华西医学

华西医学

脑卒中腕屈肌的痉挛成分及其与量表的相关性

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目的 探究脑卒中患者痉挛的腕屈肌在被动牵伸时候阻抗的组成成分以及它们与临床量表(改良 Ashworth 量表、Fugl-Meyer 量表)评分间的关系。 方法 对 2017 年 3 月—8 月于中山大学附属第一医院康复医学科住院的 15 例脑卒中患者进行横断面研究。由经验丰富的物理治疗师进行改良 Ashworth 量表、Fugl-Meyer 量表评估。用 NeuroFlexor 记录腕、手指屈肌的被动运动阻力成分。以 5°/s 的速度被动伸腕,从腕屈曲 20° 至腕伸展 30°,被动牵伸至伸腕 30° 后的 1 s 内的平均阻力作为峰阻力。对健、患侧的峰阻力采用配对t 检验进行统计比较。用 Spearman 等级相关检验各被动运动阻力成分、峰阻力与临床量表(改良 Ashworth 量表 Fugl-Meyer 量表)评分之间的相关关系。 结果 缓慢被动牵伸(5°/s)时,患侧的峰阻力明显高于健侧[(10.49±1.65)、(8.98±1.11)N,P<0.05]。改良 Ashworth 量表评分与各阻力成分、峰阻力之间无线性相关性(P>0.05),Fugl-Meyer 量表评分与患侧神经成分有线性相关性(rs=–0.645,P=0.009)。 结论 痉挛的肌肉缓慢被动牵张时的峰阻力升高。痉挛侧腕关节的神经成分与 Fugl-Meyer 量表评分相关。这些发现可能可应用于脑卒中患者腕关节的临床功能评估。

Objective To explore the components of passive movement resistance in the wrist flexor in subjects after stroke, and investigate the correlations between these components and clinical scales such as Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment (FMA). Methods From March to August 2017, a cross-sectional study was performed in 15 stroke survivors in the Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University. MAS and FMA were assessed by an experienced physical therapist. Components of passive movement resistance in the flexors of wrist and finger were recorded by NeuroFlexor (Aggro MedTech AB, Solna, Sweden), then the average resisting force in one second ensued the passive stretch at 5°/s was took as peak resisting force (PRF). The PRF between paretic side and non-paretic side was compared. Spearman’s rank correlation was used to test the relation between the components and clinical scales. Results The PRF of the paretic side during the slow passive stretch (5°/s) was significantly higher than that of the non-paretic side [(10.49±1.65) vs. (8.98±1.11) N, P<0.05]. Correlations between MAS and the components/PRF were insignificant (P>0.05). FMA had a significant correlation with neural component of the paretic side (rs=–0.645, P=0.009). Conclusions The higher PRF of slow passive stretch in the paretic side may be attributed to the higher muscle stiffness. Neural component of the paretic wrist is correlated with FMA. These findings could be applied in clinical evaluation of functional performance of the wrist muscle of stroke survivors.

关键词: 脑卒中; 痉挛; 腕关节; 被动牵伸阻力

Key words: Stroke; Spasticity; Wrist joint; Passive stretch resistance 

引用本文: 卞瑞豪, 罗子翀, 黄鑫, 黄承发, 黄东锋, 李乐. 脑卒中腕屈肌的痉挛成分及其与量表的相关性. 华西医学, 2018, 33(10): 1238-1241. doi: 10.7507/1002-0179.201805178 复制

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