【摘要】：目的：觀察不同低頻穴位電刺激方法對(duì)中風(fēng)后踝背屈障礙患者步行能力的影響,并對(duì)踝關(guān)節(jié)主動(dòng)背屈活動(dòng)度與步行能力之間的關(guān)系進(jìn)行探討,優(yōu)化治療方案,為提高臨床療效提供有力依據(jù)。方法：選擇符合納入標(biāo)準(zhǔn)的中風(fēng)后踝背屈障礙患者60例,隨機(jī)分為對(duì)照組與治療組,每組各30例。兩組患者均接受常規(guī)治療。對(duì)照組接受常規(guī)低頻穴位電刺激治療,選取患側(cè)足三里、陽(yáng)陵泉,采用斷續(xù)波(斷續(xù)比1：1),頻率為50Hz,每次20分鐘,每日1次,治療6天,休息1天,共治療4周；治療組接受屈伸肌交替低頻穴位電刺激治療,選取患側(cè)足三里、陽(yáng)陵泉、飛揚(yáng)、昆侖,電刺激的波形、頻率、治療時(shí)間、治療頻率、療程均與對(duì)照組相同。分別在療前與療后使用RM Gait步態(tài)分析系統(tǒng)對(duì)兩組患者的步行能力進(jìn)行評(píng)價(jià),并對(duì)踝關(guān)節(jié)最大主動(dòng)背屈角度及下肢Fulg-Meyer評(píng)分進(jìn)行測(cè)定。利用SPSS 230統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行處理與分析。結(jié)果：1.兩組患者療后的步速、步頻、患側(cè)步長(zhǎng)較療前差異均非常顯著(P0.01),兩組患者步速、步頻、患側(cè)步長(zhǎng)的差值組間差異有顯著性意義(P0.05),治療組優(yōu)于對(duì)照組。2.兩組患者療后患側(cè)單支撐相占步態(tài)周期百分比、雙支撐相占步態(tài)周期百分比較療前差異均非常顯著(P0.01),兩組患者患側(cè)單支撐相占步態(tài)周期百分比、雙支撐相占步態(tài)周期百分比的差值組間差異有顯著性意義(P0.05),治療組優(yōu)于對(duì)照組。3.兩組患者療后患側(cè)踝關(guān)節(jié)最大主動(dòng)背屈角度、下肢Fulg-Meyer評(píng)分較療前差異均非常顯著(P0.01),兩組患者患側(cè)踝關(guān)節(jié)最大主動(dòng)背屈角度的差值組間差異有顯著性意義(P0.05),兩組患者下肢Fulg-Meyer評(píng)分的差值組間差異非常顯著(P0.01),治療組優(yōu)于對(duì)照組。4.兩組患者患側(cè)踝關(guān)節(jié)最大主動(dòng)背屈角度的差值與步速、步頻、患側(cè)步長(zhǎng)、患側(cè)單支撐相占步態(tài)周期百分比、雙支撐相占步態(tài)周期百分比的差值的相關(guān)性分析P值均小于0.01,提示患側(cè)踝關(guān)節(jié)最大主動(dòng)背屈角度的差值與步速、步頻、患側(cè)步長(zhǎng)、患側(cè)單支撐相占步態(tài)周期百分比、雙支撐相占步態(tài)周期百分比的差值相關(guān)。結(jié)論：1.屈伸肌交替低頻穴位電刺激與常規(guī)低頻穴位電刺激均能改善中風(fēng)后踝背屈障礙,對(duì)中風(fēng)后踝背屈障礙患者步行能力的提升療效顯著；2.屈伸肌交替低頻穴位電刺激對(duì)改善中風(fēng)后踝背屈障礙療效優(yōu)于常規(guī)低頻穴位電刺激；3.踝背屈功能在維持下肢負(fù)重、步行的平衡與穩(wěn)定性方面有著重要的作用,是影響步行能力的重要因素。
[Abstract]:Objective: to observe the effect of different low frequency acupoint electrical stimulation on walking ability of patients with ankle dorsoflexion disorder after stroke, and to explore the relationship between active dorsiflexion activity and walking ability of ankle joint, and to optimize the treatment scheme. In order to improve the clinical efficacy to provide a strong basis. Methods: 60 patients with malleolus dorsiflexion were randomly divided into control group and treatment group with 30 cases in each group. Both groups received routine treatment. The control group was treated with conventional low frequency acupoint electrical stimulation. Zusanli and Yanglingquan of affected side were treated with intermittent wave (intermittent ratio of 1:1), frequency was 50 Hz, every time was 20 minutes, once a day, treatment for 6 days, rest for 1 day, a total of 4 weeks; The treatment group was treated with alternating low frequency electric stimulation of flexor and extensor muscle. The waveform, frequency, treatment time, treatment frequency and course of treatment were the same as those of the control group in Zusanli, Yanglingquan, Feiyang, Kunlun and electric stimulation groups. The walking ability of the two groups was evaluated by RMGait gait analysis system before and after treatment, and the maximum active dorsiflexion angle of ankle joint and the Fulg-Meyer score of lower extremity were measured. SPSS 230 statistical software was used to process and analyze the data. The result is 1: 1. There were significant differences in step speed, frequency and length of the affected side between the two groups (P0.01). There were significant differences between the two groups (P0.05), the treatment group was better than the control group. 2. There were significant differences between the two groups in the percentage of gait cycle and the percentage of double support phase in gait cycle after treatment (P0.01), and the percentage of the affected unilateral support phase in gait cycle was significant (P0.01). There was significant difference in the percentage of double support phase in gait cycle between groups (P0.05), the treatment group was better than the control group. 3. The maximum active dorsiflexion angle of ankle joint of the two groups after treatment, Fulg-Meyer score of lower extremity was significantly different from that before treatment (P0.01). There was significant difference in the difference of the maximal active dorsiflexion angle between the two groups (P0.05). The difference of Fulg-Meyer score between the two groups was very significant (P0.01). The treatment group was better than the control group (P0.01). The difference between the maximum active dorsiflexion angle of the ankle joint of the two groups and the step speed, step frequency, the length of the affected side, the percentage of the affected side single bracing phase to the gait cycle, Correlation Analysis of the percentage of double bracing Phase in gait cycle P < 0.01, indicating that the difference between the maximum active dorsiflexion angle of the affected ankle joint and the step speed, step frequency, step length of the affected side, and the percentage of the single bracing phase of the affected side to the gait cycle, the ratio of the maximum active dorsiflexion angle of the affected ankle to the gait cycle. The difference between double bracing phase and gait cycle percentage is correlated. Conclusion 1. Alternately low frequency acupoint electrical stimulation of flexion and extensor muscle and conventional low frequency acupoint electrical stimulation can improve the ankle dorsoflexion disorder after stroke, and the effect on walking ability of patients with ankle dorsoflexion disorder after stroke is significant. 2. The effect of alternating low frequency acupoint electrical stimulation of flexion and extensor muscle on improving ankle dorsal flexion disorder after apoplexy was better than that of conventional low frequency acupoint electrical stimulation. The function of ankle dorsiflexion plays an important role in maintaining the weight bearing of lower limbs, balance and stability of walking, and is an important factor affecting walking ability.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R246.6

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