發(fā)布時間：2018-06-02 11:11

  本文選題：腦卒中 + 偏癱��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討不同足位對腦卒中偏癱患者坐站轉(zhuǎn)移時下肢負(fù)重及患側(cè)下肢肌肉電活動的影響。方法選取腦卒中偏癱康復(fù)醫(yī)學(xué)科住院患者30例,在雙足(both foots,BF)、足置后(paretic foot posterior,PFP)或非優(yōu)勢足置后(undominant foot posterior,UDFP)和健足置后(non-paretic foot posterior,NPFP)或優(yōu)勢足置后(dominant foot posterior,DFP)3種足位下完成坐-站轉(zhuǎn)移測試,采用JE-TB型肌電采集系統(tǒng)和AL-080型平衡功能訓(xùn)練評估系統(tǒng)對受試者患側(cè)下肢脛骨前肌(TA)、腓腸肌(GM)、股四頭肌(QUA)和乆繩肌(HMS)的表面肌電(sEMG)活動以及坐-站轉(zhuǎn)移的時間和雙下肢負(fù)重進(jìn)行測量,探討其不同差異以及它們之間的相關(guān)性。結(jié)果1.不同足位下完成坐-站轉(zhuǎn)移時下肢負(fù)重及表面肌電的參數(shù)比較:BF與PFP相比較,脛前肌iEMG、股四頭肌iEMG、肌肉活動時間、坐-站時間(s)、協(xié)同收縮率、WBasym具有明顯差異(P0.05);BF與NPFP相比較,腓腸肌收縮延遲時間、脛前肌iEMG、股四頭肌iEMG、肌肉活動時間、坐-站時間(s)、協(xié)同收縮率、WBasym具有明顯差異(P0.05);PFP與NPFP相比較,腓腸肌收縮延遲時間、脛前肌iEMG、股四頭肌iEMG、肌肉活動時間、坐-站時間(s)、協(xié)同收縮率、WBasym具有明顯差異(P0.05);剩余指標(biāo)差異不具有統(tǒng)計學(xué)意義(P0.05)。在PFP時,WBasym、脛前肌iEMG、股四頭肌iEMG值最大,協(xié)同收縮率最小,說明在此足位下,患側(cè)負(fù)重最多,對稱性最好,主動肌肌力最大,而肌痙攣最小;在NPFP時,肌肉活動時間和坐-站時間值最小,說明在此足位下,坐-站轉(zhuǎn)移完成最快;在NPFP時,WBasym值最小,協(xié)同收縮率最大,說明在此足位下,患側(cè)負(fù)重最小,而肌痙攣最大。2.不同足位下完成坐-站轉(zhuǎn)移時iEMG、協(xié)同收縮率與WBasym的相關(guān)性分析:在不同足位下完成坐-站轉(zhuǎn)移時iEMG與WBasym之間的相關(guān)性分析顯示:BF(r=0.423、p=0.00),PFP(r=0.950、p=0.00),NPFP(r=0.821、p=0.00),呈正相關(guān)性(詳見圖1-3),說明患側(cè)下肢負(fù)重增加,主動肌肌力增大;協(xié)同收縮率與WBasym之間的相關(guān)性分析顯示:BF(r=-0.889、p=0.00),PFP(r=-0.901、p=0.00),NPFP(r=-0.863、p=0.00),協(xié)同收縮率與WBasym之間呈高度負(fù)相關(guān)性(詳見圖4-6),說明患側(cè)下肢負(fù)重最少,而患側(cè)下肢肌肉痙攣最大。結(jié)論1.腦卒中偏癱患者在坐-站轉(zhuǎn)移時,足位變化引起患者雙下肢負(fù)重的對稱性發(fā)生改變。健足置后時腦卒中偏癱患者患側(cè)負(fù)重最小,而肌痙攣最大,有利于提高坐-站轉(zhuǎn)移的穩(wěn)定性;患足置后時偏癱患者患側(cè)下肢負(fù)重最大,患側(cè)負(fù)重最多,對稱性最好,主動肌肌力最大,而肌痙攣最小,有利患側(cè)下肢肌肉功能的恢復(fù)。2.腦卒中偏癱患者在足位置改變下完成坐-站轉(zhuǎn)移時患側(cè)下肢負(fù)重與患側(cè)下肢主動肌呈正相關(guān)性,患側(cè)下肢負(fù)重增加,主動肌肌力增大;而患側(cè)下肢拮抗肌與患側(cè)下肢負(fù)重呈高度負(fù)相關(guān)性,說明患側(cè)下肢負(fù)重最少,而患側(cè)下肢肌肉痙攣最大。
[Abstract]:Objective to investigate the effects of different foot positions on lower extremity load and muscle electrical activity in stroke patients with hemiplegia. Methods Thirty inpatients with stroke hemiplegia in the department of rehabilitation medicine of hemiplegia were selected to complete sit-station transfer tests in 3 kinds of podocytes: bipedal both footsm, posteriorus (PFP) or undominant foot posteriorus (UDFPP) and non-paretic foot posteriorFP (NPFP) or dominant foot posteriorus (DFPN). The surface electromyography (EMG) activity and the time of sit-station transfer, as well as the time of sit-station transfer, were evaluated by using the JE-TB electromyography acquisition system and the AL-080 balance function training system for the surface electromyography (SEMG) activity and sit-station transfer of the affected lower extremity tibial anterior muscles, gastrocnemius, quadriceps femoris (QUAA) and human chorda. The weight of the lower extremities was measured, To explore their different differences and their correlation. Result 1. Comparison of the parameters of lower extremity load and surface myoelectric activity during sit-station transfer under different foot positions: compared with PFP, the anterior tibialis muscle, quadriceps femoris muscle, muscle activity time, sit-station time and co-contraction rate of WBasym were significantly different compared with NPFP. Delayed contraction time of gastrocnemius muscle, iEMG of anterior tibial muscle, iEMG of quadriceps femoris, time of muscle activity, time of sitting and standing, cocontraction rate of WBasym were significantly different. Compared with NPFP, delayed contraction time of gastrocnemius muscle, iEMG of tibial anterior muscle, iEMG of quadriceps femoris, time of muscle activity, The co-contraction rate of WBasym was significantly different (P < 0.05), but the difference of the remaining indexes was not statistically significant (P 0.05). In PFP, the iEMG value of anterior tibial muscle and quadriceps femoris muscle were the largest, and the co-contraction rate was the lowest, which indicated that, in this position, the affected side had the most load, the symmetry was the best, the muscle strength of the active muscle was the largest, and the muscle spasm was the least; in the case of NPFP, the muscle strength of the affected side was the largest, and the muscle spasm was the least. Muscle activity time and sit-station time were the smallest, which indicated that sit-station transfer was the fastest in this position, and WBasym was the smallest and the cooperative contraction rate was the largest at NPFP, indicating that the affected side had the smallest load and the muscle spasm was the largest at this position. Analysis of the correlation between WBasym and iEMG when the sit-station transfer was completed under different foot positions: the correlation analysis between iEMG and WBasym showed that there was a positive correlation between iEMG and WBasym in different foot positions (see figure 1-3, showing that the lower extremity load of the affected side increased, and the weight of the lower extremity of the affected side was increased, as shown in Fig. 1-3), which showed that there was a positive correlation between iEMG and WBasym when the sit-station transfer was completed under different foot positions (see Fig. 1-3, for more details, the weight of the lower extremities of the affected side was increased, as shown in Fig. 1-3, which indicated that the weight of the affected lower extremities increased. The analysis of the correlation between the co-contraction rate and WBasym showed that the cocontraction rate was significantly negative correlated with WBasym, but the muscle spasm of the lower extremity was the largest in the affected side (Fig. 4-6), but the muscle spasm of the lower extremity was the largest in the affected side (Fig. 4-6 for further details, the correlation between the co-contractile rate and the WBasym was higher than that in the control group), and there was a high negative correlation between the co-contraction rate and the WBasym (Fig. 4-6, which indicated that the affected side had the least load and the lower extremity spasm was the largest.) Conclusion 1. When stroke hemiplegia patients transfer from sitting to station, the symmetry of lower extremity load is changed due to the change of foot position. After foot placement, hemiplegia patients with stroke had the smallest load and the largest muscle spasm, which was beneficial to improve the stability of sit-station transfer, while the hemiplegic patients had the largest lower extremity load, the most affected side weight and the best symmetry. The muscle strength of the active muscle was the largest and the muscle spasm was the smallest, which was beneficial to the recovery of muscle function of the affected side. There was a positive correlation between the load of lower extremity and the active muscle of lower extremity in stroke patients with hemiplegia under the change of foot position, and the muscle strength of active muscle increased with the increase of load on the affected side of lower extremity. However, there was a high negative correlation between the antagonistic muscle of the affected side and the load of the affected side, which indicated that the affected side had the least load, while the muscle spasm of the affected side was the largest.
【學(xué)位授予單位】：安徽醫(yī)科大學(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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