目的 比较不同踝关节治疗体位下发散式体外冲击波（rESWT）治疗脑卒中后小腿三头肌痉挛的临床疗效，为优化治疗方案提供循证依据。 方法 采用前瞻性随机单盲（对评估者设盲）对照设计，纳入2023年6月至2024年12月中山大学附属第五医院收治的58例患者，随机分为观察组（踝背屈位29例）和对照组（踝放松位29例）。两组均接受常规康复联合体外冲击波治疗。在治疗前（T₀）、治疗结束当天（T₁）、治疗结束2周（T₂）、治疗结束4周（T₃）评估踝关节综合痉挛量表（CSS）、10米步行时间（10MWT）、步频、改良Ashworth量表（MAS）、踝关节被动活动度（PROM）及Fugl-Meyer下肢运动功能量表（FMA-L）。 结果 干预后比较观察组与对照组的干预效果，主要发现如下：（1）CSS评分随时间显著下降，观察组在中期（T₂）和后期（T₃）评分显著低于对照组（P < 0.01），改善幅度更大（5.65分 vs. 3.17分，P = 0.003）。（2）10MWT结果显示两组改善趋势一致，但观察组在T₂时显著优于对照组（P < 0.01），总体改善更明显（7.76 s vs. 6.38 s）。（3）步频随时长而提高，观察组在T₂、T₃时均高于对照组（P < 0.05），提升幅度更大（15.41步/min vs. 11.31步/min）。（4）MAS评分显示，观察组在早中期（T₁、T₂）痉挛缓解优于对照组（P < 0.01），但T₃时对照组评分更低（P < 0.05）。（5）PROM量表显示，观察组在各时点踝背屈活动度改善均优于对照组（P < 0.001），总体改善更明显（7.65° vs. 4.76°）。（6）FMA-L评分同样显示观察组在各时点运动功能均优于对照组（P < 0.001），总体提升幅度更大（1.62分 vs. 0.55分）。 结论 在常规康复基础上，rESWT可显著改善脑卒中后踝痉挛及步行功能。俯卧位下踝背屈位在多项功能指标上优于踝放松位，提示牵伸状态可获得更佳疗效，推荐作为临床治疗首选体位。

Objective To compare the clinical efficacy of radial extracorporeal shock wave therapy （rESWT） applied with the ankle in different positions for treating triceps surae spasticity after stroke， and to provide evidence for optimizing treatment protocols. Methods A prospective， randomized， single-blind （assessor-blinded）， controlled design was employed. A total of 58 patients admitted to the hospital between June 2023 and December 2024 were enrolled and randomly assigned to either the experimental group （n = 29， ankle dorsiflexion position） or the control group （n = 29， ankle relaxation position）. Both groups received conventional rehabilitation therapy combined with extracorporeal shock wave treatment. Assessments were conducted at four time points： before treatment initiation （T₀）， on the final day of treatment （T₁）， at 2 weeks post-treatment （T₂）， and at 4 weeks post-treatment （T₃）. The outcome measures included the Composite Spasticity Scale （CSS） for the ankle， 10-Meter Walk Test time （10MWT）， step frequency， the Modified Ashworth Scale （MAS）， passive range of motion （PROM） of the ankle， and the Fugl-Meyer Assessment for lower extremity motor function （FMA-L）. Results The comparative analysis of intervention effects between the experimental and control groups revealed the following key findings： （1）CSS scores decreased significantly over time， with the experimental group showing markedly lower scores than the control group at both mid-term （T₂） and late-term （T₃） assessments （P < 0.01）， and a greater overall improvement （5.65 points vs. 3.17 points， P = 0.003）. （2）The 10MWT results demonstrated a consistent improving trend in both groups， although the experimental group performed significantly better than the control group at T₂ （P < 0.01）， with a more pronounced overall improvement （7.76 s vs. 6.38 s）. （3）Step frequency increased over time， with the experimental group exhibiting higher values than the control group at both T₂ and T₃ （P < 0.05）， and a greater magnitude of improvement （15.41 steps/min vs. 11.31 steps/min）. （4）MAS scores indicated that spasticity relief in the experimental group was superior to that in the control group during the early and mid-term phases （T₁， T₂） （P < 0.01）； however， the control group showed lower scores at T₃ （P < 0.05）. （5）PROM assessment revealed that ankle dorsiflexion range of motion improvement in the experimental group was significantly better than that in the control group at all time points （all P < 0.001）， with a greater overall increase （7.65° vs. 4.76°）. （6）FMA-L scores similarly demonstrated that motor function in the experimental group was superior to that in the control group at all assessed time points （all P < 0.001）， with a larger overall improvement （1.62 points vs. 0.55 points）. Conclusions rESWT combined with conventional rehabilitation effectively alleviates ankle spasticity and improves gait and motor function in post-stroke patients. Administering rESWT with the ankle in a dorsiflexed position yields superior therapeutic effects on a comprehensive set of functional outcomes compared to a relaxed ankle position. Therefore， the dorsiflexion position is recommended as the preferred posture for clinical application of rESWT in this patient population.