痉挛性斜颈(spasmodic torticollis,ST)是临床上最常见的局灶型肌张力障碍,以颈部肌肉不自主收缩导致头颈部运动和姿势异常为特征,常引起头向一侧扭转或阵发性倾斜.其患病率在不同研究略有差异,流行病学调查显示ST的发病率在5.7/10万一40/10万[1-2].

目的:探讨BTE PrimusRS模拟训练系统对脑卒中患者上肢运动功能的影响.方法:选择2017年12月至2019年12月在无锡市同仁康复医院康复科住院的脑卒中患者44例,随机分为BTE组和对照组.对照组采用常规康复及内科治疗,BTE组在此基础上应用BTE PrimusRS模拟训练系统进行患侧上肢运动功能的训练,每天共治疗30分钟,每周5天,共治疗4周.治疗前后采用Fugl-Meyer量表(FMA)评估上肢运动功能,明尼苏达协调性动作测试评估上肢的运动及协调功能,改良Barthel指数(MBI)量表评估日常生活活动能力.结果:治疗前,两组患者上肢FMA评估得分、明尼苏达协调性动作测试耗时及MBI评估得分均无统计学差异(P>0.05);治疗4周后,两组患者上肢FMA及MBI评估得分较前提高(P<0.05),明尼苏达协调性动作测试耗时较前降低(P<0.05);BTE组改善程度优于对照组,差异具有统计学意义(P<0.05).结论:BTE PrimusRS模拟训练系统能够改善脑卒中偏瘫患者的上肢运动功能及协调功能,提高日常生活活动能力,值得临床推广应用.

目的:探讨经颅直流电双侧刺激(tDCS)联合康复训练对脑卒中视空间障碍的作用及疗效评估指标的可行性.方法:40例脑卒中后视空间障碍患者分为治疗组(n=20)和对照组(n=20),治疗组康复训练同步tDCS刺激,对照组康复训练同步tDCS假刺激.分别于治疗前、治疗4周和8周后,采用画钟试验(CDT)、韦氏成人智力量表的木块试验(WAIS-BD)、线方向判断测试(JLO)、改良Barthel指数(MBI)评定疗效,并分析JLO＞18为症状改善的早期指标.结果:治疗4周后,治疗组CDT、WAIS-BD、JLO、MBI评分均较治疗前显著提高(P＜0.05).治疗8周后,两组CDT、WAIS-BD、JLO、MBI评分均较治疗前显著提高(P＜0.05).治疗组4周后CDT、JLO评分及8周后CDT、WAIS-BD、JLO、MBI评分均显著高于对照组(P＜0.05).治疗前后两组JLO与WAIS-BD、CDT、MBI呈显著相关(P＜0.05).治疗组8周后症状改善率(JLO＞18)显著高于对照组(P＜0.05).结论:tDCS双侧刺激联合康复训练有效改善脑卒中患者视空间障碍,JLO＞18分可作为视空间障碍症状改善的早期评价指标.

目的:运用表面肌电结合等速测试仪探讨基于正常行走模式的功能性电刺激(FES)对脑卒中患者下肢痉挛及功能的影响.方法:54例脑卒中患者随机分为2组,FES组及安慰刺激组(对照组).2组患者均接受常规的临床及康复治疗.FES组在此基础上接受基于正常行走模式的FES治疗,安慰刺激组给予无电流输出的电刺激.治疗前及治疗4周后,采用表面肌电图结合等速测试仪测试患者下肢股四头肌和小腿三头肌,计算各肌肉的均方根值(RMS)和积分肌电值(iEMG);同时采用改良Ashworth痉挛量表(MAS)、Fugl-Meyer运动功能量表(FMA)的下肢部分及10m步行速度评估患者的下肢功能.结果:治疗4周后,2组患者股四头肌及小腿三头肌MAS评分、RMS值、iEMG值均较治疗前有所降低(P＜0.05),下肢FMA评分及10m步行速度较治疗前增加(P＜0.05);治疗第4周组间比较,FES组各评分值改善程度优于安慰刺激组(P＜0.05).结论:基于正常行走模式的FES能有效降低脑卒中患者下肢股四头肌及小腿三头肌的肌张力,改善偏瘫患者的下肢伸肌痉挛模式,提高下肢运动功能及步行能力,值得临床推广应用.

