下肢闭链等速肌力训练对脑卒中患者下肢肌肉功能及步行能力的影响

摘要

Objective:To explore the influence of lower limb closed kinetic chain isokinetic exercises on muscle function and walking ability in convalescent stroke patients.Method:Sixty cases of the initial disease of convalescent stroke patients were randomly divided into treatment group and control group with 30 cases in each group.Control group were given the Bobath neurodevelopmental therapy.The treatment group received closed kinetic chain exercises besides Bobath neurodevelopmental therapy.The mode of the exercise is isokinetic eccentric/eccentric,continuous treatment for 8 weeks,with 3 times per week.Isokinetic peak torque(PT),peak torque/weight(PT/BW),the peak torque of flexion /the peak torque of exertion (H/Q),total work(TW) and average power(AP) were used to evaluate muscle function of the patients before and after treatment.And 30s chair-stand test and time-up-and-go tests were used for measuring gait and walking ability of the patients.Result:After continuous 8 weeks treatment,isokinetic peak torque(PT),peak torque/weight (PT/BW)、the peak torque of flexion /the peak torque of extension (H/Q),total work(TW) and average power(AP) in two groups were increased significantly as compared with those pre-treatment(P＜0.05).All the scores in the treatment group were significantly higher than in control group(P＜0.05).TUG scores in both groups after treatment were increased as compared with pre-treatment (P ＜ 0.05),and the scores of TUG in the treatment group were significantly higher than those in the control group(P＜ 0.05).However,there was no obvious change for 30 CST test result in both groups(P ＞ 0.05).Conclusion:As a new choice of rehabilitation treatment,lower limb closed kinetic chain isokinetic exercises can obviously improve lower limb muscle function and walking ability in stroke patients.%目的:观察下肢闭链等速肌力训练对脑卒中恢复期患者下肢肌肉功能及步行能力的影响.方法:采用随机数字法将60例初次发病的恢复期脑卒中偏瘫患者随机分为治疗组和对照组,每组30例.对照组采用Bobath为主的神经发育疗法,治疗组在此基础上增加偏瘫下肢闭链肌力训练,训练模式为普通等速离心/离心模式,连续治疗8周,每周治疗3次.治疗前后分别采用等速肌力测试训练仪的峰力矩(peak torque,PT)、相对峰力矩(peak torque/body weight,PT/BW)、屈膝肌峰力矩与伸膝肌峰力矩比值(Hamstring/quadriceps,H/Q)、总功率(total work,TW)、平均功率(average power,AP)对患肢肌肉功能情况进行分析;利用30秒坐起测试(30s chair-stand test,30CST)、计时站立起步测试(time-up-and-go,TUG)评价患者步态、步行能力.结果:连续训练8周后,2组患者膝关节伸屈肌肌肉功能评定指标均较治疗前明显提高(P＜0.05),相比对照组,治疗组提高更明显(P＜0.05).TUG结果提示两种治疗方式都可以改进患者步行能力(P＜0.05),但治疗组效果更明显(P＜0.05).30CST结果显示,两种治疗方式在治疗后都无明显改变(P＞0.05).结论:采用闭链等速肌力训练方式能明显改善脑卒中恢复期患者下肢肌肉功能和步行能力,是脑卒中患者康复治疗的新选择.