【摘要】 目的：观察神经肌肉关节促进法（NJF）对脑梗死偏瘫患者上肢肌张力、上肢及手部运动功能、翻身转移能力的影响。方法：回顾性分析2017年8月—2019年1月在中山大学附属第一医院神经内科治疗的脑梗死患者136例，根据是否使用NJF技术治疗分为对照组和试验组，分别为70、66例。2组均接受脑卒中常规的药物治疗。对照组在常规治疗基础上接受上肢康复治疗，主要包括功能性电刺激、关节被动活动训练、转移能力训练，每项均20 min/次，1次/d,5 d/周，共10 d。试验组在对照组基础上接受NJF技术训练（上肢伸展-内收-内旋模式、上肢屈曲-外展-外旋模式、上肢屈曲-内收-外旋模式、上肢伸展-外展-内旋模式），治疗时间60 min/次，其中NJF技术训练20 min，对照组治疗内容缩短为40 min/次，1次/d,5 d/周，共训练10 d。分别于治疗前后采用改良Ashworth痉挛分级量表（MAS）评定患者上肢肌张力；采用Brunnstrom分期评定患侧上肢及手部的运动功能情况；采用转移时所需的帮助量评定患者的翻身转移能力（包括向健侧翻身、向患侧翻身）。结果：(1)上肢MAS评分和上肢、手部Brunnstrom评分：与治疗前比较，2组治疗后MAS评分、上肢Brunnstrom评分差异具有统计学意义（P<0.05），试验组治疗后手部Brunnstrom评分差异具有统计学意义（P<0.05）。与对照组比较，试验组MAS分级、上肢及手部Brunnstrom分期好转率明显更高，差异具有统计学意义（P<0.05）。(2)翻身转移能力：与治疗前比较，2组治疗后向健侧翻身评分差异具有统计学意义（P<0.05），对照组治疗后向患侧翻身评分差异具有统计学意义（P<0.05）。与对照组比较，试验组向健侧翻身好转率明显更高，差异具有统计学意义（P<0.05）。结论：NJF技术可以降低脑梗死偏瘫患者患侧上肢高肌张力，改善上肢及手部运动功能，提高翻身转移能力。更多还原

【Abstract】 Objective: To explore the therapeutic effect of neuromuscular joint faciclitation(NJF) on the upper extremity muscle tone, upper limb and hand motor function, bed mobility and transfers in hemiplegic patients with cerebral infarction. Methods: A total of 136 patients with cerebral infarction treated in the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University from August 2017 to January 2019 were divided into control group and experimental group according to whether the treatment included the NJF technique, with 70 and 66 cases in each group, respectively. Both groups received conventional drug therapy for stroke. The control group received upper limb rehabilitation therapy in addition, including functional electrical stimulation,passive joint movement training and transfer ability training, and each training was 20 minutes a time, once a day, five days a week for a total of 10 days. The experimental group received NJF training plus the therapy given to the control group, including upper limb extension-adduction-internal rotation mode, upper limb flexion-abduction-external rotation mode, upper limb flexion-adduction-external rotation mode and upper limb extension-abduction-internal rotation mode, 60 minutes a time, with NJF training for 20minutes, and the same training as the control group shortened to 40 minutes, once a day, five days a week for 10 days. Before and after the treatment, modified Ashworth scale(MAS) for spasticity was used to assess the muscle tone of the upper limbs; Brunnstrom staging was used to assess the motor function of the affected upper limb and hand; the assist level with transfer was used to assess the bed mobility(including turning over to the healthy side and turning over to the affected side). Results:(1) MAS score of upper limb and Brunnstrom score of upper limb and hand: compared with before treatment, the differences in MAS and Brunnstrom scores of the upper limb of the two groups after treatment were statistically significant(P<0.05), and the difference of Brunnstrom score of hand in the experimental group after treatment was statistically significant(P<0.05). Compared with the control group, the improvement rate of MAS grading, upper limb and hand Brunstrom staging in the experimental group were significantly higher, and the differences were statistically significant(P<0.05).(2) Turning over in bed and transfer ability: compared with that before treatment, the difference in the score of turning over to the healthy side of both groups after treatment was statistically significant(P<0.05), while the difference of turning over to the affected side of the control group after treatment was statistically significant(P<0.05). Compared with the control group, the improvement rate of turning over to the healthy side of the experimental group was significantly higher, and the difference was statistically significant(P<0.05). Conclusion: NJF technique can reduce the high muscle tone of upper extremity, improve the upper extremity and hand motor function, and improve the bed mobility and transfers of hemiplegic patients with cerebral infarction.更多还原