体外冲击波联合肌电生物反馈对脑卒中后足下垂的影响

doi:10.3877/cma.j.issn.2095-123X.2023.05.005

目的

探讨体外冲击波治疗（ESWT）联合肌电生物反馈治疗（EMG-BFT）对脑卒中后足下垂的影响。

方法

选取恩施土家族苗族自治州中心医院康复医学科自2019年5月至2022年5月收治的90例脑卒中后足下垂患者，按照随机数字表法分为观察组、BFT组和对照组，每组30例。对照组患者接受常规康复治疗，BFT组在对照组基础上接受EMG-BFT，观察组在对照组基础上采用ESWT联合EMG-BFT，3组患者均治疗4周。3组患者分别在治疗前及治疗4周后行踝关节背屈活动度、综合痉挛量表（CSS）和Fugl-Meyer运动功能量表下肢部分（FMA-LE）评定及表面肌电图测定，观察踝关节活动度、踝关节痉挛、下肢运动功能及关键肌表面肌电改善情况。

结果

3组患者治疗前踝关节活动度、CSS评分、FMA-LE评分、胫骨前肌iEMG、腓肠肌iEMG和足背屈CR比较，差异无统计学意义（P>0.05）。3组患者治疗后踝关节活动度、CSS评分、FMA-LE评分均较治疗前有明显改善，观察组和BFT组患者胫骨前肌iEMG、腓肠肌iEMG和足背屈CR结果均较治疗前有明显改善，且观察组踝关节活动度、CSS评分、胫骨前肌iEMG、足背屈CR优于BFT组和对照组，差异均有统计学意义（P<0.05）。

结论

联合运用ESWT和EMG-BFT治疗脑卒中后足下垂效果良好，可提高患侧踝关节主被动活动度，改善痉挛和下肢运动功能。

关键词: 体外冲击波, 肌电生物反馈, 脑卒中, 足下垂

Objective

To investigate the effect of extracorporeal shock wave therapy (ESWT) combined with electromyography biofeedback therapy (EMG-BFT) on foot drop after stroke.

Methods

Ninety patients with poststroke foot drop admitted to the Rehabilitation Medicine Department of Enshi Tujia and Miao Autonomous Prefecture Central Hospital from May 2019 to May 2022 were randomly divided into 3 group using a random number table method: observation group, BFT group, and control group, 30 patients in each group. The control group received routine rehabilitation treatment, the BFT group received EMG-BFT on the basis of the control group, and the observation group received ESWT combined with EMG-BFT on the basis of the control group. All 3 groups were treated for 4 weeks. The ankle dorsiflexion mobility, comprehensive spasticity scale (CSS) and Fugl-Meyer motor function scale lower extremity (FMA-LE) and surface electromyography were performed before and after 4 weeks of treatment for all patients. The improvement of ankle range of motion, ankle spasms, lower limb motor function, and key muscle surface electromyography were observed.

Results

The differences in ankle mobility, CSS score, FMA-LE score, anterior tibial muscle iEMG, gastrocnemius muscle iEMG and foot dorsiflexion CR before treatment in the 3 groups were not statistically significant (P>0.05). After treatment, ankle mobility, CSS score, and FMA-LE score in all three groups improved significantly compared with those before treatment (P<0.05); the results of tibialis anterior muscle iEMG, gastrocnemius muscle iEMG and foot dorsiflexion CR in patients in the observation group and BFT group improved significantly compared with those before treatment (P<0.05), and after treatment, the ankle mobility, CSS score, anterior tibialis iEMG, and foot dorsiflexion CR were better in the observation group than in the BFT group and the control group (P<0.05).

Conclusion

The combined use of ESWT and EMG-BFT was significantly more effective in improving the active and passive mobility of the affected ankle joint, improving spasticity, and improving motor function of the lower extremity than the absence of both treatments or the use of EMG-BFT alone.

