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目的探讨脑卒中对下肢肌肉协调性的影响以及康复训练对肌肉功能的改善作用。方法共选取10例脑卒中偏瘫患者(处于基线期)和6例年龄和性别与之相匹配的正常对照者。采用速度编码相位对比MRI(VE-PC MRI)和表面肌电图(sEMG)评价膝关节屈伸运动中股四头肌和大腿后部及内侧肌群(腘绳肌和内收肌群)的肌肉协调性以及康复训练对上述肌肉的影响。结果VE-PC MRI检查结果显示,在基线期间,患侧股直肌的最大运动速度较正常对照者显著降低(P<0.01),且股直肌和股肌(股内侧肌、股中间肌、股外侧肌)达到最大运动速度的时间具有非同步性,而正常对照者具有同步性。患肢伸膝时大腿内、后组肌群和股四头肌的共同收缩较正常对照者明显(P<0.05),共同收缩主要归因于内收肌群的活动。sEMG结果表明,患侧股直肌和股二头肌在膝屈伸运动时的活动水平显著高于正常对照者(P<0.05),各组间股内侧肌的活动水平差异无统计学意义。患侧股二头肌和股四头肌的共同收缩水平较正常对照者显著(P<0.05)。经平均40d康复训练后随访发现,脑卒中患者Barthel指数评分显著提高(P<0.05),患侧股四头肌各部分肌肉活动趋向于同步性。结论脑卒中患者股直肌和股肌的收缩具有非同步性,股直肌在脑卒中后其功能受拟较严重。VE-PC MRI可定量评价在体肌肉功能活动信息,对于指导行之有效的个体化康复治疗具有重要意义。
Objective To investigate the effect of stroke on muscular coordination of lower limbs and the effect of rehabilitation training on muscle function. Methods A total of 10 patients with stroke (baseline) and 6 healthy controls matched for age and gender were selected. The muscles of the quadriceps femoris and posterior and medial muscular groups (hamstrings and adductor muscles) in knee flexion and extension exercises were evaluated by velocity-coded phase contrast MRI (VE-PC MRI) and surface electromyography (sEMG) Coordination and the impact of rehabilitation training on these muscles. Results The results of VE-PC MRI showed that the maximal speed of ipsilateral rectus femoris was significantly lower than that of the normal controls (P <0.01) at baseline, and the rectus femoris and femoral muscles (medialis, medialis, Lateral femoral muscle) reached the maximum speed of the time with asynchronous, and normal controls were synchronized. The common contraction of the thigh, the posterior group muscle and the quadriceps muscle was significant (P <0.05) compared with the normal control when the knee extensor knee was extended. The common contraction was mainly attributed to the adduct muscle activity. The results of sEMG showed that the activities of ipsilateral rectus femoris and biceps femoris were significantly higher than those of normal controls (P <0.05). There was no significant difference in the activities of medial femur between each group. The contractile level of ipsilateral biceps femoris and quadriceps femoris was significantly higher than that of normal controls (P <0.05). After an average of 40 days of rehabilitation training, Barthel index score was significantly increased in stroke patients (P <0.05). The muscle activities of various quadriceps muscles tended to be synchronous. Conclusion The contractions of the rectus femoris muscle and femoral muscle in patients with stroke are asynchronous, and the function of the rectus femoris muscle is more serious after stroke. VE-PC MRI can quantitatively evaluate the information of functional activity of muscle in vivo and is of great significance for guiding the effective individualized rehabilitation.