中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2006年
20期
170-172
,共3页
刘雅丽%高伟%尤春景%郭铁成%许涛%喻澜
劉雅麗%高偉%尤春景%郭鐵成%許濤%喻瀾
류아려%고위%우춘경%곽철성%허도%유란
脊髓损伤%痉挛%电生理学%肌电描记术
脊髓損傷%痙攣%電生理學%肌電描記術
척수손상%경련%전생이학%기전묘기술
背景:中枢神经系统受损后,肌电图F波是检测损伤节段以下的腱反射和肌张力的有价值的手段.上运动神经元损伤所致的痉挛、僵硬和肌张力增高可以有F波放电的改变.然而,目前对脊髓损伤后F波的变化以及F波与损伤后节段以下肢体痉挛之间的关系尚不十分明确.目的:分析脊髓损伤患者F波的最小潜伏期、F波的出现率以及F波的时间离散度各指标与脊髓损伤后痉挛之间的相关性.设计:病例-对照观察.单位:华中科技大学同济医学院附属同济医院康复医学科.对象:于2002-06/2004-03在华中科技大学同济医学院附属同济医院康复医学科住院的外伤性脊髓损伤患者29例,为脊髓损伤组;另选取同期正常健康自愿受试者29例,为正常对照组.方法:采用Ashworth量表对脊髓损伤患者双下肢痉挛程度进行分级,评定患者双侧髋关节屈曲、膝关节屈曲和踝背屈的Ashworth分级.采用丹麦产的Kepoint1.5型肌电图仪进行F波的检测.记录双下肢胫神经F波的最小潜伏期、F波的最大潜伏期和F波的出现率,计算F波的时间离散度(即为F波的最大潜伏期与F波的最小潜伏期之间的差值)以及F波的平均出现率.主要观察指标:比较各指标在脊髓损伤患者和正常人之间的差异并分析脊髓损伤患者痉挛与F波的时间离散度、F波的出现率以及F波的最小潜伏期之间的相关性.结果:纳入患者29例和正常对照者29例,均进人结果分析.①脊髓损伤患者F波的时间离散度值比正常对照者高,两者比较差异非常显著[分别为(9.2±1.9),(6.7±1.0)ms,P＜0.000 1].②脊髓损伤患者F波的出现率比正常对照者低,两者比较差异显著[分别为(84.5±6.2)%,(89.5±5.7)%,P＜0.05].③脊髓损伤患者F波的最小潜伏期比正常对照者高,两者比较差异无显著性(P＞0.05).④脊髓损伤患者F波的时间离散度与痉挛Ashworth评分之间呈线性正相关(r=0.790 31,P＜0.000 1);脊髓损伤患者F波的出现率与痉挛Ashworth评分之间呈线性正相关(r=0.742 03,P＜0.000 1);脊髓损伤患者F波的最小潜伏期与痉挛Ashworth评分之间无明显相关性(r=0.081 68,P＞0.05).结论:F波的时间离散度和F波的出现率可以作为脊髓损伤患者电生理评价的敏感性指标,用于评价脊髓损伤患者的痉挛程度.
揹景:中樞神經繫統受損後,肌電圖F波是檢測損傷節段以下的腱反射和肌張力的有價值的手段.上運動神經元損傷所緻的痙攣、僵硬和肌張力增高可以有F波放電的改變.然而,目前對脊髓損傷後F波的變化以及F波與損傷後節段以下肢體痙攣之間的關繫尚不十分明確.目的:分析脊髓損傷患者F波的最小潛伏期、F波的齣現率以及F波的時間離散度各指標與脊髓損傷後痙攣之間的相關性.設計:病例-對照觀察.單位:華中科技大學同濟醫學院附屬同濟醫院康複醫學科.對象:于2002-06/2004-03在華中科技大學同濟醫學院附屬同濟醫院康複醫學科住院的外傷性脊髓損傷患者29例,為脊髓損傷組;另選取同期正常健康自願受試者29例,為正常對照組.方法:採用Ashworth量錶對脊髓損傷患者雙下肢痙攣程度進行分級,評定患者雙側髖關節屈麯、膝關節屈麯和踝揹屈的Ashworth分級.採用丹麥產的Kepoint1.5型肌電圖儀進行F波的檢測.記錄雙下肢脛神經F波的最小潛伏期、F波的最大潛伏期和F波的齣現率,計算F波的時間離散度(即為F波的最大潛伏期與F波的最小潛伏期之間的差值)以及F波的平均齣現率.主要觀察指標:比較各指標在脊髓損傷患者和正常人之間的差異併分析脊髓損傷患者痙攣與F波的時間離散度、F波的齣現率以及F波的最小潛伏期之間的相關性.結果:納入患者29例和正常對照者29例,均進人結果分析.①脊髓損傷患者F波的時間離散度值比正常對照者高,兩者比較差異非常顯著[分彆為(9.2±1.9),(6.7±1.0)ms,P＜0.000 1].②脊髓損傷患者F波的齣現率比正常對照者低,兩者比較差異顯著[分彆為(84.5±6.2)%,(89.5±5.7)%,P＜0.05].③脊髓損傷患者F波的最小潛伏期比正常對照者高,兩者比較差異無顯著性(P＞0.05).④脊髓損傷患者F波的時間離散度與痙攣Ashworth評分之間呈線性正相關(r=0.790 31,P＜0.000 1);脊髓損傷患者F波的齣現率與痙攣Ashworth評分之間呈線性正相關(r=0.742 03,P＜0.000 1);脊髓損傷患者F波的最小潛伏期與痙攣Ashworth評分之間無明顯相關性(r=0.081 68,P＞0.05).結論:F波的時間離散度和F波的齣現率可以作為脊髓損傷患者電生理評價的敏感性指標,用于評價脊髓損傷患者的痙攣程度.
