脑卒中后腕屈肌痉挛的神经与外周因素的分型量化评估  

Classificated quantitative assessment of neural and peripheral factors in spasticity of wrist flexors after stroke

作　　者：冷雁[1,2] 卞瑞豪 罗炜樑[1,2] 李乐 黄东锋[2,3] LENG Yan;BIAN Ruihao;LUO Weiliang(Dept,of Rehabilitation Medicine,The First Affifiliated Hospital,Sun Yat-sen University,Guangzhou,510080)

机构地区：[1]中山大学附属第一医院康复医学科,广东省广州市510080 [2]广东省康复医学与临床转化工程技术研究中心 [3]中山大学附属第七医院康复医学科

出　　处：《中国康复医学杂志》2021年第10期1247-1252,共6页Chinese Journal of Rehabilitation Medicine

基　　金：国家重点研发计划项目(2020YFC2004300);国家自然科学基金(31771016);中山大学临床医学研究5010计划资助(2014001)。

摘　　要：目的:本研究旨在探索量化区分痉挛状态的神经及外周因素的可行性,了解痉挛肌肉的生物力学特性变化。方法:纳入脑卒中后痉挛性偏瘫患者40例,Neuro Flexor比较双侧腕屈肌被动牵伸时的神经成分阻力(neural component,NC)、肌肉弹性成分阻力(elasticity component,EC)和粘性成分阻力(viscosity component,VC),Myotonometer比较双侧桡侧腕屈肌的肌肉硬度(stiffness,S)及张力(frequency,F)。用改良Ashworth量表(modified Ashworth scale,MAS)评估患侧痉挛程度。不同方法测量的参数及其与MAS之间进行相关性分析。结果:Neuro Flexor测量的脑卒中患者的痉挛状态腕屈肌的NC、EC和VC均较健侧明显升高(P<0.05)。Myotonometer测量的痉挛状态腕屈肌的S和F都高于健侧(P<0.001)。相关性分析发现患侧EC与S(P=0.035)和F(P=0.007)呈弱到中等强度正相关,MAS与NC(P<0.001)、S(P=0.001)和F(P=0.006)均呈中等强度正相关。结论:脑卒中后痉挛状态腕屈肌的肌肉张力、硬度及粘性等生物力学特征变大,Neuro Flexor和Myotonometer测量的参数与MAS呈正相关,提示二者用于量化评估脑卒中后痉挛状态腕屈肌的神经和外周因素具有临床可行性。Objective:To explore the feasibility to distinguish the neural factors and peripheral factors that contribute to spasticity by quantitative methods to evaluate spasticity. The study also aimed to assess the biomechanical properties of spastic muscles.Method:Forty patients of stroke were included. The Neuroflexor was used to measure the neural component(NC) and the peripheral muscle tissues including the elasticity component(EC) and viscosity component(VC)of the wrist flexor muscles. Myotonometer was used to measure the muscle stiffness(S) and tension(F) of the bilateral flexor carpi radialis. Muscle spasticity was assessed by the the modified Ashworth scale(MAS).The correlation between the parameters measured by different methods and the MAS was analyzed.Result:The results of the Neuroflexor measurements in 40 stroke patients indicated the NC,EC and VC on the affected side were significantly higher than those on the normal side(P<0.05). The S and F of the affected side,as measured by Myotonometer,were significantly higher than those on the un-affected side(P<0.001).The results of the correlation analysis showed that there were mild to moderate positive correlations between EC with S(r=0.335,P=0.035) and F(r=0.417,P=0.007). Moderate positive correlations were observed between MAS with NC(r=0.566,P<0.001),MAS with S(r=0.512,P=0.001) and MAS with F(r=0.424,P=0.006).Conclusion:Muscle tension,stiffness and viscosity of spasm wrist flexor muscles increased after stroke occurrence. The quantitative parameters of spasticity measured by Neuro Flexor and Myotonometer were positively correlated with MAS, suggesting the clinical feasibility of Neuro Flexor and Myotonometer to quantify the neural factors and peripheral factors of spasticity in stroke.

关 键 词：脑卒中 痉挛状态 量化评估 神经因素 外周因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]