《中国康复理论与实践》

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (5): 518-523.doi: 10.3969/j.issn.1006-9771.2019.05.004

• 专题 脑卒中并发症康复 • 上一篇    下一篇

不同输出压力体外冲击波对脑卒中后小腿三头肌痉挛的影响

李亚梅, 冯荣建, 黄林, 徐丽, 田金艳, 余茜   

  1. 电子科技大学附属医院·四川省人民医院康复医学科，四川成都市 610072
  • 收稿日期:2018-11-26 修回日期:2018-12-25 出版日期:2019-05-25 发布日期:2019-05-29
  • 通讯作者: 余茜(1968-)，女，汉族，四川泸州市人，博士，主任医师，主要研究方向：神经系统疾病康复。E-mail： yqswc11@163.com
  • 作者简介:李亚梅(1986-)，女，汉族，四川资阳市人，硕士，主治医师，主要研究方向：神经系统疾病康复。
  • 基金资助:
    四川省医学会科研项目(No. Q14046)

Effects of Extracorporeal Shock Wave Therapy in Different Output Pressures on Triceps Surae Spasticity after Stroke

LI Ya-mei, FENG Rong-jian, HUANG Lin, XU Li, TIAN Jin-yan, YU Qian   

  1. Department of Rehabilitation, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China
  • Received:2018-11-26 Revised:2018-12-25 Published:2019-05-25 Online:2019-05-29
  • Contact: YU Qian, E-mail： yqswc11@163.com
  • Supported by:
    Sichuan Medical Association Research Project (No. Q14046)

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摘要： 目的 观察不同输出压力体外冲击波治疗(ESWT)对脑卒中患者小腿三头肌痉挛的疗效差异及可能的电生理机制。方法 2015年1月至2017年12月，脑卒中后偏瘫侧小腿三头肌痉挛住院患者90例，随机分为对照组、治疗组1和治疗组2，各30例。3组均予基础和常规康复治疗，两个治疗组在此基础上增加ESWT治疗，输出压力分别为1.5 bar和2.0 bar，共4周。治疗前后采用踝关节综合痉挛量表(CSS)、踝关节被动活动度(PROM)、10米步行时间(10MWT)和神经电生理(H反射潜伏期、Hmax/Mmax)进行评定。两个治疗组在每次ESWT治疗结束后，采用视觉模拟评分(VAS)评估治疗时疼痛。结果 治疗后，3组患者CSS评分、PROM和10MWT均较治疗前显著改善(t > 7.261, P < 0.001)，两个治疗组CSS评分和10MWT均低于对照组(P < 0.05)，治疗组2 10MWT低于治疗组1 (P < 0.05)。治疗后，两个治疗组H反射潜伏期显著延长(t > 15.025, P < 0.001)，Hmax/Mmax均显著下降(t > 14.850, P < 0.001)，治疗组1 H反射潜伏期长于对照组(P < 0.01)。两个治疗组VAS评分无显著性差异(t = 0.735, P > 0.05)。结论 2.0 bar和1.5 bar ESWT均可有效改善脑卒中后小腿三头肌痉挛，提高步行功能，2.0 bar较1.5 bar对步行功能的改善更大。其电生理机制尚需进一步研究。

关键词: 脑卒中, 痉挛, 体外冲击波, 输出压力, H反射

Abstract: Objective To evaluate the effects of different output pressures of extracorporeal shock wave therapy (ESWT) on triceps surae spasticity after stroke, and to explore the electrophysiologic mechanism involved.Methods From January, 2015 to December, 2017, 90 hemiplegic stroke patients with triceps surae spasticity were randomly assigned into control group (n = 30), treatment group 1 (n = 30) and treatment group 2 (n = 30). All the patients accepted routine medicine and rehabilitation, while the treatment groups 1 and 2 received ESWT of 1.5 bar and 2.0 bar in addition, respectively, for four weeks. They were assessed with Composite Spasticity Scale (CSS), passive range of motion (PROM), 10-meter walk test (10MWT), and H reflex latency and the Hmax/Mmax ratio before and after treatment, and the two treatment groups were assessed with Visual Analogue Scale (VAS) immediately after ESWT. Results All the groups improved in scores of CSS, PROM and 10MWT after treatment (t > 7.261, P < 0.001), and improved more in scores of CSS and 10MWT in the two treatment groups than in the control group (P < 0.05), and the 10MWT was less in the treatment group 2 than in the treatment group 1 (P < 0.05). H reflex latency lengthened (t > 15.025, P < 0.001) and Hmax/Mmax ratio decreased (t > 14.850, P < 0.001) after treatment in the two treatment groups, and the H reflex latency was longer in the two treatment groups than in the control group (P < 0.01). There was no significant difference in VAS between the two treatment groups (t = 0.735, P > 0.05). Conclusion ESWT of both 2.0 bar and 1.5 bar can improve triceps surae spasticity after stroke, and ESWT of 2.0 bar may more benefit the ability of walking. Further study is needed to explore the involved electrophysiologic mechanism.

Key words: stroke, spasticity, extracorporeal shock wave therapy, output pressure, H reflex

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