不同角速度下等速肌力训练治疗脑卒中膝过伸的临床观察

关键词：等速肌力训练  膝过伸  脑卒中  角速度

Keywords:isokinetic muscle strength training  knee hyperextension  stroke  angular velocity

摘要：

      摘要 目的：观察不同角速度等速肌力训练对脑卒中患者膝过伸的训练效果，探讨改善膝过伸的更优角速度参数。 方法：80例脑卒中膝过伸患者随机分为对照组、30°/s组、60°/s组和90°/s组，每组20例。对照组只接受常规康复治疗，其余3组在常规康复治疗基础上分别加上30°/s、60°/s和90°/s的患侧膝关节屈/伸等速肌力训练。治疗前和治疗3周后对患者伸膝肌群和屈膝肌群的峰力矩值（peak torque， PT）、峰力矩/体重比（peak torque/body weight， PT/BW）、平均肌电值（average electromyography， AEMG）和积分肌电值（integrated electromyographic， iEMG）、膝过伸有效率，以及下肢简化Fugl-Meyer运动功能评定量表（Fugl-Meyer assessment， FMA）进行疗效评定。 结果：治疗前，4组患者之间无显著性差异（P>0.05）。治疗3周后，4组患者伸膝肌群和屈膝肌群的PT值、PT/BW值、AEMG值、iEMG值以及下肢FMA评分均明显高于治疗前（P<0.01），且30°/s组、60°/s组和90°/s组均高于对照组（P<0.05），30°/s组和60°/s组均高于90°/s组（P<0.05），30°/s组和60°/s组之间无显著性差异（P>0.05）。此外，30°/s组和60°/s组的膝过伸有效率（85%）明显高于对照组（40%）（P<0.05），而90°/s组与对照组之间无显著性差异（P>0.05）。 结论：不同角速度的等速肌力训练，可以增加膝关节屈伸肌群的肌力，提高膝关节的控制能力，更好地改善脑卒中膝过伸问题。在角速度的选择上，宜选择低速角速度（≤60°/s），训练效果更优。

Abstract:

      Abstract Objective： To observe the effects of isokinetic muscle strength training at different angular velocities on knee hyperextension in patients after stroke， and to find out better angular velocity. Method： Eighty patients with knee hyperextension after stroke were randomly divided into four groups： the control group， 30°/s group， 60°/s group and 90°/s group， 20 cases in each group. The control group received only routine rehabilitation treatment， and the other three groups received an additional 30°/s， 60°/s or 90°/s isokinetic knee flexion/extension training besides the routine treatment, respectively. Before and 3 weeks after treatment， peak torque （PT）， peak torque to body weight ratio （PT/BW）， average electromyographic（AEMG） and integrated electromyographic（iEMG） of the extensor and flexor knee muscles， the effective rate of knee hyperextension and lower limb Fugl-Meyer motor function score （FMA） were measured. Result： Before treatment， there was no significant difference among the four groups （P>0.05）. After 3 weeks treatment， PT， PT/BW， AEMG， iEMG of the extensor and flexor knee muscles and FMA in four groups were significantly improved as compared with those before treatment（P<0.01）. Moreover， the improvement of evaluation results in the 30°/s group， 60°/s group and 90°/s group were higher than those in the control group （P<0.05）， and those in the 30°/s group and 60°/s group were higher than those in the 90°/s group（P<0.05）. However， no significant difference was found between 30°/s group and 60°/s group（P>0.05）. In addition， the effective rate of knee hyperextension in the 30°/s group or 60°/s group（85%） was significantly higher than that in the control group（40%）（P<0.05）， but there was no significant difference between the 90°/s group and the control group （P>0.05）. Conclusion： Isokinetic muscle strength training at different angular velocities can increase the muscle strength of knee flexors and extensors， improve the control ability of knee joint， and better improve knee hyperextension in patients after stroke. The lower angular velocity （≤60°/s） has a better effect.