脑卒中偏瘫患者患侧和健侧上肢关节的等速肌力特征研究

关键词：脑卒中  等速肌力  患侧  健侧  握力  捏力  运动诱发电位

Keywords:stroke  isokinetic muscle strength  affected side  unaffected side  grip strength  pinch strength  motor evoked potential

摘要：

      摘要 目的：分析脑卒中患者患侧和健侧上肢肩关节和腕关节周围肌力特征。 方法：选取脑卒中偏瘫患者30例作为观察组，同时选取同龄健康人30例作为对照组。观察组患者双侧均进行肩和腕关节等速肌力测试（60°/s和120°/s）、握力及捏力测试、经颅磁刺激检测上肢运动诱发电位（motor evoked potential， MEP）。健康人对照组选择与观察组患侧相应的肢体侧进行检测。对观察组患侧等速肌力与Fugl-Meyer上肢运动功能评定量表（FMA-UE）和MEP进行相关性分析。 结果：①等速肌力测试：在60°/s和120°/s时，与健侧和对照组相比，观察组患侧肩屈伸肌、肩内收外展肌和腕屈伸肌的峰力矩（peak torque， PT）、总功（total work， TW）和平均功率（average power， AP）均显著下降（均P<0.05）；在60°/s时，与健康人相比，观察组健侧肩屈伸肌、肩内收外展肌和腕屈伸肌的PT、TW和AP均具有下降趋势，其中肩内收肌的PT、TW和AP下降具有显著性意义（P<0.05）；在120°/s时，与健康人相比，观察组健侧肩屈伸肌和肩内收外展肌的PT、TW和AP均具有下降趋势，其中，肩伸肌的PT、AP与肩内收肌的PT、TW和AP下降具有显著性意义（P<0.05）；腕屈肌的PT和AP、腕伸肌PT均有下降趋势。②握力及捏力测试：观察组患侧握力、指头—指侧捏力和指尖—指尖捏力较健侧和健康人均明显下降（均P<0.05）；观察组健侧握力、指头—指侧捏力和指尖—指尖捏力较健康人均明显下降（P<0.05）。③神经电生理检测：患侧上肢MEP潜伏期和中枢运动传导时间（central motor conduction time， CMCT）较健侧和健康人均明显延长（均P<0.05）；与健康人相比，健侧上肢MEP潜伏期和CMCT差异无显著性意义（P>0.05）。④相关性分析：观察组患侧上肢肩和腕关节周围肌群的等速肌力与FMA-UE均有明显正相关（P<0.05）；但与患侧上肢MEP潜伏期和CMCT无相关性。 结论：脑卒中偏瘫患者双侧均存在肌力下降的现象，且在Brunnstrom Ⅲ期之后，肌力可能与运动神经传导速度无关。未来的研究和临床治疗应该扩大关注范围，不局限于患侧，提倡双侧评估及训练。

Abstract:

      Abstract Objective： To analyze the characteristics of muscle strength around the shoulder and wrist joints of the ipsilateral and contralateral upper limbs of stroke patient. Method： A total of 30 stroke patients with hemiplegia were selected as the observation group， and 30 healthy people of the same age were selected as the control group. In the observation group， all patients underwent bilateral shoulder and wrist isokinetic muscle strength tests （60°/s and 120°/s）， grip strength and pinch strength test，and upper extremity motor evoked potential （MEP） test by transcranial magnetic stimulation. In the healthy control group， the limbs corresponding to the affected side of the observation group were detected. The correlation analysis was performed between the results of isokinetic muscle strength test on the affected side of the observation group and FMA-UE and upper limb MEP. Result： ①Isokinetic muscle strength test：At 60°/s and 120°/s， compared with those of the healthy side and the control group， the peak torque （PT）， total work （TW） and average power （AP） of shoulder flexor and extensor muscles， shoulder adductors and abductors and wrist flexor and extensor muscles of the affected side in the observation group were significantly decreased （P<0.05）. At 60°/s， compared with those of the healthy people， the PT， TW and AP values of the shoulder flexor and extensor muscles， shoulder adductors and abductors and wrist flexors and extensors in the observation group showed a downward trend. And the PT， TW and AP values of the shoulder adductors decreased with statistical significance（P<0.05）. At 120°/s， compared with the healthy people，the PT，TW and AP values of the shoulder flexor and abductor muscles on the healthy side of the observation group all showed a downward trend. The PT and AP of the shoulder extensor muscle， and the PT， TW and AP of the shoulder adductor muscle decreased with statistical significance （P<0.05）； the PT and AP value of the wrist flexor muscle and the PT value of the wrist extensor muscle showed a downward trend. ②Grip strength and pinch strength test： The grip strength， lateral pinch strength and fingertip pinch strength of the affected side of the observation group were significantly lower than those of the unaffected side and the healthy people （P<0.05）. The grip strength， lateral pinch strength and fingertip pinch strength of the unaffected side of the observation group were significantly lower than those of the healthy people （P<0.05）. ③Neuroelectrophysiological test： The MEP latency and central motor conduction time （CMCT） of the affected upper limb were significantly longer than those of the healthy side and healthy person （P<0.05）； There was no significant difference in the MEP latency and CMCT between the healthy upper limb and the healthy people （P>0.05）. ④Correlation analysis： In the observation group， isokinetic muscle strength of the muscle groups around the shoulder and wrist joints of the affected side were significantly positively correlated with FMA-UE （P<0.05）， while had no correlation with MEP latency and CMCT of the affected upper limb. Conclusion： Stroke patients with hemiplegia have bilateral muscle strength decline， and after Brunnstrom Ⅲ， muscle strength may not be related to motor nerve conduction velocity. Future research and clinical treatment should expand the focus beyond the affected side and advocate bilateral assessment and training.