功能性电刺激与肌电生物反馈治疗脑卒中后足下垂内翻的疗效评价研究

发布时间：2018-03-10 05:19

本文选题：功能性电刺激　切入点：肌电生物反馈　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：[目的]1、比较FES与肌电生物反馈疗法治疗脑卒中患者足下垂内翻的临床疗效。2、为FES对脑卒中患者足下垂内翻的临床治疗提供客观依据。[方法]筛选21例符合入组标准的脑卒中患者通过微软Excel软件中的Rand函数随机分为功能性电刺激(Functional electrical stimulation, FES)组和肌电生物反馈(Electromyographic Biofeedback, EMG-BF)组。21例患者中3例由于某些原因未能完成本研究,最终18例患者完成本研究。FES组9例(年龄60.18±15.82岁,病程83.56±55.51天,其中男7例,女2例；梗塞4例,出血5例),EMG-BF组9例(年龄63.21±19.73岁,病程78.78±59.43天,其中男6例,女3例,梗塞3例,出血6例)。两组常规治疗相同,包括药物和基本的康复训练。此外,FES组给予功能性电刺激治疗,EMG-BF组给予肌电生物反馈疗法；入选患者分别于治疗前、治疗后2周、治疗后4周接受以下量表评定：改良Ashworth肌张力分级(踝背伸)(Modified Ashworth Spasticity Scale, MAS)、下肢简化Fugl-Meyer运动功能评分(Fugl-Meyer Assessment of Motor Function,FMA)、下肢Brunnstrom运动恢复分期(Recovery Stage of Brunn strom, RSB)、步行功能评定(Functional Ambulation Classification, FAC)以及10米步行能力测试(10-meter Walk Test,10m WT)。采用SPSS17.0对结果进行统计分析,设定P0.05为差异有统计学意义。[结果]1.一般资料比较：FES组和EMG-BF组在年龄、性别、脑卒中性质、病程等方面差异无统计学意义(P0.05),两组资料具有可比性。2.治疗前比较：治疗前两组在MAS、FMA、RSB、FAC以及10mWT等方面差异无统计学意义(P0.05),两组资料具有可比性。3.治疗后组内比较：治疗2周后、4周后评分与治疗前评分相比,两组在FMA、RSB、FAC以及10mWT等方面差异均有统计学意义(P0.05)。FES组在治疗2周后MAS评分与治疗前比较有统计学差异(P0.05),在治疗4周后与治疗前比较无统计学差异(P0.05)。EMG-BF组在治疗2周、4周后MAS评分与治疗前评分相比,差异均有统计学意义(P0.05)。4.治疗后组间比较治疗2周后两组在FMA、10mWT结果之间差异有统计学意义(P0.05),在MAS、RSB、FAC之间差异无统计学意义(P0.05)。治疗4周后两组在FMA、10mWT结果之间差异有统计学意义(P0.05),在MAS、RSB、FAC评分差异无统计学意义(P0.05)。[结论]1.FES可以延缓脑卒中后足下垂内翻患者下肢痉挛加重的趋势和程度。2.FES可以改善脑卒中后足下垂内翻患者的运动功能及步行速度,且疗效较EMG-BF疗法更显著。
[Abstract]:[objective] 1. To compare the clinical efficacy of FES and electromyoelectric biofeedback therapy in the treatment of foot ptosis varus in stroke patients. [methods] to provide objective basis for the clinical treatment of foot ptosis varus with FES. [methods] 21 patients with stroke were selected. Standard stroke patients were randomly divided into functional electrical stimulation (FESs) group and electromyographic biofeedback (EMG-BF) group through Rand function in Microsoft Excel software. FES group (age 60.18 卤15.82 years, course 83.56 卤55.51 days, male 7 cases, female 2 cases, infarction 4 cases, bleeding 5 cases EMG-BF 9 cases (age 63.21 卤19.73 years, course 78.78 卤59.43 days), male 6 cases, female 3 cases, infarction 3 cases, infarction 3 cases, the course of disease 78.78 卤59.43 days. The two groups received the same routine treatment, including drugs and basic rehabilitation training. In addition, the FES group was treated with functional electrical stimulation and EMG-BF group was given myoelectric biofeedback therapy, the patients were enrolled before treatment and 2 weeks after treatment. Four weeks after treatment, the following scales were assessed: modified Ashworth Spasticity scale (MASE), lower extremity simplified Fugl-Meyer Assessment of Motor function scale, lower extremity Brunnstrom recovery stage, recovery Stage of Brunnstrom, and functional Ambulation evaluation. Classification (FAC) and 10-meter Walk test (10m WTT). The results were statistically analyzed by SPSS17.0. The differences were statistically significant. [results] 1.General data were compared between the EMG-BF group and the two groups in age, sex, stroke nature, There was no significant difference in course of disease between the two groups (P 0.05), and the data of the two groups were comparable. 2. Comparison before treatment: there was no significant difference between the two groups in MASFMARSBFAC and 10mWT before treatment (P 0.05). The data of the two groups were comparable. 3. After treatment, there was no significant difference between the two groups in terms of MASFMA-RSB-FAC and 10mWT. The scores after 2 weeks and 4 weeks after treatment were compared with those before treatment. There were significant differences in FMA-RSB-FAC and 10mWT between the two groups. The MAS scores in the FES group after 2 weeks of treatment were significantly different from those before treatment, and there was no significant difference between the two groups after 4 weeks of treatment and before treatment (P0.05U. EMG-BF group at 2 weeks and 4 weeks after treatment). Post MAS scores were compared with pre-treatment scores, After 2 weeks of treatment, there was a significant difference between the two groups in the FMA10mWT results. There was no significant difference between the two groups in the FMA10mWT results. There was no significant difference between the two groups in the FMA10mWT results after 4 weeks of treatment, and there was no significant difference between the two groups in the FMA10mWT results after 4 weeks of treatment. There was no significant difference in the scores of FAC between the two groups. [conclusion] 1. FES can delay the tendency and degree of spasticity of lower extremities in patients with stroke. 2. FES can improve the motor function and walking speed of patients with prolapsed foot varus after stroke. The curative effect was more significant than that of EMG-BF therapy.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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