本文選題：脊髓損傷　切入點(diǎn)：截癱　出處：《成都中醫(yī)藥大學(xué)》2013年碩士論文

【摘要】：目的：通過電針脛骨前肌運(yùn)動(dòng)點(diǎn)復(fù)合康復(fù)訓(xùn)練治療不完全性脊髓損傷患者,觀察患者脛骨前肌肌力改善的情況,驗(yàn)證電針運(yùn)動(dòng)點(diǎn)治療方案的有效性,為臨床治療不完全性脊髓損傷探索一種安全有效的新方案。 方法：本研究采用隨機(jī)對(duì)照試驗(yàn)設(shè)計(jì),納入24例不完全性脊髓損傷患者,48塊脛骨前肌。隨機(jī)分為觀察組和對(duì)照組,兩組均進(jìn)行常規(guī)康復(fù)治療,觀察組在此基礎(chǔ)上采用電針陽明經(jīng)穴加脛骨前肌運(yùn)動(dòng)點(diǎn),對(duì)照組采用電針陽明經(jīng)穴加脛骨前肌非運(yùn)動(dòng)點(diǎn)經(jīng)穴。電針、康復(fù)治療1次/日,10天為1個(gè)療程,連續(xù)治療3個(gè)療程。在試驗(yàn)開始時(shí)、治療10天后、治療20天后與完成療程后,均進(jìn)行ASIA分級(jí)評(píng)定、脛骨前肌徒手肌力評(píng)定(Manual muscle test, MMT)、踝關(guān)節(jié)主動(dòng)背屈關(guān)節(jié)活動(dòng)度(Range of motion, ROM)測量,肌電積分(Integrated electromyography, iEMG)評(píng)測。通過前后指標(biāo)對(duì)比,比較兩種治療方法對(duì)不完全性脊髓損傷患者脛骨前肌肌力的影響。 結(jié)果：兩組受試者組內(nèi)對(duì)比,脛骨前肌徒手肌力變化、踝關(guān)節(jié)背屈關(guān)節(jié)活動(dòng)度變化以及ASIA分級(jí)變化在治療10天、20天、30天時(shí)均無統(tǒng)計(jì)學(xué)意義(P0.05),兩組受試者組間對(duì)比,脛骨前肌徒手肌力變化、踝關(guān)節(jié)角度變化以及ASIA分級(jí)變化在治療10天、20天、30天時(shí)均無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組與對(duì)照組的脛骨前肌iEMG變化在治療10天、20天、30天時(shí),組內(nèi)及組間對(duì)比均有統(tǒng)計(jì)學(xué)意義(P0.05),觀察組結(jié)果優(yōu)于對(duì)照組(P0.05)。 結(jié)論： 1.電針脛骨前肌運(yùn)動(dòng)點(diǎn)復(fù)合康復(fù)訓(xùn)練可提高脛骨前肌肌力； 2.采用iEMG定量分析,能在功能活動(dòng)產(chǎn)生前精確評(píng)定單塊肌肉肌力變化； 3.電針脛骨前肌運(yùn)動(dòng)點(diǎn)的作用機(jī)制可能與通過有效的傳入刺激,啟動(dòng)任務(wù)依賴性可塑性,促進(jìn)中樞模式發(fā)生器重新激活脊髓神經(jīng)元回路重組有關(guān)。
[Abstract]:Objective: to observe the improvement of tibial anterior muscle muscle strength in patients with incomplete spinal cord injury by electroacupuncture combined rehabilitation training of anterior tibial muscle movement point, and to verify the effectiveness of electroacupuncture exercise point therapy. To explore a new safe and effective scheme for the treatment of incomplete spinal cord injury. Methods: Twenty-four patients with incomplete spinal cord injury (sci) were randomly divided into observation group (n = 48) and control group (n = 48). On this basis, the observation group was treated with electroacupuncture Yangming meridian plus tibial anterior muscle motility point, while the control group with electroacupuncture Yangming meridian plus tibial anterior muscle non-exercise point meridian. Electroacupuncture, rehabilitation therapy once a day for 10 days was used as a course of treatment. At the beginning of the trial, 10 days after the treatment, 20 days after the treatment and after the completion of the course of treatment, all patients were assessed with ASIA grade, manual muscle test with the assessment of the bare-handed muscle strength of the anterior tibia muscle, and the range of motion of ankle joint active dorsiflexion joint. The effects of two treatment methods on tibial anterior muscle strength in patients with incomplete spinal cord injury were compared by comparing the indexes before and after the evaluation of integrated electromyography (iEMG). Results: there was no significant difference in the muscle strength of the tibial anterior muscle, the range of motion of the dorsiflexion joint of the ankle and the ASIA grade between the two groups at 10 days, 20 days and 30 days after treatment (P 0.05), and there was no significant difference between the two groups. The changes of tibial anterior muscle strength, ankle angle and ASIA grade were not statistically significant at 10 days, 20 days and 30 days after treatment. The changes of iEMG of tibial anterior muscles in the observation group and the control group were observed on the 10th day, the 20th day, and the 30th day, respectively. The results of observation group were better than that of control group (P 0.05). Conclusion:. 1. Electroacupuncture combined rehabilitation training of tibial anterior muscle motor point can improve tibial anterior muscle strength; 2.The quantitative analysis of iEMG can accurately evaluate the muscle strength change of a single muscle before the functional activity. 3. The mechanism of electroacupuncture on the motor point of the anterior tibial muscle may be related to the activation of task-dependent plasticity through effective afferent stimulation and the promotion of reactivation of the spinal cord neuronal circuit by the central pattern generator.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R246.9

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