CAJ | 학술논문

目的：利用超声肌肉检查技术观察抗痉挛治疗前后脑卒中患者的肌肉结构参数(MAP)变化规律，并分析其在痉挛评价中的作用和价值。方法选取脑卒中后接受口服抗痉挛药物、抗痉挛体位摆放、痉挛肌牵伸训练和拮抗肌主动收缩训练等抗痉挛治疗的6例患者作为研究对象。选取腓肠肌外侧头肌肉纤维作为研究靶肌肉，分别对健、患侧肢体进行评定和超声MAP测量。测量内容包括：改良Ashworth量表(MAS)分级评定；MAP中的肌肉羽状角度(PA)、肌纤维长度(FL)和肌纤维厚度(MT)。分析抗痉挛治疗前、治疗后2周及治疗后4周MAS和MAP的变化趋势和规律。结果脑卒中患者随着抗痉挛治疗时间的增加，MAS评分、PA和MT出现下降趋势，FL出现上升趋势。其中MAS评分治疗前与治疗后2周、4周相比有显著性差异(P<0.05)，而治疗后2周与治疗后4周相比无显著性差异(P>0.05)；MAP参数中：FL不仅治疗前与治疗后4周相比有显著性差异(P<0.05)，而且治疗后2周与治疗后4周相比较也有显著性差异(P<0.05)；PA治疗前与治疗后4周比较有显著性差异(P<0.05)；而MT治疗前及治疗后2周、4周间比较均无显著性差异(P>0.05)。结论评定肌纤维肌张力的显著性变化时，MAS与MAP均具有良好的敏感性，结合应用MAS和MAP可以更加准确客观地评定肌张力的细微变化，从而更好地评定临床抗痉挛治疗效果，指导治疗。
목적：이용초성기육검사기술관찰항경련치료전후뇌졸중환자적기육결구삼수(MAP)변화규률，병분석기재경련평개중적작용화개치。방법선취뇌졸중후접수구복항경련약물、항경련체위파방、경련기견신훈련화길항기주동수축훈련등항경련치료적6례환자작위연구대상。선취비장기외측두기육섬유작위연구파기육，분별대건、환측지체진행평정화초성MAP측량。측량내용포괄：개량Ashworth량표(MAS)분급평정；MAP중적기육우상각도(PA)、기섬유장도(FL)화기섬유후도(MT)。분석항경련치료전、치료후2주급치료후4주MAS화MAP적변화추세화규률。결과뇌졸중환자수착항경련치료시간적증가，MAS평분、PA화MT출현하강추세，FL출현상승추세。기중MAS평분치료전여치료후2주、4주상비유현저성차이(P<0.05)，이치료후2주여치료후4주상비무현저성차이(P>0.05)；MAP삼수중：FL불부치료전여치료후4주상비유현저성차이(P<0.05)，이차치료후2주여치료후4주상비교야유현저성차이(P<0.05)；PA치료전여치료후4주비교유현저성차이(P<0.05)；이MT치료전급치료후2주、4주간비교균무현저성차이(P>0.05)。결론평정기섬유기장력적현저성변화시，MAS여MAP균구유량호적민감성，결합응용MAS화MAP가이경가준학객관지평정기장력적세미변화，종이경호지평정림상항경련치료효과，지도치료。
Objective To observe the changes of muscle architecture parameters (MAP) in stroke by ultrasound before and after antispas-modic treatment. Methods 6 spastic hemplegic stroke patients were enrolled. All patients accepted anti-spastic rehabilitation training and took oral antispastic medicine. The muscle tone was assessed with modified Ashworth Scale (MAS), and MAP was measured by ultrasound before, 2 weeks and 4 weeks after treatment. MAP included pennation angle (PA), fascicle length (FL) and muscular thickness (MT). All da-ta were analyzed. Results There were significant difference in MAS between baseline level and 2 weeks, and 4 weeks after treatment (P<0.05). There were significant difference in FL and PA between baseline level and 4 weeks after treatment (P<0.05). There were statistical sig-nificance in FL between 2 weeks and 4 weeks after treatment as well (P<0.05). With the treatment, the difference in MAS, FL, PA and MT decreased between both side legs. Conclusion MAP and MAS are sensitive in evaluating the significant change of muscle tone. MAP com-bined with MAS may be optimal choice for evaluating antispasticity effects in poststroke.