本文選題：腦卒中 + 手功能障礙��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:手功能支具作為一種操作簡便成本低廉的康復(fù)干預(yù)手段已經(jīng)在臨床上得到應(yīng)用,本研究針對腦卒中后手功能障礙恢復(fù)期的患者(2周病程1年),應(yīng)用自主研發(fā)的伸展位手功能支具,觀察其在腕手功能恢復(fù)過程中的作用,評價患者腕手功能恢復(fù)水平,評估功能恢復(fù)預(yù)后情況。方法:招募符合入組標準的46例腦卒中后手功能障礙患者,隨機分配到試驗組(21例,脫落2例)和對照組(22例,脫落1例),兩組均接受每周5次,共4周的基礎(chǔ)康復(fù)治療;試驗組在基礎(chǔ)康復(fù)治療以外的時間,佩戴手功能支具維持,每天不低于8小時,每周7天,共4周的康復(fù)干預(yù)。分別于干預(yù)前、干預(yù)2周、干預(yù)4周,采用改良Ashworth分級法評分(MAS)、改良巴氏指數(shù)(MBI)、Fug1-Meyer上肢運動功能評定(FMA-UE)三組量表評估手部肌肉痙攣情況、日常生活能力、上肢運動功能改善情況;另運用美國NORAXON公司生產(chǎn)的Desktop DTS型16導(dǎo)聯(lián)表面肌電圖遙測儀,結(jié)合專用肌電信號處理軟件MyoResearch XP Basic edition 3.8.20采集并記錄腕關(guān)節(jié)屈伸肌、大魚際肌、四指伸肌等相關(guān)肌肉收縮時的表面肌電信號,提取均方根值RMS和最大振幅MAX進行比較。所有試驗數(shù)據(jù)應(yīng)用SPSS19.0統(tǒng)計軟件進行統(tǒng)計分析,計數(shù)資料采用卡方檢驗顯著性,前后三次測量數(shù)據(jù)采用重復(fù)測量方差分析,對重復(fù)測量變量進行組內(nèi)比較和組間比較,并檢驗顯著性。在此基礎(chǔ)上,進一步探索量表評分和sEMG值在各組中的增長趨勢。結(jié)果:(1)試驗組和對照組MAS、MBI、FMA-UE量表評分,三次重復(fù)測量組內(nèi)比較均有統(tǒng)計學(xué)差異(P0.001),MAS、MBI和FMA-UE組間比較無統(tǒng)計學(xué)差異(P0.05);(2)腕屈肌、腕伸肌、大魚際肌、指伸肌sEMG的RMS值和MAX值,三次重復(fù)測量組內(nèi)比較均有統(tǒng)計學(xué)差異(P0.001),但組間比較無統(tǒng)計學(xué)差異(P0.05);(3)試驗組應(yīng)用手功能支具后療程內(nèi)FMA-UE量表評分為指標的改善趨勢,腕伸肌、大魚際肌和指伸肌的肌電數(shù)據(jù)sEMG值增長率(△ RMS以及△ MAX斜率)均顯著優(yōu)于對照組(P0.05)。結(jié)論:(1)兩組中療程因素對腦卒中后腕手的痙攣水平恢復(fù)、日常生活活動能力提高和上肢運動功能提高均有影響;(2)兩組中療程因素對腕屈肌、腕伸肌、大魚際肌、指伸肌的康復(fù)療效有明顯影響;(3)手工能支具相比常規(guī)康復(fù)在4周療程終點的量表評分和肌電指標上沒有顯著的改善;(4)手功能支具在康復(fù)早期階段介入可能使患者上肢運動能力得到更快恢復(fù),對促進腕伸肌、大魚際肌、指伸肌的肌力康復(fù)也可能具有一定作用。
[Abstract]:Objective: as a simple and low-cost rehabilitation intervention, hand functional bracing has been applied in clinic. The purpose of this study was to evaluate the recovery level of wrist and hand function in patients with hand dysfunction after stroke by using the extended hand functional support developed by ourselves, and observing its role in the recovery of wrist and hand function, in order to evaluate the recovery level of wrist and hand function, and to evaluate the recovery level of wrist and hand function in patients with hand dysfunction. To evaluate the prognosis of functional recovery. Methods: 46 patients with hand dysfunction after stroke were recruited and randomly assigned to the experimental group (21 cases) and the control group (22 cases) and the control group (1 case). The two groups received basic rehabilitation therapy 5 times a week for 4 weeks. After basic rehabilitation treatment, the experimental group wore manual functional braces and maintained them for not less than 8 hours a day, 7 days a week, a total of 4 weeks of rehabilitation intervention. Before the intervention, 2 weeks and 4 weeks, the modified Ashworth grading method was used to evaluate the muscle spasm of the hand, the activity of daily living and the improvement of the motor function of the upper limb. In addition, the Desktop DTS type 16 lead surface electromyography telemeter produced by NORAXON Company was used to collect and record the wrist flexion and extensor muscle, thenar muscles, combined with the special EMG processing software MyoResearch XP Basic edition 3.8.20. The surface electromyography (EMG) signals of four finger muscles such as extensor digitorum were extracted and compared with maximum amplitude MAX (MAX) and root mean square (RMS). All the test data were analyzed by SPSS19.0 statistical software. The counting data were statistically significant by chi-square test, and repeated measurement variance analysis was used before and after three times of measurement, and intra-group and inter-group comparisons of repeated measurement variables were carried out. And test the significance. On this basis, further explore the growth trend of scale score and sEMG value in each group. Results there was no significant difference in the scores of MAS-MBII-UE scale between the test group and the control group. The RMS and MAX values of sEMG of flexor carpi, extensor carpal muscle, thenar extensor muscle, extensor digitorum muscle and extensor digitorum group were not significantly different between the two groups. There were statistical differences in the three repeated measurement groups (P 0.001), but there was no statistical difference between the two groups (P 0.05). In the test group, the improvement trend of FMA-UE scale after the treatment course of hand function support was the improvement trend, the extensor carpi muscle was improved. The sEMG growth rate (RMS and MAX slope) of thenar muscle and extensor digitorum muscle were significantly higher than that of control group (P 0.05). Conclusion (1) the therapeutic factors in the two groups have an effect on the recovery of spasticity of wrist and hand, the improvement of activities of daily living and the improvement of motor function of upper extremities after stroke.) in the two groups, the factors of course of treatment on flexor carpi muscle, extensor carpi muscle, thenar muscle were significantly affected. The curative effect of extensor digitorum muscle rehabilitation was significantly affected. (3) compared with the conventional rehabilitation, there was no significant improvement on the score and electromyography index of the end of the 4-week course of rehabilitation.) the intervention of the functional support of the hand in the early stage of rehabilitation may cause the patients to get involved. Faster recovery of upper limb movement, It may also play a role in promoting muscle strength rehabilitation of wrist extensor muscle, thenar muscle and extensor digitorum muscle.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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