三维打印分指板对脑卒中早期患者手指痉挛的疗效评价

doi:10.16138/j.1673-6087.2021.04.007

摘要/Abstract

摘要：

目的：探讨应用三维（three dimension,3D）打印分指板对脑卒中早期患者手指痉挛及其康复疗效。方法：选取90例脑卒中手功能障碍患者,按照随机数字表法分为3D打印组、传统组及对照组3组。分别给予个性化制作的3D打印分指板治疗、工厂批量生产的传统分指板治疗及常规良肢位摆放治疗。在基线及治疗3个月后,分别评估患者表面肌电图（surface electromyography,sEMG）手指屈肌群被动均方根（root-mean-square,RMS）值、改良阿什沃思量表（modified Ashworth scale,MAS）、Fugl-Meyer评定上肢（Fugl-Meyer assessment upper extremity, FMA-UE）、手指关节活动度（掌指、近端指间、远端指间）、改良巴塞尔指数（modified Barthel index,MBI）。结果：共有86例患者完成本研究,年龄59~79（70.92±4.75）岁,其中3D打印组29例,传统组28例,对照组29例。3组患者手指屈肌群被动RMS值、手MAS评级、FMA-UE及MBI均较治疗前差异有统计学意义（均P<0.001）,3组患者关节活动度（掌指、近端指间、远端指间）治疗前后差异无统计学意义（均P>0.05）。治疗3个月后,3组患者手指屈肌群被动RMS、MAS、FMA-UE、MBI指标差异有统计学意义（均P<0.05）, 3D打印组均优于传统组及对照组（均P<0.05）;但3组患者的关节活动度差异无统计学意义（P>0.05）。结论：早期使用3D打印分指板可有效预防脑卒中患者手指肌张力的升高和痉挛的发生,促进上肢运动功能恢复,改善患者日常生活活动能力。

关键词: 3D打印分指板, 脑卒中, 肌张力, 上肢运动功能, 关节活动度, 日常生活活动能力

Abstract:

Objective To explore the early use of three dimensional (3D) printing fingerboard to prevent finger spasm in the stroke patients and its rehabilitation effect. Methods Totally 90 cases of the stroke patients with hand dysfunction were divided into 3 groups according to random single-blind method, which included 3D printing group, traditional group and control group. They were treated with personalized 3D printing finger splint, traditional finger splint from factory mass production and conventional good limb positioning. Before starting treatment and after 3 months treatment, the patients’ surface electromyography(sEMG), passive root-mean-square(RMS) value of flexor finger group, modified Ashworth scale (MAS), Fugl-Meyer assessment upper extremity (FMA-UE), range of motion (metacarpal, proximal interphalangeal, distal interphalangeal), and modified Barthel index (MBI) were assessed. Results A total of 86 patients completed the study, and the age range were 59-79 (70.92±4.75) years, including 29 cases in 3D printing group, 28 cases in traditional group, and 29 cases in control group. The passive RMS value of finger flexor group, hand MAS rating, FMA-UE and MBI of 3 group patients were significantly different from those before treatment(all P<0.001). The joint range of motion of 3 group patients (march finger, proximal finger, far finger) had no statistical difference before and after treatment (all P>0.05). After 3 months treatment, the passive RMS, MAS, FMA-UE and MBI indexes of the finger flexors of 3 groups were statistically different(all P<0.05). Comparison among groups, the 3D printing group was better than traditional group and control group(both P<0.05); but there was no statistical difference in the range of motion among 3 group patients (P>0.05). Conclusions Early use of 3D printed fingerboards can effectively prevent increasing of finger muscle tension and spasm in the stroke patients, promote recovery of upper limbs motor functions, and improve patients’ activities of daily living.

Key words: Three dimensional printed fingerboard, Stroke, Muscle tension, Upper limb motor function, Joint range of motion, Activities of daily living

中图分类号:

R743

陆春华, 王凯, 曾贞, 张琴, 何雯, 郑春红, 张晓, 李果. 三维打印分指板对脑卒中早期患者手指痉挛的疗效评价[J]. 内科理论与实践, 2021, 16(04): 255-260.

LU Chunhua, WANG Kai, ZENG Zhen, ZHANG Qin, HE Wen, ZHEN Chunhong, ZHANG Xiao, LI Guo. Effects of three dimensional printing fingerboard on finger spasm in early stroke patients[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 255-260.

