重复经颅磁刺激与肌电生物反馈电刺激疗法联合治疗脑卒中后足下垂的疗效观察

摘要

目的:观察重复经颅磁刺激联合肌电生物反馈电刺激疗法治疗卒中后足下垂的疗效是否优于单纯应用肌电生物反馈电刺激.方法:将120例脑卒中后足下垂患者随机分为3组各40例, A组给予单纯肌电生物反馈电刺激治疗, B组给予肌电生物反馈电刺激联合重复经颅磁刺激治疗, C组给予肌电生物反馈联合假重复经颅磁刺激治疗.治疗前及治疗8周后对3组患者进行疗效评定, 采用肌力测定仪评定踝关节背伸肌力;表面肌电分析仪处理表面肌电信号, 记录最大踝关节背屈时, 胫骨前肌等长收缩状态下相关肌群的肌电积分值;Gaitwatch三维步态分析与训练系统记录行走时的步态参数, 主要评定指标:步速、患侧支撑相百分比、踝关节最大背伸角度.结果:通过8周的康复训练, 3组患者的肌力、步态及胫骨前肌iEMG值均较治疗前明显改善 (P＜0.05), B组各项指标均优于A组、C组 (P＜0.05), A、C两组间治疗效果差异无统计学意义.结论:重复经颅磁刺激联合肌电生物反馈电刺激疗法治疗卒中后足下垂疗效显著, 明显优于单纯肌电生物反馈电刺激.%Objective:To investigate whether repetitive transcranial magnetic stimulation combined with electromyography triggered stimulation is superior to simple electromyography triggered stimulation in the treatment of foot drop in stroke patients. Methods:According to the different treatment methods, 120 patients who met the standards were randomly assigned to 3 groups (n=40 each). The patients in group A were treated with electromyography triggered stimulation, those in group B were given repetitive transcranial magnetic stimulation and electromyography triggered stimulation, and those in group C were subjected to electromyography triggered stimulation and ineffective repetitive transcranial magnetic stimulation. Muscle force of ankle dorsiflexion was evaluated with hand-held dynamometer; electromyogram of isometric contraction of anterior tibialis anterior under maximum ankle dorsiflexion was assessed with Muscle Tester; gait parameters were assessed with 3 D gait analysis system. Results:Muscle force of ankle dorsiflexion and iEMG and gait parameters of three groups were significantly improved at the end of 8 weeks (P＜0.05), and those in group B were superior to group A and group C (P＜0.05). There was no significant difference in the therapeutic effect between groups A and B (P＞0.05). Conclusion:Repetitive transcranial magnetic stimulation combined with electromyography triggered stimulation is superior to simple electromyography triggered stimulation in the treatment of foot drop in stroke patients.