减重步态训练联合膝关节控制对脑卒中后膝过伸患者康复疗效分析

殷其勇; 徐青亲; 陈德生; 汪敏; 陈和木

doi:10.16766/j.cnki.issn.1674-4152.003043

减重步态训练联合膝关节控制对脑卒中后膝过伸患者康复疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003043

1.
安徽医科大学第一附属医院康复医学科，安徽合肥 230022
2.
中国人民解放军联勤保障部队第九〇一医院康复医学科，安徽合肥 230031

基金项目:

安徽省高校自然科学研究项目 KJ2020ZD18

安徽省省级高等学校质量工程项目 2020SJJXSFK1370

详细信息

通讯作者:
陈和木，E-mail：chenhemu123@126.com

中图分类号: R743.3 R493
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出版历程
- 收稿日期: 2022-11-08
- 网络出版日期: 2023-08-26

Rehabilitation efficacy analysis of the body weight supported treadmill training combined with knee joint controlling on knee hyperextension in patients after stroke

1.
Department of Rehabilitation Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨减重步态训练联合膝关节控制训练对脑卒中后膝过伸患者下肢运动功能的康复疗效，旨在改善患者下肢运动功能，提高行走稳定性及安全性。方法选取2021年6月—2022年6月安徽医科大学第一附属医院康复医学科接诊的脑卒中患者30例，采用随机数表法分为对照组和实验组，每组15例；同时招募15名年龄、性别相匹配的健康受试者作为正常对照组，采集足底压力数据。对照组予以常规康复治疗，实验组在常规康复治疗的基础上增加减重步态训练和膝关节控制训练。治疗4周前后，比较2组患者的Berg平衡量表(BBS)、Fugl-Meyer下肢运动功能评分(FMA-LE)、10米步行试验(10MWT)、膝过伸次数测定及足底压力分析[包括双侧足底压力百分比、对称指数(SI)及身体压力中心摆动面积(COP)]。结果 2组患者治疗后BBS、FMA-LE、10MWT、膝过伸次数测定均较治疗前改善(P＜0.05)，除10MWT外，实验组结果均优于对照组[BBS: (22.87±1.96)分vs.(20.93±2.23)分；FMA-LE: (22.07±2.64)分vs.(19.67±2.61)分；10MWT: (27.13±8.20)s vs.(30.73±10.95)s；膝过伸次数测定：(14.00±2.95)次vs.(17.40±3.91)次，均P < 0.05]。2组患者SI及COP值较入院前改善，且实验组结果优于对照组(P＜0.05)，但与正常对照组仍存在差距(P＜0.001)。结论脑卒中后膝过伸患者采用减重步态训练联合膝关节控制可有效提高患者步行及平衡能力。
- 脑卒中 /
- 膝过伸 /
- 减重步态训练 /
- 膝关节控制 /
- 足底压力分析
Abstract: Objective To explore the rehabilitation efficacy of body weight supported treadmill training (BWSTT) combined with knee joint controlling (KJC) on lower limb motor function in patients with knee hyperextension (KH) after stroke, so as to improve the motor function of lower limbs and enhance walking stability and safety. Methods Thirty stroke patients admitted to Department of Rehabilitation Medicine of the First Affiliated Hospital of Anhui Medical University from June 2021 to June 2022 were selected. They were divided into a control group and an experimental group by using the random number table method, with 15 cases in each group. In order to collect plantar pressure data, 15 aging and gender-matched healthy subjects were recruited as the normal controls. The control group was treated with conventional rehabilitation therapy, while the experimental group received BWSTT and KJC on the basis therapy. The Berg balance scale (BBS), Fugl-Meyer assessment of lower extremity (FMA-LE), 10-meter walking test (10MWT), KH measurements and plantar pressure analysis [bilateral plantar pressure percentage, symmetry index (SI) and center of pressure (COP)] were compared between the two groups before and after 4 weeks of treatment. Results The BBS, FMA-LE, 10MWT and KH measurements improved in both groups after 4 weeks of treatment (P < 0.05), and the experimental group had better results than the control group except for 10MWT [BBS score: (22.87±1.96) points vs. (20.93±2.23) points; FMA-LE: (22.07±2.64) points vs. (19.67±2.61) points; 10MWT: (27.13±8.20) seconds vs. (30.73±10.95) seconds; KH measurements: (14.00±2.95) times vs. (17.40±3.91) times, all P < 0.05]. The SI and COP improved in both groups compared to pre-admission and were better in the experimental group than those in the control group (P < 0.05), but had difference with normal subjects (P < 0.001). Conclusion BWSTT combined with KJC can effectively improve walking and balance in stroke patients with KH.
- Stroke /
- Knee hyperextension /
- Body weight supported treadmill training /
- Knee joint controlling /
- Plantar pressure analysis

