深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的效果

doi:10.3969/j.issn.1006-9771.2024.12.011

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (12): 1452-1460.doi: 10.3969/j.issn.1006-9771.2024.12.011

深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的效果

梁艳华¹^,², 张琦¹^,²(), 胡晓诗¹^,², 李晓松¹^,², 岳青¹^,², 周天添¹^,², 李思佳¹^,², 冯啊美¹^,²

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院儿童物理疗法科，北京市100068

收稿日期:2024-08-05 修回日期:2024-11-19 出版日期:2024-12-25 发布日期:2024-12-30
通讯作者: 张琦 E-mail:13501320729@163.com
作者简介:梁艳华(1988-)，女，汉族，陕西咸阳市人，主管技师，主要研究方向：儿童运动康复。
基金资助:
中国康复研究中心青年基金项目(2021zx-Q10)

Effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy

LIANG Yanhua¹^,², ZHANG Qi¹^,²(), HU Xiaoshi¹^,², LI Xiaosong¹^,², YUE Qing¹^,², ZHOU Tiantian¹^,², LI Sijia¹^,², FENG Amei¹^,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of Paediatric Physical Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2024-08-05 Revised:2024-11-19 Published:2024-12-25 Online:2024-12-30
Contact: ZHANG Qi E-mail:13501320729@163.com
Supported by:
China Rehabilitation Research Center Youth Fund(2021zx-Q10)

摘要/Abstract

摘要：

目的观察深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的影响。

方法 2023年1月至2024年3月，北京博爱医院痉挛型脑瘫儿童30例，随机分为对照组(n = 15)和干预组(n = 15)。两组均接受常规康复治疗，干预组增加深层肌肉刺激，共4周。训练前后采用超声诊断系统对腓肠肌行横切和纵切两个方向检查，比较肌纤维长度、肌肉羽状角度、肌肉厚度和肌肉横截面积，采用改良Ashworth量表(MAS)评定患侧下肢肌张力，采用粗大运动功能测试(GMFM)的D区和E区评价运动功能。

结果治疗后，两组肌纤维长度和肌肉羽状角度均显著改善(|t| > 6.329, P < 0.001)，且干预组优于对照组(|t| > 2.347, P < 0.05)；两组MAS评分均降低(t > 2.432, P < 0.05)，且干预组低于对照组(t = 2.140, P < 0.05)；两组GMFM D区、E区评分均显著增加(|t| > 8.473, P < 0.001)，且干预组优于对照组(|t| > 2.191, P < 0.05)。

结论深层肌肉刺激可以改善痉挛型脑瘫儿童腓肠肌肌纤维长度和肌肉羽状角度，改善下肢痉挛和运动功能。

关键词: 脑性瘫痪, 深层肌肉刺激, 痉挛, 肌肉结构

Abstract:

Objective To observe the effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy.

Methods From January, 2023 to March, 2024, 30 children with spastic cerebral palsy in Beijing Bo'ai Hospital were randomly divided into control group (n = 15) and intervention group (n = 15). Both groups received conventional rehabilitation therapy, while the intervention group added deep muscle stimulation, for four weeks. Before and after training, the gastrocnemius muscle was examined by ultrasound diagnosis system in two aspects: transverse incision and longitudinal incision. Indicators included fascicle length, muscular thickness, cross sectional area and pennation angle. The modified Ashworth Scale (MAS) was used to assess the muscle tension of the lower extremity of the affected side. The standing, walking, running and jumping function were evaluated by Gross Motor Function Measure (GMFM) D and E areas.

Results After training, the fascicule length and pennation angle improved significantly in both groups (|t| > 6.329, P < 0.001), and they were better in the intervention group than in the control group (|t| > 2.347, P < 0.05); the scores of MAS decreased in both groups (t > 2.432, P < 0.05), and were better in the intervention group than in the control group (t = 2.140, P < 0.05); the scores of GMFM D and E areas significantly decreased in both groups (|t| > 8.473, P < 0.001), and were better in the intervention group than in the control group (|t| > 2.191, P < 0.05).

