肌肉振动治疗配合常规康复对脑卒中后肩-手综合征的临床效果观察

关键词：肌肉振动治疗  脑卒中  肩-手综合征  随机对照试验

Keywords:muscle vibration therapy  shoulder-hand syndrome  stroke  randomized controlled trial

摘要：

      摘要 目的：探讨3周肌肉振动治疗结合常规康复方案对脑卒中后肩-手综合征（SHS）的临床疗效。 方法：将60例患者随机分为振动与常规康复结合组（试验组，20例）、振动组（对照组A组，20例）、常规组（对照组B组,20例），肌肉振动治疗由经过专门培训的治疗师进行，每次用时20 min，每日治疗1次，每周治疗5天，持续治疗3周。干预前后采用肩-手综合征评分标准 对患手及腕关节疼痛、肿胀及患侧肱骨关节活动度进行评定，同时采用手及腕部Fugl—Meyer评分法（0—24分）对患手及腕功能进行评定。 结果：干预前各组基线值无显著意义差别（P>0.05）。三组SHS疼痛、肿胀得分均有所降低（P<0.05），Fugl-Meyer评分提高（P<0.05）。组内对比，干预后结合组及振动组肱骨外展及肱骨外旋得分有所降低（P<0.05），常规组无明显变化（P>0.05）。三组组间比较，干预后结合组SHS疼痛、肿胀,肱骨外展及肱骨外旋得分较常规组低（P<0.05）；Fugl-Meyer评分(FMA)较两对照组高（P<0.05）；结合组疼痛、肿胀得分较振动组低（P<0.05）；结合组肱骨外旋及外展得分与振动组无明显差异（P>0.05）。干预后两对照组SHS疼痛、肿胀、肱骨外展、肱骨外旋及Fugl-Meyer评分得分无明显差异（P>0.05）。试验过程中不良反应轻微而且短暂。 结论：肌肉振动治疗结合常规康复可以更加有效地减轻脑卒中后肩-手综合征的肿胀、疼痛症状，促进手及腕部功能恢复；肌肉振动治疗可以扩大肱骨外展及外旋活动度；肌肉振动治疗的可接受性强，刺激过程中未见明显不良反应。

Abstract:

      Abstract Objective: To discuss the clinical efficacy of muscle vibration therapy combined with conventional intervention treating shoulder-hand syndrome after stroke． Method: Sixty patients were randomly divided into three groups receiving conventional interventions coupled with muscle vibration therapy (combined group, study group, 20 cases) or single muscle vibration therapy (control group, 20 cases) or single conventional interventions (control group, 20 cases). Muscle vibration therapy was performed by specially trained therapists, 20 minutes per day, five times per week for 3 consecutive weeks. After the intervention, the efficacy of treatments was assessed with Shoulder-Hand Syndrome (SHS) Score and Fugl-Meyer scale for wrist/hand (0 to 24). Result：There were no significant differences among groups at baseline. After intervention, the three groups showed lower SHS scores including pain, edema, and higher Fugl-Meyer scale（P<0.05） than those before intervention. Compared with pre-intervention，both combined group and muscle vibration therapy group showed lower SHS scores including abduction and external rotation of humerus, while conventional group showed no significant difference（P>0.05）. Compared to conventional group, combined group showed better performance in terms of all the outcomes (P<0.05). Compared to muscle vibration therapy group, combined group showed lower SHS scores including pain, edema, and higher Fugl-Meyer scale（P<0.05）. Abduction of humerus，external rotation of humerus showed no significant difference between muscle vibration therapy group and combined group（P>0.05）.After intervention, SHS scores including pain, edema, abduction of humerus，external rotation of humerus and Fugl-Meyer scale showed no significant difference between the two control groups（P>0.05）. The most common side-effect in combined group and muscle vibration therapy group was transient numbness, which disappeared in few minutes. Conclusion：Muscle vibration therapy coupled with conventional intervention could relieve pain, edema and improve the function of wrist and hand. Muscle vibration therapy could improve shoulder range of abduction and external rotation of humerus.