Key words: Extracorporeal shock wave, Electromyography biofeedback, Stroke, Foot drop

表1 3组患者的一般资料比较

Tab.1 Comparison of general information among three groups

组别	例数	性别		年龄（岁，Mean±SD）	病程（d，Mean±SD）	病变部位		偏瘫侧别		Brunnstrom分期
组别	例数	男	女	年龄（岁，Mean±SD）	病程（d，Mean±SD）	脑梗死	脑出血	左侧	右侧	Brunnstrom分期
对照组	26	14	12	48.76±8.27	39.65±14.72	17	9	15	11	2.92±1.01
BFT组	30	21	9	48.87±10.29	38.43±13.52	16	14	16	14	3.13±0.86
观察组	29	17	12	49.86±9.79	35.76±14.35	18	11	13	16	3.24±0.87
χ²/F值		1.651		0.114	0.551	0.921		0.954		0.851
P值		0.438		0.892	0.579	0.631		0.621		0.431

表1 3组患者的一般资料比较

Tab.1 Comparison of general information among three groups

组别	例数	性别		年龄（岁，Mean±SD）	病程（d，Mean±SD）	病变部位		偏瘫侧别		Brunnstrom分期
组别	例数	男	女	年龄（岁，Mean±SD）	病程（d，Mean±SD）	脑梗死	脑出血	左侧	右侧	Brunnstrom分期
对照组	26	14	12	48.76±8.27	39.65±14.72	17	9	15	11	2.92±1.01
BFT组	30	21	9	48.87±10.29	38.43±13.52	16	14	16	14	3.13±0.86
观察组	29	17	12	49.86±9.79	35.76±14.35	18	11	13	16	3.24±0.87
χ²/F值		1.651		0.114	0.551	0.921		0.954		0.851
P值		0.438		0.892	0.579	0.631		0.621		0.431

表2 3组患者治疗前后踝关节主动活动度比较（°，Mean±SD）

Tab.2 Comparison of ankle joint active range of motion before and after treatment among 3 groups (°, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	10.85±2.57	13.69±2.23	-4.341	<0.001
BFT组	30	10.57±2.49	17.10±2.69^a	-10.919	<0.001
观察组	29	10.31±3.22	20.14±2.60^ab	-12.050	<0.001
F值		0.254	53.110
P值		0.776	<0.001

表2 3组患者治疗前后踝关节主动活动度比较（°，Mean±SD）

Tab.2 Comparison of ankle joint active range of motion before and after treatment among 3 groups (°, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	10.85±2.57	13.69±2.23	-4.341	<0.001
BFT组	30	10.57±2.49	17.10±2.69^a	-10.919	<0.001
观察组	29	10.31±3.22	20.14±2.60^ab	-12.050	<0.001
F值		0.254	53.110
P值		0.776	<0.001

表3 3组患者治疗前后踝关节被动活动度比较（°，Mean±SD）

Tab.3 Comparison of passive ankle range of motion before and after treatment among 3 groups (°, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	48.38±5.43	52.35±3.37	-3.357	0.003
BFT组	30	49.47±4.54	56.27±2.77^a	-7.597	<0.001
观察组	29	50.17±4.17	59.69±3.44^ab	-12.520	<0.001
F值		0.996	36.176
P值		0.374	<0.001

表3 3组患者治疗前后踝关节被动活动度比较（°，Mean±SD）

Tab.3 Comparison of passive ankle range of motion before and after treatment among 3 groups (°, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	48.38±5.43	52.35±3.37	-3.357	0.003
BFT组	30	49.47±4.54	56.27±2.77^a	-7.597	<0.001
观察组	29	50.17±4.17	59.69±3.44^ab	-12.520	<0.001
F值		0.996	36.176
P值		0.374	<0.001

表4 3组患者治疗前后综合痉挛量表评分比较（分，Mean±SD）

Tab.4 Comparison of comprehensive spasticity scale scores before and after treatment among 3 groups (score, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	11.42±1.30	9.27±1.66	5.943	<0.001
BFT组	30	11.54±1.98	7.57±2.46^a	6.723	<0.001
观察组	29	11.72±1.65	5.76±2.01^ab	11.991	<0.001
F值		0.221	17.318
P值		0.802	<0.001

表4 3组患者治疗前后综合痉挛量表评分比较（分，Mean±SD）

Tab.4 Comparison of comprehensive spasticity scale scores before and after treatment among 3 groups (score, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	11.42±1.30	9.27±1.66	5.943	<0.001
BFT组	30	11.54±1.98	7.57±2.46^a	6.723	<0.001
观察组	29	11.72±1.65	5.76±2.01^ab	11.991	<0.001
F值		0.221	17.318
P值		0.802	<0.001

