PNF技术调整骨盆控制能力改善卒中患者步行及平衡功能的临床研究

Clinical study of proprioceptive neuromuscular facilitation regulating control of pelvic in improving walking and balance function in stroke patients with hemiplegia

关键词:  卒中  偏瘫  本体感觉神经肌肉促进技术  骨盆控制  步行功能  平衡功能

Key words:  stroke  hemiplegia  proprioceptive neuromuscular facilitation  pelvic control  walking function  balance function

摘要:

[目的] 探讨本体感觉神经肌肉促进技术（PNF）调整骨盆控制能力改善脑卒中患者步行及平衡功能的临床疗效。[方法] 将纳入符合纳入标准的脑卒中患者随机分为对照组和PNF组。两组患者均给予常规对症支持治疗及针刺治疗；同时对照组给予常规康复训练；而PNF组则予以PNF技术调整骨盆控制能力。于治疗前后采用美国国立卫生院脑卒中量表（NIHSS）量表评价患者的神经功能缺损程度并评价临床疗效；采用改良Ashworth量表评价髋、膝、踝关节肌张力；Fugl-Meyer量表评价运动功能；改良的Barthel指数量表（MBI）评价日常生活活动能力；Berg平衡量表评价平衡能力；计时起立行走测试评价跌倒风险；10 m步行测试评价步行功能；印迹法评价步态。[结果] 与治疗前相比，两组患者髋、膝、踝关节MAS评分显著降低（均P<0.01），FMA-LE和MBI评分显著提高（P<0.05，P<0.01）；治疗后两组患者的步行和平衡能力明显提高，抗跌倒能力增加，步态明显改善（均P<0.01）；且PNF组的改善效果更为明显（均P<0.05）。[结论] PNF技术通过调整骨盆控制能力来增强骨盆及躯干的稳定性，能有效纠正偏瘫患肢的异常肌张力，进而改善步行功能，降低跌倒风险，提高生活自理能力。

Abstract:

[Objective] In this study,the clinical efficacies of proprioceptive neuromuscular facilitation (PNF) regulating control of pelvic in the treatment of walking and balance function in patients with hemiplegia after stroke were investigated. [Methods] Stroke patients who met the inclusion criteria were randomly divided into control and PNF groups. Both groups of patients were given routine symptomatic support treatment and acupuncture treatment. Beside this,the control group was given regular rehabilitation training and the PNF group was given PNF treatment to regulate control of pelvic. Before and after treatment,the NIHSS scale was used to evaluate the degree of neurological deficit and evaluate the clinical efficacy;the modified Ashworth scale was used to evaluate the hip,knee and ankle joint muscle tension;the Fugl-Meyer scale was used to evaluate the motor function;and the improved Barthel index was evaluated. Daily life activity ability;Berg balance scale to evaluate balance ability;timed standing test to assess fall risk;10 m walk test to evaluate walking function;and ink-blotting method to assess gait. [Results] Compared with before treatment,the MAS scores of hip,knee and ankle were significantly lower in both groups (P<0.01),and the FMA-LE and MBI scores were significantly increased (P<0.05,P<0.01). The patient's balance ability and walking ability were significantly improved,and the anti-fall ability was increased (all P<0.01);and the improvement effect of the PNF group was more obvious (P<0.05). [Conclusion] PNF can effectively improve the muscle tension of stroke patients with hemiplegia,thereby improving the walking function of patients,reducing the risk of falls and improving the ability of self-care through improving the stability of bone and trunk by adjusting pelvic control.