屈伸肌交替低频穴位电刺激促进中风患者拇指运动功能恢复的临床观察

发布时间：2018-01-12 07:26

本文关键词：屈伸肌交替低频穴位电刺激促进中风患者拇指运动功能恢复的临床观察　出处：《黑龙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察屈伸肌交替低频穴位电刺激与电针方法对中风患者拇指运动功能障碍的临床疗效,进一步探讨屈伸肌交替低频穴位电刺激对中风患者拇指关节活动度及相关肌肉的影响,优化中风上肢治疗方案。方法:将符合纳入标准的拇指运动功能障碍患者60例,采用随机数字表法分成治疗组和对照组,两组各30例。治疗前,采集两组患者患侧拇指外展、对掌的最大关节活动度及拇指侧捏时拇指内收肌群的肌电峰值。治疗时,对照组应用电针治疗,波形选用连续波,频率2Hz;治疗组应用低频穴位电刺激治疗,刺激模式为屈伸肌交替刺激,波形选用断续波,断续比1:1,频率50Hz。两组均每次治疗30分,强度以患者耐受为度,每日1次,治疗6天,休息1天,共治疗4周。分别在治疗前后选用M600肌电及关节活动度运动检测系统检测特征值(拇指侧捏时,拇指内收肌群表面肌电峰值,拇指对掌、外展时,关节最大活动度)、Lindmark运动功能评分(腕、手)、改良Barthel指数评分(上肢部分)和神经功能缺损评分(CSS)来评价疗效,利用统计学软件SPSS19.0对数据进行处理与分析。结果:1.低频穴位电刺激组与电针组患者治疗后患侧拇指侧捏时拇指内收肌群表面肌电峰值较治疗前明显增高,差异具有统计学意义(p0.01),且两组患者拇指内收肌群肌电峰值、治疗前后差值的组间比较,差异具有统计学意义(P0.05),治疗组优于对照组。2.低频穴位电刺激组与电针组患者治疗后患侧拇指外展、对掌角度较治疗前明显增大,差异具有统计学意义(P0.01),且两组患者拇指外展、对掌角度、治疗前后差值的组间比较,差异具有统计学意义(P0.01),治疗组优于对照组。3.低频穴位电刺激组与电针组患者治疗后Lindmark运动功能评分(腕、手)、改良Barthel指数评分(上肢部分),与治疗前相比均有明显提高;神经功能缺损评分(CSS)较治疗前相比,明显降低,差异具有统计学意义(P0.01),且两组患者各量表评分、治疗前后差值的组间比较,差异具有统计学意义(P0.05),治疗组优于对照组。4.低频穴位电刺激组总有效率为90%,电针组总有效率为63.33%,两组有效率对比,差异具有统计学意义(P0.01),低频穴位电刺激组总有效率高于电针组。结论:1.低频穴位电刺激与电针治疗均能改善中风患者患肢拇指运动功能,对于中风患者拇指运动功能重建具有显著疗效,且低频穴位电刺激治疗明显优于电针治疗效果。2.低频穴位电刺激对于拇指内收肌群肌力改善明显,可能通过提高拇指周边肌肉肌力从而使拇指关节活动度得到扩大。3.低频穴位电刺激能改善手指精细运动功能,综合提高患者上肢精细运动能力,提高患者日常生活能力。
[Abstract]:Objective: to observe the clinical effect of alternating low frequency acupoint electric stimulation and electroacupuncture on motor dysfunction of thumb in patients with apoplexy. To further investigate the effect of alternating low frequency acupoint electrical stimulation of flexion and extensor on the motion of thumb joint and related muscles in patients with apoplexy. Methods: 60 patients with thumb motor dysfunction were randomly divided into treatment group and control group, 30 cases in each group. Before treatment, 60 patients with thumb motor dysfunction were divided into two groups: control group (n = 30), control group (n = 30) and control group (n = 30). The maximal joint activity and the peak value of the adductor muscle group of the thumb were collected in the two groups. The control group was treated with electroacupuncture, the waveform was continuous wave and the frequency was 2Hz. The treatment group was treated with low frequency acupoint electrical stimulation, the stimulation mode was alternately flexion and extensor muscle stimulation, the waveform was selected as intermittent wave, the intermittent ratio was 1: 1, and the frequency was 50 Hz. The two groups were treated for 30 minutes each time. The intensity was determined by patient tolerance once a day for 6 days and rest for 1 day for a total of 4 weeks. M600 electromyography and joint motion measurement system were used before and after treatment respectively to detect the characteristic values (thumb side pinch). The maximal motion of the joint was evaluated by Lindmark motor function score (wrist, hand). Modified Barthel index score (upper limb part) and neurologic impairment score (NDS) were used to evaluate the efficacy. The data were processed and analyzed by the statistical software SPSS19.0. Results:. 1. The peak value of surface electromyography of adductor muscle group was significantly higher in patients with low frequency acupoint stimulation and electroacupuncture than before treatment. The difference was statistically significant (P 0.01), and the peak value of adductor muscle group in the two groups, the difference between the groups before and after treatment, the difference was statistically significant (P 0.05). The treatment group is superior to the control group .2.The low-frequency acupoint electrical stimulation group and electroacupuncture group after treatment of thumb abduction, the palmar angle was significantly larger than before treatment, the difference was statistically significant (P 0.01). And the two groups of thumb abduction, palm angle, difference before and after treatment, the difference was statistically significant (P 0.01). The treatment group is superior to the control group .3.The low frequency acupoint electrical stimulation group and electroacupuncture group patients after treatment Lindmark motor function score (wrist, hand, modified Barthel index score (upper limb part)). Compared with before treatment, there was significant improvement. The neurological impairment score (CSS) was significantly lower than that before treatment, the difference was statistically significant (P 0.01), and the scores of each scale and the difference before and after treatment were compared between the two groups. The difference was statistically significant, the treatment group was better than the control group .4.The total effective rate of the low frequency acupoint stimulation group was 90, the total effective rate of the electroacupuncture group was 63.33, the effective rate of the two groups was compared. The total effective rate of low frequency acupoint electrical stimulation group was higher than that of electroacupuncture group. Conclusion the low frequency acupoint electrical stimulation and electroacupuncture treatment can improve the motor function of the affected limb thumb in apoplexy patients. For stroke patients with motor function reconstruction has a significant effect, and the low frequency acupoint electrical stimulation treatment is significantly better than electroacupuncture treatment effect. 2. Low frequency acupoint electrical stimulation for the thumb adductor muscle group improved significantly. It is possible to increase the muscle strength of the peripheral muscles of the thumb so as to expand the motion of the joint of the thumb .3.Electric stimulation at low frequency acupoints can improve the fine movement function of the finger and improve the fine motor ability of the upper extremity of the patients. Improve the ability of daily life of patients.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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