电针运动点复合康复训练对不完全性脊髓损伤后胫骨前肌肌力影响的临床观察

发布时间：2018-03-26 08:58

本文选题：脊髓损伤　切入点：截瘫　出处：《成都中医药大学》2013年硕士论文

【摘要】：目的：通过电针胫骨前肌运动点复合康复训练治疗不完全性脊髓损伤患者,观察患者胫骨前肌肌力改善的情况,验证电针运动点治疗方案的有效性,为临床治疗不完全性脊髓损伤探索一种安全有效的新方案。方法：本研究采用随机对照试验设计,纳入24例不完全性脊髓损伤患者,48块胫骨前肌。随机分为观察组和对照组,两组均进行常规康复治疗,观察组在此基础上采用电针阳明经穴加胫骨前肌运动点,对照组采用电针阳明经穴加胫骨前肌非运动点经穴。电针、康复治疗1次/日,10天为1个疗程,连续治疗3个疗程。在试验开始时、治疗10天后、治疗20天后与完成疗程后,均进行ASIA分级评定、胫骨前肌徒手肌力评定(Manual muscle test, MMT)、踝关节主动背屈关节活动度(Range of motion, ROM)测量,肌电积分(Integrated electromyography, iEMG)评测。通过前后指标对比,比较两种治疗方法对不完全性脊髓损伤患者胫骨前肌肌力的影响。结果：两组受试者组内对比,胫骨前肌徒手肌力变化、踝关节背屈关节活动度变化以及ASIA分级变化在治疗10天、20天、30天时均无统计学意义(P0.05),两组受试者组间对比,胫骨前肌徒手肌力变化、踝关节角度变化以及ASIA分级变化在治疗10天、20天、30天时均无统计学意义(P0.05)。观察组与对照组的胫骨前肌iEMG变化在治疗10天、20天、30天时,组内及组间对比均有统计学意义(P0.05),观察组结果优于对照组(P0.05)。结论： 1.电针胫骨前肌运动点复合康复训练可提高胫骨前肌肌力； 2.采用iEMG定量分析,能在功能活动产生前精确评定单块肌肉肌力变化； 3.电针胫骨前肌运动点的作用机制可能与通过有效的传入刺激,启动任务依赖性可塑性,促进中枢模式发生器重新激活脊髓神经元回路重组有关。
[Abstract]:Objective: to observe the improvement of tibial anterior muscle muscle strength in patients with incomplete spinal cord injury by electroacupuncture combined rehabilitation training of anterior tibial muscle movement point, and to verify the effectiveness of electroacupuncture exercise point therapy. To explore a new safe and effective scheme for the treatment of incomplete spinal cord injury. Methods: Twenty-four patients with incomplete spinal cord injury (sci) were randomly divided into observation group (n = 48) and control group (n = 48). On this basis, the observation group was treated with electroacupuncture Yangming meridian plus tibial anterior muscle motility point, while the control group with electroacupuncture Yangming meridian plus tibial anterior muscle non-exercise point meridian. Electroacupuncture, rehabilitation therapy once a day for 10 days was used as a course of treatment. At the beginning of the trial, 10 days after the treatment, 20 days after the treatment and after the completion of the course of treatment, all patients were assessed with ASIA grade, manual muscle test with the assessment of the bare-handed muscle strength of the anterior tibia muscle, and the range of motion of ankle joint active dorsiflexion joint. The effects of two treatment methods on tibial anterior muscle strength in patients with incomplete spinal cord injury were compared by comparing the indexes before and after the evaluation of integrated electromyography (iEMG). Results: there was no significant difference in the muscle strength of the tibial anterior muscle, the range of motion of the dorsiflexion joint of the ankle and the ASIA grade between the two groups at 10 days, 20 days and 30 days after treatment (P 0.05), and there was no significant difference between the two groups. The changes of tibial anterior muscle strength, ankle angle and ASIA grade were not statistically significant at 10 days, 20 days and 30 days after treatment. The changes of iEMG of tibial anterior muscles in the observation group and the control group were observed on the 10th day, the 20th day, and the 30th day, respectively. The results of observation group were better than that of control group (P 0.05). Conclusion:. 1. Electroacupuncture combined rehabilitation training of tibial anterior muscle motor point can improve tibial anterior muscle strength; 2.The quantitative analysis of iEMG can accurately evaluate the muscle strength change of a single muscle before the functional activity. 3. The mechanism of electroacupuncture on the motor point of the anterior tibial muscle may be related to the activation of task-dependent plasticity through effective afferent stimulation and the promotion of reactivation of the spinal cord neuronal circuit by the central pattern generator.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R246.9

【参考文献】