2018, 14 stroke patients from Affiliated Suzhou Science ＆ Technology Town Hospital of Nanjing Medical University were included. They were measured elbow flexor contraction ratio (integrated electromyogram of flexor/integrated electromyogram of antagonist) with wireless surface electromyography as standing and walking in normal speed, and sway index with Biodex as standing, in four conditions: the affected arm without fixing, and fixed with elbow orthosis, and with unaffected hand backwards and forwards.

Results

The contraction ratio was the most as the arm fixed with elbow orthosis in both standing and walking (F > 2.687, P < 0.05). The sway index was the most as the arm fixed with unaffected hand forwards (F = 21.091, P < 0.05).

Conclusion

The elbow orthosis restraint may lead to increased contraction of the affected elbow flexor, which is unsatisfactory to inhibit flexor activity of the upper extremities; while restraint of unaffected hand forwards may lead to instable balance.

Key words: stroke, upper extremity restraint, balance, flexor

中图分类号:

R743.3

陈昕,王盛,王彤,吴勤峰,李向哲. 不同上肢限制法对脑卒中偏侧肘屈肌活跃性和平衡的影响[J]. 《中国康复理论与实践》, 2021, 27(5): 609-614.

Xin CHEN,Sheng WANG,Tong WANG,Qin-feng WU,Xiang-zhe LI. Effects of Different Upper Extremity Fixing Approaches on Elbow Flexor Activities and Balance for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(5): 609-614.

图/表 2

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限制方法	n	摆动指数	站立肘屈肌收缩率	步行肘屈肌收缩率
无限制	14	0.51±0.22	1.38±0.51	2.01±1.03
限制方法1	14	0.69±0.26	1.80±1.11^c	3.06±1.16^a,c,d
限制方法2	14	0.93±0.32^a	1.11±0.24	1.21±0.46
限制方法3	14	1.50±0.51^a,b,c	1.37±0.44	1.78±1.02
F值		21.091	2.687	9.135
P值		< 0.001	0.023	< 0.001

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不同上肢限制法对脑卒中偏侧肘屈肌活跃性和平衡的影响

Effects of Different Upper Extremity Fixing Approaches on Elbow Flexor Activities and Balance for Stroke Patients

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编号	性别	偏瘫侧	年龄 (岁)	体质量(kg)	身高 (cm)	脑卒中类型	病程 (月)	Fulg-Meyer评定量表上肢部分	Berg平衡量表	改良Barthel指数
1	男	左	57	65	165	脑出血	6	22	40	80
2	男	左	40	81	176	脑出血	3	19	54	65
3	男	右	22	64	175	脑出血	8	29	54	95
4	男	左	65	76	175	脑梗死	2	15	37	55
5	男	右	55	63	172	脑梗死	2	24	40	40
6	女	左	37	40	153	脑出血	7	24	42	60
7	女	左	41	43	145	脑出血	2	20	45	65
8	男	右	41	75	175	脑梗死	1	42	50	75
9	男	右	48	88	172	脑出血	6	27	54	90
10	女	左	22	68	172	脑出血	4	37	53	80
11	男	左	45	60	161	脑梗死	3	54	56	100
12	男	右	30	72	172	脑出血	9	35	53	95
13	男	右	51	55	168	脑出血	6	28	43	75
14	女	左	48	49	156	脑出血	3	40	54	95