山东医药

目的 观察便携式等速训练在脑卒中后早期偏瘫患者下肢功能康复中的应用效果。方法 前瞻性选择脑卒中后早期（发病≤3个月）偏瘫患者80例，采用随机数字表法分为对照组与等速训练组各40例。对照组接受常规综合康复治疗；等速训练组在对照组基础上加用便携式等速肌力训练系统实施床旁膝关节屈伸训练。于干预前及干预4周后分别评定偏瘫侧下肢肌张力[改良Ashworth量表（MAS）]、偏瘫侧下肢肌力[60°/s角速度下峰力矩（PT）与总功（TW）]、运动功能[Fugl-Meyer运动功能评定量表（FMA）]、平衡功能[Berg平衡量表（BBS）]及步行功能[Holden功能性步行分级量表（FAC）]。结果 干预前，两组偏瘫侧下肢MAS分级比较差异无统计学意义（P>0.05）；干预后，等速训练组MAS分级低于对照组（P<0.05）。干预前，两组偏瘫侧伸肌PT、TW及屈肌PT、TW比较差异均无统计学意义（P均>0.05）；干预后，两组伸肌PT、TW及屈肌PT、TW均高于干预前，且等速训练组各肌力指标均高于对照组（P均<0.05）。干预前，两组FMA、BBS评分及FAC分级比较差异均无统计学意义（P均>0.05）；干预后，两组FMA、BBS评分及FAC分级均高于干预前，且等速训练组FMA、BBS评分及FAC分级均高于对照组（P均<0.05）。结论 在脑卒中偏瘫患者早期常规综合康复基础上加用便携式等速肌力训练，可能进一步改善偏瘫侧下肢肌张力与肌力水平，并促进运动、平衡及步行能力恢复。

Objective To investigate the application effect of portable isokinetic training on lower-limb functional rehabilitation in patients with early post-stroke hemiplegia. Methods Eighty patients with early post-stroke hemiplegia(onset ≤ 3 months) were prospectively enrolled and randomly assigned(random number table) into the control group(n=40) and isokinetic training group(n=40). Patients in the control group received conventional comprehensive rehabilitation. In addition to conventional rehabilitation, patients in the isokinetic training group underwent bedside knee flexion-extension training using a portable isokinetic muscle strength training system. Assessments were performed before intervention and after 4 weeks, including muscle tone of the paretic lower limb [modified Ashworth scale(MAS)], muscle strength of the paretic lower limb [peak torque(PT) and total work(TW) at an angular velocity of 60°/s], motor function [Fugl-Meyer Assessment(FMA)], balance function [Berg Balance Scale(BBS)], and walking ability [Holden's Functional Ambulation Category(FAC)]. Results Before intervention, no significant difference was found in the MAS grade of the paretic lower limb between these two groups(P>0. 05). After intervention, the isokinetic training group showed lower MAS grade than the control group(P<0. 05). Before intervention, there were no significant differences in PT or TW of the paretic extensors or flexors between these two groups(all P>0. 05). After intervention, PT and TW of both extensors and flexors increased in both groups in comparison with the baseline, and all strength indices were higher in the isokinetic training group than in the control group(all P<0. 05). Before intervention, there were no significant differences in FMA and BBS scores or FAC grades between groups(all P>0. 05). After intervention, FMA and BBS scores and FAC grades increased in both groups compared with the baseline, and the isokinetic training group achieved higher FMA and BBS scores and higher FAC grades than the control group(all P<0. 05). Conclusion Adding portable isokinetic strength training to conventional comprehensive rehabilitation in the early stage after stroke may further reduce muscle tone and improve muscle strength of the paretic lower limb, thereby facilitating recovery of motor, balance, and walking abilities.