1病例资料 患者,男,55岁.2019年4月21日患者因A型主动脉夹层、肠系膜动脉夹层在市人民医院心胸外科行肠系膜上动脉夹层术,左肾动脉造影,支架植入术.术后发现对答不畅,左口角歪斜,左侧肢体活动不能,查头颅CT未见出血灶,右侧额颞顶枕叶低密度影.患者病情稍稳定后于2019年5月15日全麻体外循环下行升主动脉置换、全弓置换、术中主动脉支架置人,患者病情好转后为进一步康复治疗,于2019年5月29日转入我院治疗.

目的:分析六步手法联合体外冲击波治疗老年膝关节炎的临床效果.方法:选取2017年1月至2019年6月到我科进行治疗的老年膝关节炎患者60例,根据治疗方式不同分为对照组和观察组(各30例),对照组采用塞来昔布胶囊联合体外冲击波治疗,观察组采用六步手法联合体外冲击波治疗,检测2组患者治疗前后血清中C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β)水平,观察和记录两组患者疗效、疼痛视觉模拟评分(VAS)、WOMAC骨关节炎指数评分及Barthel指数.结果:观察组治疗有效率(90.0％)高于对照组(67.7％),差异有统计学意义(P＜0.05).治疗后观察组CRP,TNF-α及IL-1β均低于对照组,差异有统计学意义(P＜0.05).治疗后1周、1个月、2个月和3个月观察组VAS评分及WOMAC骨关节炎指数评分均高于对照组,而Barthel指数均低于对照组,差异有统计学意义(P＜0.05).结论:六步手法联合体外冲击波治疗老年膝关节炎疗效明显,能降低患者炎症因子,减轻疼痛,改善膝关节功能,提高患者独立生活能力,且安全性较好.

《中国心血管病报告2018》显示我国心脑血管病人数已经高达2.9亿[1],其中脑卒中1300万.脑卒中年轻化趋势明显,男性易患病[2],Jokinen等[3]研究指出约83％的脑卒中存在一个及以上认知域的功能减退.然而,在临床检查中,我们倾向于关注脑卒中的躯体表现,而忽视神经心理学方面的检查[4].这可能与患者即使认知恢复不佳,仍能保持一定程度的个人独立有关[5].脑卒中后认知障碍亦影响躯体、行为和情绪等多方面的康复,对患者的远期影响超过躯体障碍,所以对脑卒中患者认知的及时评估与治疗很重要.

目的:利用表面肌电进行评估,探讨挛三针结合重复经颅磁刺激(rTMS)对中风后上肢肌肉痉挛的影响.方法:选取2019年8-12月在无锡市同仁康复医院康复科住院的脑卒中患者66例,随机分为3组,分别为rTMS组、挛三针组及联合治疗组(rTMS+针刺组),各22例.每组在治疗前及治疗4周后采用表面肌电对患者上肢肱二头肌、肱三头肌进行测试,采集各肌肉的RMS值及iEMG值,同时运用上肢Fugl-Meyer评估(FMA)和改良Barthel指数(modified Barthel index,MBI)对患者上肢运动功能及日常生活能力进行评估.结果:治疗前3组患者FMA、MBI评分及表面肌电值比较,差异均无统计学意义(P＞0.05),具有可比性.治疗4周后,3组患者患侧肱二头肌、肱三头肌的RMS及iEMG值均较治疗前降低(P＜0.05);FMA、MBI评分较前提高(P＜0.05).联合治疗组的各评分值较其余两组改善更明显(P＜0.05),而挛三针组及rTMS组比较,差异无统计学意义(P＞0.05).结论:挛三针结合rTMS能有效降低脑卒中患者肱二头肌及肱三头肌的肌张力,改善上肢运动功能,提高日常生活能力,两者结合干预具有协同作用.