Conclusion Deep muscle stimulation could improve the fascicule length and pennation angle, and improve the spasticity and motor function of lower extremities in children with spastic cerebral palsy.

Key words: cerebral palsy, deep muscle stimulation, spasm, muscle structure

中图分类号:

R742.3

梁艳华, 张琦, 胡晓诗, 李晓松, 岳青, 周天添, 李思佳, 冯啊美. 深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的效果[J]. 《中国康复理论与实践》, 2024, 30(12): 1452-1460.

LIANG Yanhua, ZHANG Qi, HU Xiaoshi, LI Xiaosong, YUE Qing, ZHOU Tiantian, LI Sijia, FENG Amei. Effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(12): 1452-1460.

图/表 12

表1

图1

图2

图3

图4

表2

Comparison of fascicule length between two groups pre- and post-treatment 单位：mm"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	33.36±5.15	-8.473	< 0.001
		后测	35.25±5.31
干预组	15	前测	35.16±3.93	-9.798	< 0.001
		后测	39.29±4.03
治疗前两组均值差			1.80±1.67	-1.076	0.291
治疗后两组均值差			4.04±1.72	-2.347	0.026

表2

表3

Comparison of pennation angle between two groups pre- and post-treatment 单位：°"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	15.47±1.25	9.539	< 0.001
		后测	14.60±1.18
干预组	15	前测	15.33±0.98	6.329	< 0.001
		后测	13.07±1.22
治疗前两组均值差			-0.13±0.41	0.326	0.747
治疗后两组均值差			-1.53±0.44	3.490	0.002

表3

表4

Comparison of muscular thickness between two groups pre- and post-treatment 单位：mm"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	7.07±0.76	0.587	0.567
		后测	7.05±0.74
干预组	15	前测	7.15±0.33	0.180	0.860
		后测	7.14±0.38
治疗前两组均值差			0.08±0.21	-0.376	0.710
治疗后两组均值差			0.09±0.21	-0.436	0.666

表4

表5

Comparison of cross sectional area between two groups pre- and post-treatment 单位：cm²"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	1.72±0.41	-1.406	0.182
		后测	1.73±0.41
干预组	15	前测	1.88±0.53	0.746	0.468
		后测	1.87±0.53
治疗前两组均值差			0.16±0.17	-0.923	0.364
治疗后两组均值差			0.14±0.17	-0.782	0.441

表5

表6

两组治疗前后腓肠肌MAS评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	2.73±0.88	2.432	0.029
		后测	2.27±0.96
干预组	15	前测	2.67±0.98	8.500	< 0.001
		后测	1.53±0.92
治疗前两组均值差			-0.07±0.34	0.196	0.846
治疗后两组均值差			0.73±0.34	2.140	0.041

表6

表7

两组治疗前后GMFM D区评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	30.40±3.16	-8.473	< 0.001
		后测	32.33±3.09
干预组	15	前测	31.27±2.76	-9.798	< 0.001
		后测	34.47±2.17
治疗前两组均值差			0.87±1.08	-0.800	0.431
治疗后两组均值差			2.13±0.97	-2.191	0.037

表7

表8

两组治疗前后GMFM E区评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	40.67±11.08	-12.865	< 0.001
		后测	46.80±11.47
干预组	15	前测	45.47±9.50	-16.538	< 0.001
		后测	55.73±10.38
治疗前两组均值差			4.80±3.77	-1.274	0.213
治疗后两组均值差			8.93±3.99	-2.236	0.033

表8

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组别	n	性别(男/女)/n^a	年龄/岁^b	GMFCS分(I/II)/n^a
对照组	15	8/7	5.13±0.50	12/3
干预组	15	10/5	4.40±0.54	13/2
Z值		-	-1.503	-
P值		0.710	0.133	1.000

深层肌肉刺激对痉挛型脑瘫儿童肌肉结构和功能的效果

Effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy

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