基于表面肌电图分析靳三针结合镜像疗法治疗脑梗死下肢功能障碍的效果研究

doi:10.12114/j.issn.1007-9572.2023.0064

中国全科医学 ›› 2023, Vol. 26 ›› Issue (17): 2162-2168.DOI: 10.12114/j.issn.1007-9572.2023.0064

所属专题：中医最新文章合集；脑健康最新研究合集

基于表面肌电图分析靳三针结合镜像疗法治疗脑梗死下肢功能障碍的效果研究

许明珠¹, 林润², 温华能¹, 王逸潇¹, 刘璐¹, 王碧涵¹, 陈科汛¹, 禤春宇¹, 崔韶阳²^,^*()

1．518100　广东省深圳市，南方医科大学深圳医院康复医学科
2．518034　广东省深圳市，广州中医药大学深圳医院（福田）康复医学科

收稿日期:2023-01-12 修回日期:2023-02-20 出版日期:2023-06-15 发布日期:2023-02-28
通讯作者: 崔韶阳
作者贡献：许明珠负责文章的构思和研究的设计，撰写论文；林润、温华能、王逸潇参与试验实施，收集表面肌电数据及分析；刘璐、王碧涵、陈科汛、禤春宇进行临床治疗及量表评估；崔韶阳负责文章的构思与设计，论文审校，质量控制并对文章负责。
基金资助:
广东省中医药管理局课题(NO.20201240)

Effect of Jin's Three Needles Therapy Combined with Mirror Therapy on Lower Limb Dysfunction with Cerebral Infarction Patients: Analysis Based on Surface Electromyography

XU Mingzhu¹, LIN Run², WEN Huaneng¹, WANG Yixiao¹, LIU Lu¹, WANG Bihan¹, CHEN Kexun¹, XUAN Chunyu¹, CUI Shaoyang²^,^*()

1. Department of Rehabilitation Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen 518100, China
2. Department of Rehabilitation Medicine, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518034, China

Received:2023-01-12 Revised:2023-02-20 Published:2023-06-15 Online:2023-02-28
Contact: CUI Shaoyang

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摘要/Abstract

摘要： 背景脑梗死常导致患者下肢功能障碍，降低生活质量。研究显示针刺结合镜像疗法可改善脑梗死患者下肢功能障碍，但研究尚少，且评价方法有待补充。目的基于表面肌电图（sEMG）分析靳三针结合镜像疗法对脑梗死患者下肢功能障碍的影响。方法选取2022年7—12月南方医科大学深圳医院康复医学科、神经内科住院部的90例脑梗死下肢功能障碍患者为研究对象，依据随机数字表法将其分为靳三针组、镜像组、靳三针+镜像组，每组30例。三组患者均给予基础治疗，靳三针组在基础治疗上增加靳三针治疗，镜像组在基础治疗上增加膝关节镜像训练，靳三针+镜像组则在基础治疗上增加靳三针治疗和膝关节镜像训练。三组均治疗1次/d，5次/周，共治疗4周。采用sEMG评估治疗前后患侧下肢肌肉神经系统功能，包括时域指标〔均方根值（RMS）〕和频域指标〔中位频率（MF）〕；采用简化Fugl-Meyer量表中的下肢部分（FMA-LE）评分评估下肢运动功能。结果镜像组与靳三针组患者患侧股二头肌、胫骨前肌、股直肌、腓肠肌治疗4周后RMS、MF比较，差异无统计学意义（P>0.05）；靳三针+镜像组患者患侧股二头肌、胫骨前肌、股直肌、腓肠肌治疗4周后RMS、MF均高于靳三针组、镜像组（P<0.05）。靳三针+镜像组患者患侧股二头肌、胫骨前肌、股直肌、腓肠肌治疗4周后RMS、MF高于组内治疗前（P<0.05）。靳三针+镜像组患者治疗4周后FMA-LE评分高于靳三针组、镜像组（P<0.05）。结论与靳三针、镜像疗法单独治疗相比，靳三针结合镜像疗法能更有效改善脑梗死患者的下肢肌肉神经系统功能及运动功能。

关键词: 脑梗死, 下肢功能障碍, 靳三针, 镜像疗法, 表面肌电图

Abstract:

Background

Cerebral infarction often leads to lower limb motor dysfunction and reduces patients' quality of life. Previous studies have shown that acupuncture combined with mirror therapy can improve lower limb dysfunction in patients with cerebral infarction, but there are few studies and the evaluation methods need to be supplemented.

Objective

To analyse the clinical efficacy of Jin's three needles therapy combined with mirror therapy in the treatment of lower limb dysfunction in patients with cerebral infarction based on surface electromyography (sEMG) .

Methods

Ninety lower limb dysfunction with cerebral infarction patients in the Department of Rehabilitation Medicine and the Department of Neurology of Shenzhen Hospital of Southern Medical University from July to December in 2022 were selected as the study subjects and divided into the Jin's three needles therapy group, mirror therapy group and Jin's three needles therapy combined with mirror therapy group. Patients in all three groups received basic treatment, Jin's three needles therapy was added to the Jin's three needles therapy group, knee mirror training was added to the mirror therapy group, and the Jin's three needles therapy and knee mirror training were both added to the Jin's three needles therapy combined with mirror therapy group. All three groups were treated once/d, 5 times/week, for a total of 4 weeks. sEMG was used to evaluate the function of the lower limb muscle and nervous system of the affected side before and after treatment, including time-domain index〔root mean square (RMS) 〕 and frequency-domain index〔median frequency (MF) 〕. Lower limb motor function was assessed using the Fugl-Meyer Assessment-Lower Extremity (FMA-LE) .

