目的 比较不同踝背屈诱发方法对脑卒中患者踝背屈功能恢复的影响。 方法 2016年9月至2018年9月，脑卒中后踝主动背屈障碍患者60例随机分为A组、B组和C组，各20例，分别采用常规治疗、叩击区法和丘墟点穴法治疗6周，治疗前后采用三维步态分析和表面肌电图进行检测。 结果 治疗后，三组患侧踝关节屈伸活动度、峰力矩和胫前肌表面肌电积分均升高(t > 2.318, P < 0.05)，B组和C组优于A组(P < 0.05)，C组优于B组(P < 0.05)。 结论 丘墟点穴法和叩击区法均能促进脑卒中患者踝背屈功能恢复，丘墟点穴法效果更好。
关键词：
脑卒中; 踝; 背屈; 丘墟; 穴位疗法
Objective To compare the effect of two kinds of methods inducing ankle dorsiflexion on ankle dorsiflexion function for stroke patients. Methods From September, 2016 to September, 2018, 60 patients with disorders of ankle active dorsiflexion after stroke were randomly divided into groups A, B and C, who accepted routine rehabilitation, tapping-zone therapy and tapping Qiuxu acupoint (GB40), respectively, for six weeks. They were assessed with three-dimensional gait analysis and surface electromyography before and after treatment. Results The range of motion of the affected ankle, the peak torque of ankle and integrated electromyography of tibialis anterior muscle increased after treatment (t > 2.318, P < 0.05), and it ranked from best to worst as group C, group B and group A (P < 0.05). Conclusion Both tapping-zone therapy and tapping Qiuxu may promote the recovery of ankle dorsiflexion in stroke patients, and the latter seems better.
1 BlanchetteA K, NoelM, RichardsC L, et al. Modifications in ankle dorsiflexor activation by applying a torque perturbation during walking in persons post-stroke: a case series [J]. J Neuroeng Rehabil, 2014, 11: 98.
2 廖燕锬,刘凤彬,林茜,等. 经穴诱发中风患者下肢Bechterev反射的电生理学效应[J]. 光明中医, 2016, 31(16): 2373-2375.
3 中华神经科学会,中华神经外科学会. 各类脑血管疾病的诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
4 章稼. 运动治疗技术[M]. 北京:人民卫生出版社, 2010: 323.
5 李威,曾祥斌,章荣,等. 核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响[J]. 中国康复医学杂志, 2014, 29(9): 819-820.
6 冯晓东,马帅统. 指压太冲、丘墟穴诱发训练对脑卒中患者踝背屈功能的影响[J]. 中国康复医学杂志, 2016, 31(7): 785.
7 魏鹏绪,井明鑫,康会坤. 刺激丘墟穴对急性期脑卒中患者踝背屈的即刻改善效应[J]. 中国现代医药杂志, 2015, 17(11): 42-43.
8 张丽华,王艳君. 点按丘墟穴及踝关节抗阻训练对脑梗死后足下垂患者运动功能障碍的影响[J]. 现代中西医结合杂志, 2012, 21(13): 1412-1413.
9 陈希源,李雪青. 巨刺丘墟透照海、昆仑透太溪结合康复训练治疗脑卒中后足下垂的随机对照研究[J]. 针灸临床杂志, 2017, 33(7): 41-43.
10 廖燕锬,刘凤彬,林茜,等. 点按丘墟穴诱发脑卒中患者Bechterev屈曲反射的脑的激活效应[J]. 中国医药科学, 2016, 6(7): 9-12.
11 AmboniM, BaroneP, IupparielloL, et al. Gait patterns in Parkinsonian patients with or without mild cognitive impairment [J]. Mov Disord, 2015, 27(12): 1536-1543.
12 LeeJ K, ParkE J. 3D spinal motion analysis during staircase walking using an ambulatory inertial and magnetic sensing system [J]. Med Biol Eng Comput, 2016, 49(7): 755-764.
13 LouisE D, RaoA K, GerbinM. Functional correlates of gait and balance difficulty in essential tremor: balance confidence, near misses and falls [J]. Gait Posture, 2012, 35(1): 43-47.
14 CenniF, LeardiniA, PieriM, et al. Functional performance of a total ankle replacement: thorough assessment by combining gait and fluoroscopic analyses [J]. Clin Biomech (Bristol,Avon), 2013, 28(1): 79-87.
15 励建安,孟殿怀. 步态分析的临床应用[J]. 中华物理医学与康复杂志, 2006, 28(7): 500-504.
16 王康玲,黄杰斌,吴文,等. 一种便携式步态分析系统的信度研究[J]. 中国康复医学杂志, 2016, 3l(7): 761-764, 785.
17 StiefF, B?hmH, MichelK, et al. Reliability and accuracy in three-dimensional gait analysis:a comparison of two lower body protocols [J]. J Appl Biomech, 2016, 29(1): 105-111.
18 WrenT A, OtsukaN Y, BowenR E, et al. Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis:results of a randomized controlled trial [J]. Gait Posture, 2013, 38(2): 236-241.
19 BoudarhamJ, RocheN, PradonD, et al. Variations in kinematics during clinical gait analysis in stroke patients [J].PLoS One, 2015, 8(6): 419-421.
20 Y JrSagawa, ArmandS, LubbekeA, et al. Associations between gait and clinical parameters in patients with severe knee osteoarthritis: a multiple correspondence analysis [J]. Clin Biomech (Bristol, Avon), 2013, 28(3): 299-305.
21 胡雪艳,恽晓平,张通. 基于数字视频和数字图像处理的步态分析在卒中康复训练中的应用[J]. 中国脑血管病杂志, 2009, 6(9): 456-460.
22 吴月峰,冯玲,张芳. 弹力绷带膝踝联合捆扎改善脑卒中患者步态及日常生活活动能力的疗效观察[J]. 中国康复医学杂志, 2017, 31(6): 672-675.
23 李芳,郑洁皎. 表面肌电图在脑卒中患者异常步态分析中的研究进展[J]. 中国康复理论与实践, 2016, 22(10): 1159-1160.
24 王培,王红星. 神经电生理检测技术在脑卒中后功能评定中的应用进展[J]. 中国康复理论与实践, 2016, 22(12): 1404-1407.
25 李芳,安丙辰,郑洁皎. 表面肌电图在脑卒中患者手神经肌肉功能评定中的应用[J]. 中国康复理论与实践, 2015, 21(3): 280-283.
