王东岩¹，何　雷²，宋　晶²，张　蕊²

（1.黑龙江中医药大学附属第二医院，黑龙江哈尔滨 150000；2.黑龙江中医药大学研究生学院，黑龙江哈尔滨 150040）

摘要：研究目的：踝关节功能障碍是脑卒中患者常见的后遗症，有限的踝关节背屈会导致步行耗能的增大、步行持久度的下降和跌倒风险的增加。本研究评价不同低频穴位电刺激方法对脑卒中后踝背屈障碍患者步行能力的康复效果，并探讨踝背屈功能与步行能力间的关系，优化治疗方案。研究方法：将符合卒中后踝背屈障碍诊断标准与纳入标准的患者60例，按随机数字表法分为对照组（n=30）与治疗组（n=30）。对照组用常规低频穴位电刺激治疗，刺激患侧足三里（ST36）、阳陵泉（GB34），波形为断续波（断续比1：1），频率50Hz，每次20分钟，每日1次，治疗6天，休息1天，共治疗4周；治疗组用屈伸肌交替低频穴位电刺激治疗，刺激患侧足三里（ST36）、阳陵泉（GB34）、飞扬（BL58）、昆仑（BL60），电刺激参数、治疗时间及疗程均与对照组相同。分别在治疗前与治疗后用RM Gait步态分析系统、踝关节最大主动背屈角度、下肢Fulg-Meyer评分对康复效果进行评价。样本量估算利用PASS 11软件进行（α=0.05，1-β=80%，单侧检验），试验所获数据经由SPSS 23统计软件分析处理。研究结果：1．两组患者步速、步频、患侧步长的疗前、疗后差值组间差异有显著性意义（P＜0.05），治疗组优于对照组。2．两组患者患侧单支撑相占步态周期百分比、双支撑相占步态周期百分比的疗前、疗后差值组间差异有显著性意义（P＜0.05），治疗组优于对照组。3．两组患者患侧踝关节最大主动背屈角度的疗前、疗后差值组间差异有显著性意义（P＜0.05），两组患者下肢Fulg-Meyer评分的差值组间差异非常显著（P＜0.01），治疗组优于对照组。4．相关性分析提示患侧踝关节最大主动背屈角度的差值与步速、步频、患侧步长、患侧单支撑相占步态周期百分比、双支撑相占步态周期百分比的差值相关（P＜0.01）。研究结论：低频穴位电刺激能改善脑卒中患者的踝背屈功能，尤其对患者步行能力的提升疗效显著；屈伸肌交替低频穴位电刺激改善脑卒中患者踝关节功能的疗效优于常规低频穴位电刺激；踝背屈功能是影响步行能力的重要因素。

关键词：针灸推拿学，脑卒中；穴位电刺激；踝背屈；步态分析

Effects of Low-frequency Electrical Acupoint Stimulation on Improving Walking Ability of Poststroke Patients with Ankle Dorsiflexion Disorder

Dongyan Wang¹, Lei He², Rui Zhang², Jing Song²

(1.The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000,China; 2.Graduate School of Heilongjiang University Of Chinese Medicine, Harbin 150040,China)

Abstract： Background and Objective: Dysfunction of the ankle joint is a common sequela in stroke patients. Limited ankle dorsiflexion can lead to increased walking energy expenditure, decreased walking endurance and increased risk of falls. The purpose of this study was to evaluate the effect of different low-frequency acupoint electrical stimulation on walking ability in patients with ankle dorsiflexion disorder after stroke, and to explore the relationship between ankle dorsiflexion function and walking ability, and to optimize the treatment program. Methods: According to the random number table method, We selected 60 post-stroke patients with ankle dorsal flexion disorder and randomly divided them into the control group(n=30) and the treatment group(n=30). The control group received the routine low-frequency electrical acupoint stimulation treatment every day which lasted 20 mins and the whole course treatment was 4 weeks. Selecting 50Hz intermittent wave (intermittent ratio1:1) and the stimulating acupoints are Tsusanli(ST36) and Yanglingquan(GB34) on the affected side. The treatment group received flexor and extensor alternation of low-frequency electrical acupoint stimulation treatment and the stimulating acupoints are Tsusanli(ST36), Yanglingquan(GB34), Feiyang(BL58) and Kunlun(BL60) on the affected side. The electrical stimulation waveform, requency, frequency and duration of treatment in the treatment group were the same as the control group. Walking ability of patients was evaluated by using RM gait analysis system before and after treatment respectively. And the maximum ankle active dorsiflexion angle and lower extremity Fulg-Meyer score were measured. The sample size was estimated using PASS 11 software (alpha =0.05, 1- beta =80%, one sided test). The data obtained were analyzed and processed by SPSS 23 statistical software. Results: 1.The difference between before treatment and after treatment of walking speed, cadence, step-length on the affected side in the treatment group was significant when compared with the control group (P<0.05), the treatment group was better than the control group.2. The difference between before treatment and after treatment of single support phase time on the affected side, double support phase time in the treatment group was significant when compared with the control group (P<0.05), the treatment group was better than the control group.3.The difference between before treatment and after treatment of the maximum ankle active dorsiflexion angle in the treatment group was significant when compared with the control group (P<0.05), and the difference between before treatment and after treatment of lower extremity Fulg-Meyer score in the treatment group was very significant when compared with the control group (P<0.01), the treatment group was better than the control group.4.The differences between before treatment and after treatment in the maximum ankle active dorsiflexion angle and The differences between before treatment and after treatment in walking spatial and temporal parameters were analyzed by linear correlation, P<0.01, showing relevance. Conclusion: Low frequency acupoint electrical stimulation can improve the ankle dorsiflexion function in patients with stroke, especially for the improvement of walking ability of patients; Flexor and extensor alternation of low-frequency electrical acupoint stimulation treatment is better than the conventional low-frequency electrical acupoint stimulation treatment on improving the function of ankle back flexion of poststroke patients. Ankle dorsiflexion is an important factor affecting walking ability.

Key words: Acupuncture,　Stroke, Electrical acupoint stimulation, Ankle dorsal flexion, Gait analysis