作者：陶康，刘兵，刘佩玉，李灿红，陈呈，赵伟 庐山康复疗养中心康复医学科，江西 九江 332000
【摘要】 目的 观察不同模式的体外冲击波(ESWT)对脑卒中后手腕屈肌痉挛的治疗效果。方法 选取2019年12月至2021年12月在庐山康复疗养中心住院且符合脑卒中后手腕屈肌痉挛状态的患者80例，按随机数表法分为四组，每组20例。四组患者均接受常规康复治疗，并给予4周不同模式体外冲击波治疗，即ESWT组1为3.5 bar，每周两次；ESWT组 2为 1.5 bar，每周两次；ESWT组 3为 1.5 bar，每周一次；常规组采用无能量输出的治疗方法。ESWT治疗组频率和冲击次数均为4 Hz和1 500次。采用改良Ashworth量表(MAS)、Fugl-Meyer上肢运动功能评定(FMA)、被动关节活动度(PROM)于治疗前、治疗后(30 min)、1周、2周、4周、6周进行评定。结果 治疗前四组患者的MAS评分、FMA评分和PROM比较差异均无统计学意义(P>0.05)；治疗后4周，ESWT组1、2、3和常规组患者的MAS评分依次为(1.05±0.22)分、(1.70±0.64)分、(2.05±0.67)分和(2.90±0.54)分，FMA评分依次为(32.80±4.01)分、(25.85±3.69)分、(21.80±3.04)分和(18.85±3.51)分，PROM值依次为(62.35±8.23)°、(47.20±7.03)°、(36.00±8.12)°和(27.75±7.40)°，ESWT三组患者的各项评分均逐渐改善，且较常规组改善更明显，差异均有统计学意义(P<0.05)；6周随访，四组患者的上述三项指标较治疗前均持续改善，且运用ESWT治疗的三组患者较常规组改善更明显，差异均有统计学意义(P<0.05)。结论 体外冲击波治疗能够显著减轻脑卒中后手腕屈肌痉挛、改善手腕功能。冲击波压强为3.5 bar，频率4 Hz，冲击次数1 500次，每周两次的治疗模式疗效相对最佳，且能够持续6周。
【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1241—05
Application of different modes of extracorporeal shock wave in wrist spasm after stroke.
TAO Kang, LIU Bing, LIUPei-yu, LI Can-hong, CHEN Cheng, ZHAO Wei. Department of Rehabilitation Medicine, Lushan Rehabilitation andRecuperation Center, Jiujiang 332000, Jiangsu, CHINA
【Abstract】 Objective To observe the therapeutic effect of different modes of extracorporeal shock wave (ES-WT) on wrist flexor spasm after stroke. Methods A total of 80 patients with post-stroke wrist flexor spasm who werehospitalized in Lushan Rehabilitation and Recuperation Center from December 2019 to December 2021 were selectedand divided into four groups according to random number table method, with 20 patients in each group. All the 4 groupsreceived conventional rehabilitation therapy, and were given extracorporeal shock wave therapy with different modesfor 4 weeks, that is, ESWT group 1 of 3.5 bar, twice a week; ESWT group 2 of 1.5 bar, twice a week; ESWT group 3of 1.5 bar, once a week; the conventional group of no energy output. In the ESWT treatment group, the frequency andnumber of shocks were 4 Hz and 1500. The modified Ashworth Scale (MAS), Fugl-Meyer Upper Limb Motor FunctionAssessment (FMA), and passive range of motion (PROM) were assessed before, after (30 min), 1, 2, 4, and 6 weeks oftreatment. Results There was no significant difference in the scores of MAS, PROM, and FMA among the four groupsbefore treatment (P>0.05). Four weeks after treatment, the MAS scores of patients in ESWT group 1, 2, 3 and conven-tional group were (1.05±0.22) points, (1.70±0.64) points, (2.05±0.67) points, (2.90±0.54) points, FMA scores were(32.80±4.01) points, (25.85±3.69) points, (21.80±3.04) points, (18.85±3.51) points, and PROM was (62.35±8.23)° ,(47.20±7.03)°, (36.00±8.12)°, (27.75±7.40)°, respectively. The scores of patients in ESWT group 1, 2, 3 were graduallyimproved, and the improvement was more significant than that in the conventional group (P<0.05). During the 6-weekfollow-up, the above three indicators of the four groups of patients were continuously improved compared with those be-fore treatment, and the three groups of patients treated with ESWT were significantly improved compared with those ofthe conventional group (P<0.05). Conclusion Extracorporeal shock wave therapy can significantly reduce wrist flexorspasm and improve wrist function after stroke. The treatment mode with shock wave pressure of 3.5 bar, the frequencyof 4 Hz, the number of shocks of 1 500 (twice a week) had the best effect, which could last for 6 weeks.
【Key words】 Extracorporeal shock wave therapy; Stroke; Wrist; Spasticity; Therapeutic effect