基于超声评估冲击波治疗卒中后下肢痉挛患者的疗效研究

关键词：脑卒中  痉挛  径向体外冲击波疗法  超声

Keywords:stroke  spasticity  radial extracorporeal shock wave therapy  ultrasound

摘要：

      摘要 目的：探讨超声成像量化评估径向体外冲击波疗法（rESWT）缓解脑卒中后偏瘫患者肌肉痉挛的疗效及应用。 方法：2022年12月—2023年8月，本院初次脑卒中后下肢偏瘫患者40例，试验组（n=22）进行常规康复联合rESWT治疗，对照组（n=18）进行常规康复治疗，在治疗前及治疗两周后分别评估患者患侧小腿三头肌的改良Ashworth（MAS）分级、下肢Brunnstrom分期、 Fugl-Meyer运动功能评分及其血液肌酸激酶值（CK）值，并使用超声成像技术记录腓肠肌外侧头的羽状角（PA）、肌肉厚度（MT）及肌纤维长度（FL）。 结果：治疗后两组患者小腿三头肌的MAS及下肢Fugl-Meyer评分，腓肠肌外侧头的PA差异具有显著性意义（P<0.05）；治疗后两组患者的Brunnstrom评分、CK值、腓肠肌外侧头的MT、FL差异无显著性意义（P>0.05）。 结论：rESWT可有效缓解卒中后下肢痉挛患者的肌张力障碍及其肢体运动功能；其改善痉挛的机制可能是通过改变肌肉的结构参数进而降低肌痉挛。

Abstract:

      Abstract Objective： To explore the efficacy and application of ultrasound imaging quantitative assessment for rESWT in relieving spasticity in hemiplegia patients after stroke. Method： From December 2022 to August 2023， 40 patients with lower limb hemiplegia after initial stroke were enrolled. The test group （n=22） received conventional rehabilitation combined with rESWT.The control group（n=18） received conventional rehabilitation. The modified Ashworth scale （MAS）， Brunnstrom stage， Fugl-Meyer motor function score and blood creatine kinase （CK） value were evaluated before and after two weeks treatment. The muscle thickness （MT） and length of muscle fibers （FL） of lateral gastrocnemius were recorded using ultrasound imaging technique. Result： After treatment， there was significant difference in MAS score of triceps calf， Fugl-Meyer score of lower limb and PA of lateral head of gastrocnemius muscle between the two groups （P<0.05）. However, there was no significant difference in Brunnstrom stage， CK value， MT and FL of lateral head of gastrocnemius muscle between the two groups after treatment. Conclusion： The rESWT can effectively relieve dystonia and limb movement function in patients after stroke, and the mechanism of improving spasm may be related to the change of muscle structural parameters.