배경:중추신경계통수손후,기전도F파시검측손상절단이하적건반사화기장력적유개치적수단.상운동신경원손상소치적경련、강경화기장력증고가이유F파방전적개변.연이,목전대척수손상후F파적변화이급F파여손상후절단이하지체경련지간적관계상불십분명학.목적:분석척수손상환자F파적최소잠복기、F파적출현솔이급F파적시간리산도각지표여척수손상후경련지간적상관성.설계:병례-대조관찰.단위:화중과기대학동제의학원부속동제의원강복의학과.대상:우2002-06/2004-03재화중과기대학동제의학원부속동제의원강복의학과주원적외상성척수손상환자29례,위척수손상조;령선취동기정상건강자원수시자29례,위정상대조조.방법:채용Ashworth량표대척수손상환자쌍하지경련정도진행분급,평정환자쌍측관관절굴곡、슬관절굴곡화과배굴적Ashworth분급.채용단맥산적Kepoint1.5형기전도의진행F파적검측.기록쌍하지경신경F파적최소잠복기、F파적최대잠복기화F파적출현솔,계산F파적시간리산도(즉위F파적최대잠복기여F파적최소잠복기지간적차치)이급F파적평균출현솔.주요관찰지표:비교각지표재척수손상환자화정상인지간적차이병분석척수손상환자경련여F파적시간리산도、F파적출현솔이급F파적최소잠복기지간적상관성.결과:납입환자29례화정상대조자29례,균진인결과분석.①척수손상환자F파적시간리산도치비정상대조자고,량자비교차이비상현저[분별위(9.2±1.9),(6.7±1.0)ms,P＜0.000 1].②척수손상환자F파적출현솔비정상대조자저,량자비교차이현저[분별위(84.5±6.2)%,(89.5±5.7)%,P＜0.05].③척수손상환자F파적최소잠복기비정상대조자고,량자비교차이무현저성(P＞0.05).④척수손상환자F파적시간리산도여경련Ashworth평분지간정선성정상관(r=0.790 31,P＜0.000 1);척수손상환자F파적출현솔여경련Ashworth평분지간정선성정상관(r=0.742 03,P＜0.000 1);척수손상환자F파적최소잠복기여경련Ashworth평분지간무명현상관성(r=0.081 68,P＞0.05).결론:F파적시간리산도화F파적출현솔가이작위척수손상환자전생리평개적민감성지표,용우평개척수손상환자적경련정도.
BACKGROUND: After the damage of central nervous system, F-waves of electromyography is the valuable way for detecting tendon reflex and muscular tension below injured segment. The increase of spasm, stiffness and muscular tension induced by upper motor neuron injury can revoke change of F-waves.However, change of F-waves after spinal injury, and relationship between Fwaves and spasm of lower limb after injury are still unclear at present.OBJECTIVE: To analyze the correlation of minimal latency, occurrence rate and every index of dispersion-time degree of F-waves with post-injured spinal cord spasm in patients with spinal injury.DESIGN: Case-control observation.SETTING: Department of Rehabilitative Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: Totally 29 patients with traumatic spinal cord injury,who were hospitalized at Department of Rehabilitative Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology between June 2002 and March 2004, were selected as spinal injury group. Another 29 normal healthy volunteers were enrolled as normal control group in the same period. METHODS: Spasm level of both lower extremities in patients with spinal injury was graded with Ashworth scale to assess flexion of both coax, flexion of knee joint and Ashworth grade of dorsiflexion of ankle. F-waves was detected with Kepoint1.5 type EMG instrument produced by Denmark.Minimal latency, maximal latency and occurrence rate of F-waves of tibial nerve of both lower extremities were recorded. The discrete-time degree (difference value of maximal latency of F-waves and minimal latency of Fwaves) and mean occurrence rate of F-waves were calculated.MAIN OUTCOME MEASURES: The difference of each index between patients with spinal injury and normal persons was compared and the correlation of spasm with discrete-time degree, occurrence rate and minimal latency of F-waves in patients with spinal injury was analyzed.RESULTS: A total of 29 patients and 29 normal persons were involved in the result analysis. ①The discrete-time degree of F-waves in patients with spinal injury was higher than that in the normal persons, which had significant difference [(9.2±1.9), (6.7±1.0) ms, P ＜ 0.000 1]. ②The occurrence rate of F-waves in patients with spinal injury was lower than that in normal persons, which had significant difference [(84.5±6.2)%, (89.5 ±5.7)%, P ＜ 0.05]. ③The minimal latency of F-waves in patients with spinal injury was higher than that in normal persons, which had insignificant difference ( P ＞ 0.05). ④The discrete-time degree of F-waves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth (r=0.790 31, P＜ 0.000 1). The occurrence rate of Fwaves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth (r=0.742 03, P ＜ 0.000 1 ). The minimal latency of F-waves in patients with spinal injury had insignificant correlation with score of spasm Ashworth (r=0.081 68, P ＞ 0.05).CONCLUSION: The discrete-time degree and occurrence rate of F-waves can be used as sensitive index to evaluate electrophysiology in patients with spinal injury so as to assess the level of spasm in patients with spinal injury.
