《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (07): 811-815.

• 特稿 • 上一篇    下一篇

改良腕手关节矫形器对脑卒中偏瘫患者腕手关节屈肌痉挛及运动功能的疗效

叶大勇，张希彬，李宝   

  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-07-25 发布日期:2015-07-25

Effect of Modified Wrist-hand Orthosis on Spasm and Motor Function of Wrist and Hand in Hemiplegics post Stroke

YE Da-yong, ZHANG Xi-bin, LI Bao   

  1. Department of Rehabilitation Medicine, the First Hospital of Qiqihaer, Qiqihaer, Heilongjiang 161005, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-07-25 Online:2015-07-25

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摘要： 目的 探讨改良腕手关节矫形器对偏瘫患者腕手关节屈肌痉挛及运动功能的疗效。方法 脑卒中后偏瘫患者 56例分为观察组与对照组各28例。两组均接受常规康复训练，包括运动疗法、作业疗法、痉挛肌电刺激疗法，观察组加用改良腕手关节矫形器，于每天训练结束后累计穿戴4~8 h，每次30~60 min，休息15 min。分别于治疗前、治疗4周、治疗8周及治疗12周对两组患者采用改良 Ashworth量表(MAS)、简式 Fugl-Meyer评定(FMA)进行评定，采用量角器测量患侧腕关节主动掌屈、背伸、桡偏、尺偏关节活动度(AROM)。结果 治疗 4周时，两组均未见明显改善，两组间也无显著性差异。治疗 8周时，两组 MAS和 FMA评分较治疗前和治疗 4周时改善(P<0.05)，观察组明显优于对照组(P<0.01)；观察组腕关节各方向 AROM与治疗前比较均有提高(P<0.05)，其中背伸 AROM 较对照组明显提高(P<0.01)。治疗 12 周时，观察组 MAS 和 FMA 评分较治疗 8 周时进一步明显改善(P<0.01)，且明显优于对照组(P<0.01)；观察组背伸、掌曲、桡偏AROM优于对照组(P<0.05)。结论 改良腕手关节矫形器可明显缓解脑卒中后偏瘫患者腕手关节屈肌痉挛，促进腕手关节运动功能恢复。

关键词: 脑卒中, 偏瘫, 屈肌, 痉挛, 腕手关节矫形器, 主动关节活动度

Abstract: Objective To investigate the effect of the modified wrist-hand orthosis on the spasm and function of wrist-hand in hemiplegic patients. Methods 56 patients with hemiplegia after stroke were divided into observation group (n=28) and control group (n=28). All the patients received routine rehabilitation, including physical therapy, occupational therapy, and Hufschmidt therapy. The observation group wore modified wrist-hand orthosis 4-8 hours a day after the treatment, with interval of 15 min per 30-60 min. All the patients were assessed with modified Ashworth Scale (MAS), simple Fugl-Meyer Assessment (FMA) and active range of motion (AROM) of flexion, extension, radial deviation and ulnar deviation of wrist before and 4 weeks, 8 weeks and 12 weeks after treatment. Results There was no significant improvement in both groups 4 weeks after treatment, nor difference between groups. The scores of MAS and FMA improved 8 weeks after treatment in both groups (P<0.05), and improved more in the observation group than in the control group (P<0.01). While the AROMs improved in the observation groups (P<0.05), and the AROM of extension was more than that of the control group (P<0.01). 12 weeks after treatment, the scores of MAS and FMA improved further in the observation group (P<0.01), and improved more than those of the control group (P<0.01). The AROMs of flexion, extension and radial deviation improved more in the observation group than in the control group (P<0.05). Conclusion The modified wrist-hand orthosis can obviously relieve the spasm of wrist-hand flexor in patients with hemiplegia after stroke, and promote the motor function.

Key words: stroke, hemiplegia, flexor, spasm, wrist-hand orthosis, active range of motion