便携式臂丛神经损伤电刺激治疗仪的研制和临床应用研究

发布时间：2018-02-12 22:07

本文关键词： 脉冲波功能性电刺激周围神经损伤治疗仪便携式臂丛神经损伤　出处：《第四军医大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:针对臂丛神经损伤的神经电刺激治疗特点,在成功研制用于单根周围神经损伤治疗的单通道神经电刺激治疗仪并临床验证的基础上,研制用于臂丛神经损伤治疗的便携式三通道臂丛神经损伤电刺激治疗仪,并应用于臂丛神经损伤患者,初步观察临床治疗效果。方法:(1)在功能性电刺激的电生理学原理基础上研制便携式单通道神经电刺激治疗仪,系统硬件部分包括微控制器、电源模块、显示模块、参数存储模块、电极脱落检测电路、电池电压检测电路、高压脉冲发生电路等七个基本模块,系统软件是基于ARM核硬件平台,通过软件编程完成;通过软件中的治疗过程控制程序,实现了多种不同的刺激波形,经表面自粘性电极片对脉冲波进行输出,作用于不同类型的单根周围神经。(2)将65例单根周围神经(尺神经20例,桡神经20例,正中神经25例)损伤术后的患者随机分成试验组35例和对照组30例,试验组术后第2周拆线后使用研制的便携式单通道神经电刺激治疗仪进行治疗,常规按时服用神经营养药物及患肢主被动功能锻炼;对照组按时服用神经营养药物及患肢主被动功能锻炼,患者术后3月、6月随访,6月时观察患者受损神经功能恢复情况。(3)针对单通道神经刺激治疗仪一次只能针对单根神经进行治疗的缺点,结合臂丛神经多组神经损伤的特点,研制便携式三通道臂丛神经损伤电刺激治疗仪。仪器由主控模块、显示模块、键盘模块、三个通道的电刺激发生器模块以及电源模块,组成便携式三通道电刺激系统,释放三组连续交替性电脉冲刺激,按照通道1、通道2、通道3连续交替性输出,且每通道刺激持续周期为1-5分钟。(4)将28例臂丛神经上中干损伤术后的患者随机分成试验组(15例)和对照组(13例),试验组术后第三周使用研制的便携式三通道臂丛神经损伤电刺激治疗仪治疗,对照组不做相关处理,患者术后8月时随访,观察患者上肢抬肩、屈肘、伸肘功能恢复情况。结果:(1)单根神经损伤术后的患者,经便携式单通道神经电刺激治疗仪的治疗,其优良率均明显好于对照组,且差异有统计学意义(P0.05)。(2)臂丛神经上中干损伤术后的患者,经便携式三通道臂丛神经损伤电刺激治疗仪的治疗,其患侧抬肩、屈肘、伸肘功能均好于治疗前,差异明显且有统计学意义(P0.05)。结论:(1)便携式单通道神经电刺激治疗仪可以有效地促进单根神经损伤术后神经功能的康复,且治疗模式可以个体化调节,成本低,使用灵活,具有专一性和安全性。(2)本研究研制成功的便携式三通道臂丛神经损伤电刺激治疗仪,可以有效地促进臂丛神经上中干损伤后上肢功能的康复,并且可以对三组神经和肌肉进行连续交替性神经电刺激,具有较好的创新性,疗效确切,方便患者使用,便于携带,集成治疗的特点,初步观察患者恢复满意。
[Abstract]:Objective: according to the characteristics of nerve electrical stimulation for brachial plexus injury, a single channel nerve stimulation apparatus for the treatment of single peripheral nerve injury was successfully developed and verified. A portable three-channel electric stimulation apparatus for brachial plexus injury was developed and used in patients with brachial plexus injury. Methods based on the electrophysiological principle of functional electrical stimulation, a portable single channel neuroelectric stimulation apparatus was developed. The hardware of the system includes microcontroller, power supply module, display module, and so on. There are seven basic modules, such as parameter storage module, electrode shedding detection circuit, battery voltage detection circuit and high voltage pulse generation circuit. The system software is based on the hardware platform of ARM core and is programmed by software. Through the therapeutic process control program in the software, a variety of different stimulation waveforms were realized. The pulse waves were output through the surface self-adhesive electrode plate, acting on the single peripheral nerve of different types. 65 cases of the single peripheral nerve (20 cases of ulnar nerve) were treated. 20 cases of radial nerve and 25 cases of median nerve) were randomly divided into experimental group (35 cases) and control group (30 cases). Routine routine use of neurotrophic drugs and active and passive function exercise of affected limbs, while the control group took neurotrophic drugs and active and passive function exercises of affected limbs on time, The patients were followed up on March and June, and the recovery of injured nerve function was observed on June) in view of the shortcoming that the single channel nerve stimulator could only treat single nerve at a time, combined with the characteristics of multiple groups of nerve injury of brachial plexus nerve. A portable three-channel electrical stimulation apparatus for brachial plexus injury was developed. The instrument consists of a main control module, a display module, a keyboard module, a three-channel electrical stimulation generator module and a power supply module, which constitute a portable three-channel electrical stimulation system. Release three groups of consecutive alternating electrical pulse stimuli, output in accordance with channel 1, channel 2, channel 3 continuously alternately, 28 cases of brachial plexus injury after middle trunk injury were randomly divided into trial group (n = 15) and control group (n = 13). The study group was treated with portable three-channel brachial plexus in the third week after operation. Treatment of nerve injury with electrical stimulation apparatus, The patients in the control group were followed up on August to observe the recovery of the function of shoulder lifting, elbow flexion and elbow extension. Results the patients with single nerve injury were treated with a portable single channel nerve stimulation apparatus. The excellent and good rates were significantly better than those in the control group, and the difference was statistically significant (P 0.05. 0. 0. 2) after the middle trunk injury of brachial plexus, the patients were treated with a portable three channel brachial plexus nerve injury electric stimulation apparatus. The elbow extension function was better than that before treatment, and the difference was significant (P 0.05). Conclusion the portable single channel nerve stimulation apparatus can effectively promote the recovery of nerve function after single nerve injury, and the treatment mode can be adjusted individually. The portable three-channel brachial plexus nerve injury electrical stimulation apparatus developed in this study can effectively promote the recovery of upper limb function after the middle trunk injury of brachial plexus nerve. Three groups of nerve and muscle can be continuously alternated nerve electrical stimulation, with better innovative, effective, convenient for patients to use, easy to carry, integrated treatment characteristics, preliminary observation of patients recovery satisfaction.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.3

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