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参考文献 20

[1]	张恺, 凌文杰. 综合康复干预对脑卒中偏瘫患者肢体功能恢复的影响[J]. 中华物理医学与康复杂志, 2020, 42(3): 249-251.
[2]	Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: 10.1016/S1474-4422(18)30500-3 URL
[3]	Kerr L, Jewell VD, Jensen L. Stretching and splinting interventions for poststroke spasticity, hand function, and functional tasks[J]. Am J Occup Ther, 2020, 74(5): 7405205050.
[4]	Choo YJ, Boudier-Revéret M, Chang MC. 3D printing technology applied to orthosis manufacturing: narrative review[J]. Ann Palliat Med, 2020, 9(6): 4262-4270. doi: 10.21037/apm-20-1185 pmid: 33040564
[5]	中华神经科学会, 中华神经外科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
[6]	王凯, 施毅颋, 何雯, 等. 3D打印分指板在脑卒中患者手功能康复中运用的初步研究[J]. 中国数字医学, 2018, 13(4): 41-44.
[7]	孙彤, 贾子善, 戈含笑, 等. 脑卒中后肢体痉挛的物理治疗研究进展[J]. 中国康复理论与实践, 2019, 25(5): 497-505.
[8]	崔利华, 山磊, 杨宇琦. 首次脑卒中后6个月内肢体痉挛情况调查[J]. 中国康复理论与实践, 2014, 20(12): 1144-1146.
[9]	中华医学会神经病学分会, 中华医学会神经病学分会神经康复学组, 中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南[J]. 中华神经科杂志, 2017, 50(6): 405-412.
[10]	Opie GM, Evans A, Ridding MC, et al. Short-term immobilization influences use-dependent cortical plasticity and fine motor performance[J]. Neuroscience, 2016, 330: 247-256. doi: 10.1016/j.neuroscience.2016.06.002 URL
[11]	刘维红. 手部矫形器分指板对脑卒中早期患者手功能恢复的影响[J]. 中华物理医学与康复杂志, 2014, 36(5): 399-400.
[12]	Basaran A, Emre U, Karadavut KI, et al. Hand splinting for poststroke spasticity: a randomized controlled trial[J]. Top Stroke Rehabil, 2012, 19(4): 329-337. doi: 10.1310/tsr1904-329 pmid: 22750962
[13]	Calabrò RS, Naro A, Russo M, et al. Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: a pilot ran-domized controlled trial[J]. PLoS One, 2017, 12(10): e0185936. doi: 10.1371/journal.pone.0185936 URL
[14]	Zheng Y, Liu G, Yu L, et al. Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial[J]. Clin Rehabil, 2020, 34(2): 194-204. doi: 10.1177/0269215519885174 URL
[15]	Wang K, Shi Y, He W, et al. The research on 3D printing fingerboard and the initial application on cerebral stroke patient’s hand spasm[J]. Biomed Eng Online, 2018, 17(1): 92. doi: 10.1186/s12938-018-0522-4 pmid: 29941033
[16]	Khoddami SM, Talebian S, Izadi F, et al. Validity and reliability of surface electromyography in the assessment of primary muscle tension dysphonia[J]. J Voice, 2017, 31(3): 386.
[17]	王凯, 施毅颋, 何雯, 等. 3D打印分指板和传统分指板对脑卒中患者手指痉挛的对照研究[J]. 康复学报, 2018, 28(1): 13-18.
[18]	Buyukavci R, Akturk S, Ersoy Y. Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients: an observational study[J]. Eur J Phys Rehabil Med, 2018, 54(5): 738-744.
[19]	林佳丽, 田靖, 贾杰. 老年脑卒中患者日常生活活动能力与上肢及手运动功能的相关性研究[J]. 老年医学与保健, 2020, 26(3): 362-366.
[20]	胡洁, 朱琳, 刘霖, 等. 上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能的疗效研究[J]. 中国康复, 2018, 33(6): 448-450.

项目	对照组（n=29）	传统组（n=28）	3D打印组（n=29）	χ²/F	P
男/女（n）	16/13	15/13	17/12	0.155	0.926
年龄（岁）	70.92±4.75	71.57±4.50	70.31±5.24	0.496	0.611
发病时间（d）	17.20±6.96	17.78±7.23	19.00±5.87	0.539	0.586
发病性质脑梗死/脑出血（n）	18/11	17/11	20/9	0.488	0.783
BrunnstromⅠ/Ⅱ（n）	27/2	24/4	25/4	0.957	0.620
有/无高血压（n）	14/15	15/13	16/13	0.302	0.860
有/无2型糖尿病（n）	13/16	14/14	12/17	0.432	0.806
有/无高脂血症（n）	7/22	5/23	6/23	0.341	0.843
有/无冠心病（n）	7/22	11/17	9/20	1.520	0.468

时间	对照组（n=29）	传统组（n=28）	3D打印组（n=29）	χ²/F	P₂
RMS（手指屈肌）（μV）
治疗前	3.86±0.95	3.66±0.94	3.67±0.95	0.412	0.664
治疗后	54.30±7.13	43.95±5.39²⁾	37.97±8.37¹⁾²⁾	39.321	<0.001
P₁	<0.001	<0.001	<0.001
手MAS（n）0/1/1+/2/3/4
治疗前	24/5/0/0/0/0	24/4/0/0/0/0	23/6/0/0/0/0	0.402	0.818
治疗后	0/3/10/11/6/0	0/8/10/8/2/0²⁾	0/14/11/4/0/0¹⁾²⁾	16.347	<0.001
P₁	<0.001	<0.001	<0.001
FMA-UE（分）
治疗前	4.07±1.98	4.46±1.64	4.72±1.41	1.098	0.338
治疗后	29.97±3.92	33.21±4.24²⁾	37.41±3.96¹⁾²⁾	24.736	<0.001
P₁	<0.001	<0.001	<0.001
掌指关节（°）
治疗前	85.14±3.84	83.82±3.52	85.31±3.62	1.396	0.253
治疗后	83.59±6.15	84.21±3.55	84.69±2.43	0.471	0.626
P₁	0.254	0.680	0.447
近端指间关节（°）
治疗前	103.03±3.97	102.04±4.15	100.69±4.89	2.109	0.128
治疗后	101.39±5.91	101.21±4.76	99.79±5.67	0.730	0.485
P₁	0.198	0.510	0.522
远端指间关节（°）
治疗前	76.69±2.92	77.46±2.06	77.45±2.83	0.808	0.449
治疗后	76.07±3.87	77.00±3.52	76.34±3.97	0.450	0.639
P₁	0.536	0.504	0.242
MBI（分,$\bar{x}±s$）
治疗前	19.76±5.67	20.25±5.66	19.00±5.42	0.363	0.697
治疗后	45.76±6.75	50.57±5.28²⁾	55.38±6.63¹⁾²⁾	17.059	<0.001
P₁	<0.001	<0.001	<0.001