表5 3组患者治疗前后Fugl-Meyer运动功能量表下肢部分评分比较（分，Mean±SD）

Tab.5 Comparison of lower extremity portion of the Fugl-Meyer motor assessment scores before and after treatment among 3 groups (score, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	18.85±2.56	23.58±3.04	-4.771	<0.001
BFT组	30	19.40±3.96	26.01±2.19^a	-8.399	<0.001
观察组	29	18.83±3.85	27.17±3.22^a	-8.221	<0.001
F值		0.213	11.336
P值		0.808	<0.001

表5 3组患者治疗前后Fugl-Meyer运动功能量表下肢部分评分比较（分，Mean±SD）

Tab.5 Comparison of lower extremity portion of the Fugl-Meyer motor assessment scores before and after treatment among 3 groups (score, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	18.85±2.56	23.58±3.04	-4.771	<0.001
BFT组	30	19.40±3.96	26.01±2.19^a	-8.399	<0.001
观察组	29	18.83±3.85	27.17±3.22^a	-8.221	<0.001
F值		0.213	11.336
P值		0.808	<0.001

表6 3组患者治疗前后胫骨前肌最大积分肌电值比较（μV，Mean±SD）

Tab.6 Comparison of tibialis anterior muscle integral electromyography signal before and after treatment among 3 groups (μV, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	53.86±13.33	57.97±18.50	-0.974	0.339
BFT组	30	52.78±16.32	84.17±14.50^a	-8.591	<0.001
观察组	29	48.06±16.09	102.39±14.22^ab	-15.383	<0.001
F值		1.132	54.875
P值		0.328	<0.001

表6 3组患者治疗前后胫骨前肌最大积分肌电值比较（μV，Mean±SD）

Tab.6 Comparison of tibialis anterior muscle integral electromyography signal before and after treatment among 3 groups (μV, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	53.86±13.33	57.97±18.50	-0.974	0.339
BFT组	30	52.78±16.32	84.17±14.50^a	-8.591	<0.001
观察组	29	48.06±16.09	102.39±14.22^ab	-15.383	<0.001
F值		1.132	54.875
P值		0.328	<0.001

表7 3组患者治疗前后腓肠肌最大积分肌电值比较（μV，Mean±SD）

Tab.7 Comparison of gastrocnemius muscle integral electromyography signal before and after treatment among 3 groups (μV, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	64.49±19.83	48.60±16.03	3.253	0.003
BFT组	30	60.19±16.77	38.53±12.31^a	6.486	<0.001
观察组	29	60.71±13.18	32.17±12.37^a	7.950	<0.001
F值		0.538	10.141
P值		0.587	<0.001

表7 3组患者治疗前后腓肠肌最大积分肌电值比较（μV，Mean±SD）

Tab.7 Comparison of gastrocnemius muscle integral electromyography signal before and after treatment among 3 groups (μV, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	64.49±19.83	48.60±16.03	3.253	0.003
BFT组	30	60.19±16.77	38.53±12.31^a	6.486	<0.001
观察组	29	60.71±13.18	32.17±12.37^a	7.950	<0.001
F值		0.538	10.141
P值		0.587	<0.001

表8 3组患者治疗前后踝关节背屈协同收缩率比较（%，Mean±SD）

Tab.8 Comparison of co-contraction ration of ankle dorsiflexion before and after treatment among 3 groups (%, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	48.96±4.01	45.03±3.15	4.456	<0.001
BFT组	30	47.21±4.16	41.47±4.36^a	5.086	<0.001
观察组	29	49.07±3.31	34.36±4.31^ab	17.048	<0.001
F值		2.143	50.909
P值		0.128	<0.001

表8 3组患者治疗前后踝关节背屈协同收缩率比较（%，Mean±SD）

Tab.8 Comparison of co-contraction ration of ankle dorsiflexion before and after treatment among 3 groups (%, Mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	26	48.96±4.01	45.03±3.15	4.456	<0.001
BFT组	30	47.21±4.16	41.47±4.36^a	5.086	<0.001
观察组	29	49.07±3.31	34.36±4.31^ab	17.048	<0.001
F值		2.143	50.909
P值		0.128	<0.001

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Effect of extracorporeal shock wave combined with myoelectric biofeedback on foot drop after stroke

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Effect of extracorporeal shock wave combined with myoelectric biofeedback on foot drop after stroke