Results

There was no statistically significant difference in the scores of RMS and MF of biceps femoris, anterior tibial muscle, rectus femoris and gastrocnemius muscle in the affected side after 4 weeks of treatment between the mirror therapy group and the Jin's three-needle therapy group (P>0.05) . The scores of RMS and MF of biceps femoris, anterior tibial muscle, rectus femoris and gastrocnemius of the affected side after 4 weeks of treatment in the Jin's three-needle therapy combined with mirror therapy group were higher than those in the Jin's three needles therapy and mirror therapy group (P<0.05) . The FMA-LE scores of patients after 4 weeks of treatment in the Jin's three needles therapy combined with mirror therapy group were higher than those in the Jin's three-needle therapy and mirror therapy groups (P<0.05) .

Conclusion

Compared with the Jin's three-needle therapy or mirror therapy, Jin's three-needle therapy combined with mirror therapy can more effectively improve the lower limb muscle nervous system function and motor function of patients with cerebral infarction.

Key words: Cerebral infarction, Lower limb dysfunction, Jin's three needles therapy, Mirror therapy, Surface electromyography

许明珠,林润,温华能,等. 基于表面肌电图分析靳三针结合镜像疗法治疗脑梗死下肢功能障碍的效果研究[J]. 中国全科医学, 2023, 26(17): 2162-2168. DOI: 10.12114/j.issn.1007-9572.2023.0064.
XU Mingzhu,LIN Run,WEN Huaneng, et al. Effect of Jin's Three Needles Therapy Combined with Mirror Therapy on Lower Limb Dysfunction with Cerebral Infarction Patients: Analysis Based on Surface Electromyography[J]. Chinese General Practice, 2023, 26(17): 2162-2168. DOI: 10.12114/j.issn.1007-9572.2023.0064.

图/表 7

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组别	例数	性别（男/女）	年龄（岁）	病程（d）
镜像组	29	15/14	61.6±9.3	98±46
靳三针组	29	16/13	59.1±9.3	98±44
靳三针+镜像组	28	15/13	59.3±10.6	96±46
F（χ²）值		0.034^a	0.583	0.008
P值		0.967	0.560	0.993

组别	例数	性别（男/女）	年龄（岁）	病程（d）
镜像组	29	15/14	61.6±9.3	98±46
靳三针组	29	16/13	59.1±9.3	98±44
靳三针+镜像组	28	15/13	59.3±10.6	96±46
F（χ²）值		0.034^a	0.583	0.008
P值		0.967	0.560	0.993

组别	例数	RMS				MF
组别	例数	治疗前	治疗4周后	t_配对值	P值	治疗前	治疗4周后	t_配对值	P值
镜像组	29	11.24±0.62	12.47±0.35	-9.636	<0.001	80.72±4.23	80.18±3.53	0.606	0.550
靳三针组	29	11.98±0.95	13.04±0.40	-5.336	<0.001	80.50±3.82	81.53±3.04	-1.095	0.283
靳三针+镜像组	28	11.65±0.82	15.74±0.86^ab	-18.561	<0.001	78.87±3.69	93.57±3.65^ab	-18.937	<0.001
F值		5.852	246.932			1.826	127.267
P值		0.054	<0.001			0.167	<0.001

组别	例数	RMS				MF
组别	例数	治疗前	治疗4周后	t_配对值	P值	治疗前	治疗4周后	t_配对值	P值
镜像组	29	11.24±0.62	12.47±0.35	-9.636	<0.001	80.72±4.23	80.18±3.53	0.606	0.550
靳三针组	29	11.98±0.95	13.04±0.40	-5.336	<0.001	80.50±3.82	81.53±3.04	-1.095	0.283
靳三针+镜像组	28	11.65±0.82	15.74±0.86^ab	-18.561	<0.001	78.87±3.69	93.57±3.65^ab	-18.937	<0.001
F值		5.852	246.932			1.826	127.267
P值		0.054	<0.001			0.167	<0.001

组别	例数	RMS				MF
组别	例数	治疗前	治疗4周后	t_配对值	P值	治疗前	治疗4周后	t_配对值	P值
镜像组	29	4.09±0.65	5.94±0.44	-12.677	<0.001	99.07±4.89	107.19±7.64	-4.387	<0.001
靳三针组	29	4.34±0.69	6.80±0.45	-15.202	<0.001	100.68±5.53	110.38±8.16	-5.411	<0.001
靳三针+镜像组	28	4.17±0.73	8.22±0.78^ab	-17.213	<0.001	100.78±5.31	116.18±8.55^ab	-7.604	<0.001
F值		0.954	109.619			0.931	8.638
P值		0.390	<0.001			0.398	<0.001

基于表面肌电图分析靳三针结合镜像疗法治疗脑梗死下肢功能障碍的效果研究

Effect of Jin's Three Needles Therapy Combined with Mirror Therapy on Lower Limb Dysfunction with Cerebral Infarction Patients: Analysis Based on Surface Electromyography

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组别	例数	治疗前	治疗4周后	t_配对值	P值
镜像组	29	16.1±1.4	20.9±1.1	-17.818	<0.001
靳三针组	29	15.9±1.5	21.2±0.8	-16.563	<0.001
靳三针+镜像组	28	16.4±1.4	24.3±1.3^ab	-27.280	<0.001
F值		0.736	75.597
P值		0.482	<0.001

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