【作者】 刘莉；

【导师】 陆晓；

【作者基本信息】 南京医科大学 ， 康复医学与理疗学（专业学位）， 2020， 硕士

【摘要】 目的:采用表面肌电(sEMG)的评价方法,探讨脑卒中恢复期偏瘫患者在不同功能状态下以及治疗前后,小腿三头肌各肌群的sEMG信号值的变化,以期从电生理的角度分析脑卒中后小腿三头肌各肌群的功能特点。方法:脑卒中恢复期且存在小腿三头肌痉挛的偏瘫患者40例,治疗前后采用同样的实验方法:分别采集伸膝位和屈膝位,踝关节被动背伸牵伸过程中,健、患侧内外侧腓肠肌以及比目鱼肌的sEMG信号,同时在患者行走5个步行周期时,分别采集健、患侧内外侧腓肠肌及比目鱼肌的sEMG信号,对所采集的sEMG的均方根(RMS)值进行分析、比较。结果:1.踝关节在作被动背伸的牵伸过程中,患侧内、外侧腓肠肌的RMS值,在伸膝位均高于屈膝位(P<0.05),而比目鱼肌则无显著性差异;伸膝位时,患侧的内侧腓肠肌RMS值最高;相同体位下内、外侧腓肠肌以及比目鱼肌的RMS值,患侧均高于健侧(P<0.05)。2.在步行过程中,支撑相时患侧内、外侧腓肠肌的RMS值显著低于健侧(P<0.05),而比目鱼肌则无显著性差异;摆动相时,患侧内、外侧腓肠肌以及比目鱼肌的RMS值均显著低于健侧(P<0.05)。支撑相时,比目鱼肌的贡献度患侧高于健侧(P<0.05),而外侧腓肠肌的贡献度患侧低于健侧(P<0.05)。3.治疗后大部分患者的小腿三头肌肌张力下降,同时内、外侧腓肠肌不同体位下的RMS值也随之明显减小(P<0.05),而比目鱼肌的RMS值,治疗后较治疗前无显著性改变。结论:结果显示内、外侧腓肠肌张力增高是导致脑卒中恢复期偏瘫患者小腿三头肌痉挛的主要因素。在步行过程中,患侧比目鱼肌的贡献度较大,由此认为,比目鱼肌代偿了部分腓肠肌的功能,成为患侧主要的踝跖屈主动收缩肌,在偏瘫患者的步行中起主要推动及稳定作用。通过从电生理的角度分析脑卒中后小腿三头肌各肌群的功能特点,为脑卒中后痉挛性足下垂、步态功能康复的合理化、精准化实施提供理论依据。更多还原

【Abstract】 Objective: Surface electromyography(sEMG)was used to investigate the changes of sEMG signal of triceps surae in stroke patients with hemiplegia under different functional states and before and after treatment,in order to analyze the functional rehabilitation characteristics of triceps muscle after stroke from the point of view of electrophysiology.Methods: Forty stroke patients with triceps spasm in the convalescent stage were selected.The same experimental method was used before and after treatment:During passive dorsiflexion distraction of ankle joint,the sEMG signals of internal and external gastrocnemius muscle and soleus muscle in knee extension position and knee flexion position were collected.During five walking cycles,sEMG signals of internal and external gastrocnemius muscle and soleus muscle were also collected.The root mean square amplitude(RMS)of sEMG is analyzed and compared.Results: 1.During passive dorsiflexion distraction of ankle joint : The RMS value of medial and lateral gastrocnemius muscle in knee extension position was significantly higher than that in knee flexion position(P<0.05),but there was no significant difference in soleus muscle.The RMS values of internal and external gastrocnemius muscle and soleus muscle in the affected side were significantly higher than those in the healthy side(P<0.05)in the same position.The RMS value of the medial gastrocnemius muscle of the affected side was the highest in the knee extension position.2.During walking: The RMS value of internal and external gastrocnemius muscle in the affected side was lower than that in the healthy side in the supporting phase(P<0.05),but there was no difference in soleus muscle.The RMS values of internal and external gastrocnemius muscle and soleus muscle in the affected side were lower than those in the healthy side(P<0.05)in the swinging phase.In the supporting phase,the contribution of soleus muscle in the affected si de was higher than that in the healthy side(P<0.05),while that of the lateral gastrocnemius muscle in the affected side was lower than that in the healthy side(P <0.05).3.After treatment,the muscle tension of triceps muscle decreased,and the RMS value of medial and lateral gastrocnemius muscle decreased significantly(P < 0.05),but the RMS value of soleus muscle had no significant change after treatment.Conclusions: The results showed that the increased tension of medial and lateral gastrocnemius muscle is the main factor leading to triceps spasm in hemiplegic patients with stroke.In the process of walking,the soleus muscle of the affected side has a greater contribution,so it is considered that the soleus muscle compensates part of the function of the gastrocnemius muscle and becomes the main active contractile muscle of ankle metatarsal flexion on the affected side.It plays a major role in promoting and stabilizing the walking of hemiplegic patients.The functional characteristics of each muscle group of triceps muscle after stroke were analyzed from the point of view of electrophysiology,which provides a theoretical basis for the rationalization and accurate implementation of spastic foot drop and gait function rehabilitation after stroke.更多还原