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表 1 3组受试者一般资料比较

Table 1. Comparison of general data among 3 groups of subjects

组别	例数	男/女 (例)	年龄 (x±s，岁)	病程 [M(P₂₅, P₇₅)，d]	梗死/出血 (例)	病灶 (左/右, 例)
对照组	15	10/5	55.60±3.86	35(22，76)	10/5	7/8
实验组	15	8/7	53.47±4.07	45(36，55)	8/7	7/8
正常对照组	15	6/9	51.60±1.82
统计量		2.143^a	0.459^b	-0.581^c
P值		0.343	0.637	0.561	0.710^d	1.000^d
注：^a为χ²值，^b为F值, ^c为Z值，^d为采用Fisher精确检验。

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表 2 2组脑卒中偏瘫患者治疗前后BBS评分比较(x±s，分)

Table 2. Comparison of BBS scores before and after treatment in the two groups of stroke patients with hemiplegia (x±s, points)

组别	例数	治疗前	治疗后	t值	P值
对照组	15	19.13±2.10	20.93±2.23	-2.215	0.035
实验组	15	18.73±1.49	22.87±1.96	-6.510	＜0.001
t值		0.602	-2.451
P值		0.552	0.021

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表 3 2组脑卒中偏瘫患者治疗前后FMA-LE评分比较(x±s，分)

Table 3. Comparison of FMA-LE scores before and after treatment between the two groups of stroke patients with hemiplegia (x±s, points)

组别	例数	治疗前	治疗后	t值	P值
对照组	15	16.27±1.97	19.67±2.61	-4.074	＜0.001
实验组	15	16.60±1.45	22.07±2.64	-7.043	＜0.001
t值		-0.538	-2.508
P值		0.695	0.018

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表 4 2组脑卒中偏瘫患者治疗前后10MWT比较(x±s，s)

Table 4. Comparison of 10MWT before and after treatment in the two groups of stroke patients with hemiplegia (x±s, s)

组别	例数	治疗前	治疗后	t值	P值
对照组	15	39.47±11.30	30.73±10.95	2.149	0.040
实验组	15	39.93±10.89	27.13±8.20	3.637	0.001
t值		-1.150	1.019
P值		0.909	0.317

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表 5 2组脑卒中偏瘫患者治疗前后膝过伸次数比较(x±s，次)

Table 5. Comparison of knee hyperextension times before and after treatment in the two groups of stroke patients with hemiplegia (x±s, times)

组别	例数	治疗前	治疗后	t值	P值
对照组	15	23.07±5.81	17.40±3.91	6.065	＜0.001
实验组	15	23.33±5.91	14.00±2.95	7.897	＜0.001
t值		-0.125	2.690
P值		0.902	0.012

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表 6 2组脑卒中偏瘫患者足底压力数据比较(x±s)

Table 6. Comparison of plantar pressure data between the two groups of stroke patients with hemiplegia (x±s)

组别	例数	SI		COP(mm²)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	15	0.60±0.03	0.57±0.02	362.73±60.19	249.07±41.92
实验组	15	0.60±0.34	0.55±0.02	364.20±36.91	198.87±33.14
t值		-0.064	2.803	-0.080	3.638
P值		0.950	0.009	0.936	0.001

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