王金磊　裘小玲　周红波

[摘要] 目的 觀察肌电生物反馈配合针刺治疗脑卒中患者足下垂的临床效果。 方法 选取我院2013年6月～2016年6月期间收治的脑卒中伴足下垂偏瘫患者100例作为研究对象，按照随机数字法将其均分为观察组和对照组，各50例。两组患者入院后均进行下肢运动功能（FMA-L）评定、踝关节主动关节活动度（AROM）测量和胫前肌表面肌电信号（sEMG）检测，随后接受神经科常规药物治疗和常规康复治疗，并给予肌电生物反馈治疗。在此基础上，观察组患者加用针刺治疗，疗程均为3个疗程。疗程结束后，比较两组患者的治疗总有效率、踝关节活动度、胫骨前肌恢复状况以及患者治疗满意度。 结果 观察组总有效率（94.00%）明显高于对照组（76.00%），差异有统计学意义（χ2=6.35，P=0.01）；观察组患者治疗满意度评分明显高于对照组（P<0.05）；治疗前后两组的FMA-L评分、AROM测量、胫前肌sEMG检测量值。观察组患者的上述各指标治疗前明显高于治疗后（P<0.05），对照组患者的各指标治疗前明显高于治疗后（P<0.05）；观察组FMA-L评分明显高于对照组（χ2=5.81，P=0.00），AROM测量明显高于对照组（χ2=3.00，P=0.00），胫前肌sEMG检测量值明显高于对照组（χ2=3.98，P=0.00）；观察组患者对治疗的满意度高于对照组，差异有统计学意义（χ2=6.35，P=0.01）。 结论 肌电生物反馈配合针刺治疗脑卒中患者足下垂的临床疗效更加显著，患者的临床指标显著改善，患者满意度高，无明显不良反应，值得在临床推广使用。

[关键词] 脑卒中；足下垂；肌电生物反馈；针刺治疗

[中图分类号] R743.3 [文献标识码] B [文章编号] 1673-9701（2017）16-0112-04

[Abstract] Objective To observe the clinical effect of electromyographic biofeedback combined with acupuncture in the treatment of foot drop in stroke patients. Methods A total of 100 patients with stroke combined with foot drop hemiplegia who were enrolled in our hospital from June 2013 to June 2016 were selected as the study subjects. According to the random number method， they were divided into the observation group and the control group， with 50 patients in each group. Lower extremity motor function（FMA-L） was evaluated， ankle joint active mobility（AROM） was measured and tibial anterior muscle surface electromyogram signal（sEMG） was tested after admission in both groups. The patients werre followed by conventional neurological treatment and routine rehabilitation therapy in the Department of Neurology， and then were given electromyographic biofeedback therapy. On this basis， the observation group was further given acupuncture treatment， with three cycles of treatment. After the treatment， the total effective rate of treatment， ankle activity， tibial anterior muscle recovery and the incidence ratte of adverse reactions and patients' satisfaction were compared between the two groups. Results The total effective rate（94%） in the observation group was significantly higher than that in the control group（76%）， and the difference was statistically significant（χ2=6.35， P=0.01）； the scores of treatment satisfaction were significantly higher in the observation group than in the control group（P<0.05）； FMA-L score， AROM measurement， tibialis anterior muscle sEMG value were measured before and after treatment. Each index in the patients in the observation group before the treatment was significantly higher than that after the treatment（P<0.05）， and each index in the patients in the control group before the treatment was significantly higher than that after the treatment （P<0.05）； the score of FMA-L in the observation group was significantly higher than that in the control group（χ2=5.81， P=0.00）， the AROM was significantly higher than that in the control group（χ2=3.00， P=0.00）， and tibialis anterior muscle sEMG value was significantly higher than that in the control group（χ2=3.98， P=0.00）； there was statistically significant difference in the satisfaction towards treatment between the observation group and the control group（χ2=6.35， P=0.01）； there were no significant adverse reactions between the two groups. Conclusion The clinical effect of electromyographic biofeedback combined with acupuncture in the treatment of foot drop in stroke patients is more significant， and the clinical indices of patients are significantly improved. The patients have high satisfaction， without significant adverse reactions. The therapy is worthy of clinical promotion and application.

[Key words] Stroke； Foot drop； Electromyographic biofeedback； Acupuncture

脑卒中是临床常見的脑血管疾病，包括出血性脑卒中和缺血性脑卒中，脑卒中可以损害神经功能，严重危害人们的生命健康[1]。近年来，随着社会老龄化和生活水平的提高，脑卒中的发生率在逐年增加，是老年人致死致残的主要原因之一。由于急救技术和监护水平的提高，脑卒中的存活率显著上升，但存活患者往往遗留神经功能缺损、肢体功能障碍，足下垂系最常见的症状[2]。脑卒中后足下垂会制约患者步态及步行能力，其发病机制主要由小腿的前肌群和外侧肌群麻痹、小腿的后肌群痉挛牵拉所引起[3]。……