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中华脑科疾病与康复杂志(电子版) ›› 2025, Vol. 15 ›› Issue (01) : 21 -25. doi: 10.3877/cma.j.issn.2095-123X.2025.01.004

临床研究

脑卒中偏瘫患者支撑期下肢肌肉协同收缩与肢体功能状况的相关性
葛苹苹1, 曹晓光1, 陈露萍1, 袁海1,()   
  1. 1. 230011 合肥市第二人民医院康复医学科
  • 收稿日期:2024-10-29 出版日期:2025-02-15
  • 通信作者: 袁海
  • 基金资助:
    合肥市科技攻关计划(自筹)项目(合科〔2017〕3号)

Correlation between co-contraction of lower limb muscles and limb function in stroke patients with hemiplegia during the stance phase of gait

Pingping Ge1, Xiaoguang Cao1, Luping Chen1, Hai Yuan1,()   

  1. 1. Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei 230011, China
  • Received:2024-10-29 Published:2025-02-15
  • Corresponding author: Hai Yuan
引用本文:

葛苹苹, 曹晓光, 陈露萍, 袁海. 脑卒中偏瘫患者支撑期下肢肌肉协同收缩与肢体功能状况的相关性[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(01): 21-25.

Pingping Ge, Xiaoguang Cao, Luping Chen, Hai Yuan. Correlation between co-contraction of lower limb muscles and limb function in stroke patients with hemiplegia during the stance phase of gait[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(01): 21-25.

目的

探讨脑卒中偏瘫患者支撑期下肢肌肉协同收缩率(CCR)与肢体功能状态的相关性。

方法

纳入合肥市第二人民医院康复医学科自2017年9月至2024年10月收治住院的55例脑卒中偏瘫患者进行回顾性分析,利用表面肌电计算偏瘫侧下肢支撑相足着地至膝关节最大伸展角度范围内的股直肌与股二头肌的CCR。采用Fugl-Meyer下肢功能评分(FMA)与Brunnstrom分期(BRS)评估下肢肢体功能,改良Ashworth评分(MAS)评估下肢肌张力;对CCR与FMA、BRS及MAS进行相关性分析。

结果

本组患者中BRS Ⅲ期10例、Ⅳ期24例、Ⅴ期19例、Ⅵ期2例。患侧下肢肌肉CCR(1.077±0.369)高于对侧(0.760±0.334),差异有统计学意义(P<0.05)。CCR与MAS呈正相关(r=0.347,P<0.05),与BRS(r=-0.913,P<0.05)及FMA(r=-0.916,P<0.05)呈负相关。

结论

CCR可定量评估脑卒中偏瘫患者下肢肢体功能状况及痉挛程度,可用于临床评估脑卒中偏瘫患者的肢体功能。

Objective

To explore the correlation between the co-contraction rate (CCR) of lower limb muscles during the stance phase in stroke hemiplegic patients and the limb function.

Methods

From September 2017 to October 2024, a total of 55 stroke hemiplegic patients admitted to the Rehabilitation Medicine Department of Hefei Second People's Hospital were iretrospectively analyzed. The CCR of rectus femoris (RF) and biceps femoris (BF) of the lower limb was computed in 55 stroke hemiplegic patients using surface electromyography between the initial foot strike and the peak of knee extension during the stance phase based on three-dimensional kinematic analysis. The Fugl-Meyer lower limb motor assessment (FMA)and Brunnstrom staging (BRS) were used to evaluate the lower limb function, and the modified Ashworth scale (MAS) was used to evaluate the muscle tone of hemiplegic lower limb; The correlation between CCR and FMA, BRS, MAS were analyzed.

Results

Among the patients in this group, there were 10 cases in stage BRS Ⅲ, 24 cases in stage Ⅳ, 19 cases in stage Ⅴ, and 2 cases in stage Ⅵ. The CCR of the involved extremity (1.077±0.369) was significantly higher than that of the uninvolved extremities (0.760±0.334) (P<0.05). A positive correlation between CCR and MAS (r=0.347, P<0.05), and negative correlation between CCR and BRS (r=-0.913, P<0.05) or FMA (r=-0.916, P<0.05) were observed during the stance phase of gait in hemiplegic stroke patients.

Conclusion

CCR can quantitatively evaluate the lower limb function status and spasm degree of patients with stroke hemiplegia, and can be used in clinical evaluation of the limb function of patients with stroke hemiplegia.

图1 支撑期足触地时BF和RF的肌电图信号 A:支撑期初始足触地的时间点;B:膝关节的运动角度;C:偏瘫步态中RF的肌电信号;D:偏瘫步态中BF的肌电信号;线a代表支撑期初始足触地的时间点;RF:股直肌;BF:肌二头肌;RL:右腿;LL:左腿(左侧偏瘫)
Fig.1 Electromyogram signals of the biceps femoris and rectus femoris during the initial foot strike of the stance phase
图2 支撑期膝关节伸展峰值时BF和RF的肌电图信号 A:支撑期膝关节伸展峰值的时间点;B:相应的膝关节运动角度;C:偏瘫步态中RF的肌电信号;D:偏瘫步态中BF的肌电信号;线b代表支撑期膝关节伸展峰值的时间点;RF:股直肌;BF:肌二头肌;RL:右腿;LL:左腿(左侧偏瘫)
Fig.2 Electromyogram signals of the biceps femoris and rectus femoris during the peak of knee extension of the stance phase
表1 不同Brunnstrom分期患者的CCR与FMA分布情况(Mean±SD
Tab.1 Distribution of CCR and FMA in different stages of Brunnstrom (Mean±SD
表2 CCR与MAS、BRS及FMA的相关性分析
Tab.2 Correlation analysis of CCR with MAS, BRS, and FMA
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