目的:观察个体音乐治疗联合常规康复训练对脑卒中后痉挛性偏瘫患者肢体痉挛程度及运动功能的影响.方法:将40例脑卒中后痉挛性偏瘫患者随机分为观察组(n=20)和对照组(n=20).对照组接受常规康复训练,观察组接受常规康复训练联合个体音乐治疗.两组患者主动运动训练时长保持一致.分别于治疗前和治疗4周后比较两组患者偏瘫肢体肘、膝关节肌张力(MAS)评分和上、下肢运动功能(FMA)评分.结果:治疗前,两组患者肘、膝关节MAS评分和上、下肢FMA评分差异无显著性意义,组间具有可比性.治疗后,两组患者肘、膝关节MAS评分均较治疗前明显降低(P＜0.01),上、下肢FMA评分均明显提高(P＜0.01);组间比较,观察组肘、膝关节MAS评分和上、下肢FMA评分均优于对照组(P＜0.05).结论:常规康复训练联合个体音乐治疗能更有效降低脑卒中后痉挛性偏瘫患者的肘、膝关节痉挛程度,提高偏瘫肢体运动功能.

OBJECTIVE:To compare the clinical efficacy difference between encircling needling combined with physical factor therapy and simple physical factor therapy for severe pressure sore, and to explore the optimal method for severe pressure sores.METHODS:Thirty-four patients with IV-grade pressure sore were randomly divided into an observation group and a control group, 17 cases in each one. Patients in the control group were treated with conventional nursing, ultrasonic wave and short-wave ultraviolet therapy; additionally, the encircling needling was applied in the observation group. All the treatment was given once a day, 5 times a week, and 4-week treatment constituted one session. Totally, two sessions of treatment were performed. Three indices, including the area of pressure sore, 24-h volume of exudates and wound-bed tissue type, were compared between the two groups before and after treatment; the clinical efficacy was evaluated in the two groups.RESULTS:After treatment of one session and two sessions, the area of pressure sore, 24-h volume of exudates and wound-bed tissue type were significantly reduced in the two groups (P < 0.01, P < 0.05), which was more obvious in the observation group (all P < 0.05). The total effective rate in the observation group was 76.5% (13/17) after 1 session and 94.1% (16/17) after 2 sessions, which were superior to 35.3% (6/17) after 1 session and 64.7% (11/17) after 2 sessions in the control group (both P < 0.05).CONCLUSION:Encircling needling combined with physical factor therapy can obviously reduce the pressure sore area and 24-h volume of exudates and improve wound-bed tissue type, which is superior to simple physical factor therapy.

Objective To investigate the factors related to outcome(recovery of motor,activities of daily living,and balance) of stroke patients.Methods 67 stroke patients with hemiplegia were evaluated with the Ueda Classfication of upper and lower limbs function,Functional Independence Measure(FIM),Berg balance scale(BBS) before and after treatment.The scores of all the assessment were as the dependent variable respectively,and regression analyzed with the factors possiblely related to the outcome.Results The positive factors for lower limbs function included rehabilitation intervention,time of rehabilitation,and hypercholesterolemia;while the negative factors were body mass index(BMI),and damage of superficial sensibility.The positive factors for upper limbs function were rehabilitation intervention and time of rehabilitation;while the negative factors were BMI,dysphagia,damage of superficial sensibility,and frequency of attack.The positive factors for hand function were rehabilitation interventions and interval from diagnosis to rehabilitation,while the negative factors were the muscle tension,incontinence,and frequency of attack.The positive factors for FIM were the rehabilitation intervention,while the negative factors were BMI,incontinence,hypercholesterolemia,gender and residence status.The positive factors for BBS were the rehabilitation intervention,while the negative factors were BMI,frequency of attack,and hyperglycemia.Conclusion Rehabilitation promotes the recovery of stroke patients,but the BMI may block it.