摘要
目的:观察脑卒中恢复期偏瘫上肢正中神经电生理变化及其与偏瘫侧肢体功能的相关性。方法:选取符合纳入标准的脑卒中恢复期患者30例,分别于T1(8～12周)、T2(16～20周)对其偏瘫侧和非偏瘫侧正中神经进行运动神经传导和感觉神经传导检查,以及双侧拇短展肌(APB)行同心圆针肌电图检查,采用Brunnstrom分期评估偏瘫侧手功能。分析脑卒中恢复期内不同时期正中神经电生理的差异及其与手功能Brunnstrom分期的相关性。结果:T1、T2正中神经偏瘫侧复合肌肉动作电位(CMAP)波幅和感觉神经电位(SNAP)波幅均较非偏瘫侧明显减低(P<0.05),偏瘫侧T2拇短展肌的自发电位分级较T1显著减少(P<0.05),偏瘫侧T2的手功能Brunnstrom分期较T1显著提高(P<0.05),偏瘫侧T1、T2自发电位分级与手功能Brunnstrom分期均呈负相关(T1:rs=-0.616,P<0.05;T2:rs=-0.781,P<0.05)。结论:中枢神经损伤继发的周围神经损伤以神经轴索损害为主,脑卒中恢复期偏瘫侧自发电位分级与手功能Brunnstrom分期具有相关性。
引文
[1]高一鹭,王文志.脑血管病流行病学研究进展[J].中华神经科杂志,2015,48(4):337-340.
[2]Simpson LA,Eng JJ,Backman CL,et al.Rating of everyday arm-use in the community and home(reach)scale for capturing affected arm-use after stroke:development,reliability,and validity[J].PloS One,2013,8(12):83405.
[3]Matsumoto S,Shimodozono M,Etoh S,et al.Anti-spastic effects of footbaths in post-stroke patients:aproof-of-principle study[J].Complement Ther Med,2014,22(6):1001-1009.
[4]王赛华,马艳,郭铁成.电生理检查在痉挛评估中的应用[J].中华物理医学与康复杂志,2017,39(10):787-789.
[5]Van Kuijk AA,Pasman JW,Hendricks HT,et al.Supratentorial ischemic stroke:more than an upper Motor neuron disorder[J].J Clin Neurophysiol,2007,24(6):450-455.
[6]Benecke R,Berthold A,Conrad B.Denervatitivity in the EMG of patients with upper motor neuron lesions:time course,local distribution and pathogenetic aspects.[J].J Neurol,1983,230(3):143-151.
[7]林楠.大鼠卒中后运动系统跨突触变性的电生理和病理研究[D].北京协和医学院,2014.
[8]王培,付娟娟,周停,等.脑卒中患者周围神经与肌肉神经电生理特征分析[J].中国康复医学杂志,2018,33(5):545-550.
[9]廖诚诚,冯珍.正中神经电刺激用于昏迷促醒的机制研究进展[J].中国康复医学杂志,2017,32(5):588-591.
[10]王荣.应用指频仪来评价上肢周围神经损伤的康复研究[D].2017.
[11]朱家恺,卢传新,王书诚,等.周围神经外科学[M].广州:三环出版社,1991:34-35.
[12]中华神经学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[13]崔丽英,潘华.轻松学习肌电图:神经传导检查和肌电图操作指南[M].北京:北京大学医学出版社,2017:42-43.
[14]Sevgi IA,Ilkin M,Oya UY,et al.Virtual reality in upper extremity rehabilitation of stroke patients:arandomized controlled trial[J].JStroke Cerebrovasc Dis,2018,27(12):3473-3478.
[15]Ya Z,Shin HH,Ying-Chih W,et al.Assessing hand muscle structural modifications in chronic stroke[J].Front Neurol,2018,9:296.
[16]Lukács M.Electrophysiological signs of changes in motor units after ischaemic stroke[J].Clin Neurophysiol,2005,116(7):1566-1570.
[17]Tuffaha SH,Budihardjo JD,Sarhane KA,et al.Growth hormone therapy accelerates axonal regeneration,promotes motor reinnervation,and reduces muscle atrophy following peripheral nerve injury[J].Plast Reconstr Surg,2016,137(6):1771-1780.
[18]党静霞.肌电图诊断与临床应用[M].北京:人民卫生出版社,2013:24-24.
[19]Souayah N,Saadeh P,Krivitskaya N,et al.Abnormal spontaneous muscle activity in plegic limb appears to initiate distal to the upper motor neuron:a case report in a stroke patient[J].J Vasc Interv Neurol,2013,5(2):1-3.
[20]Mcpherson LM,Negro F,Thompson CK,et al.Properties of the motor unit action potential shape in proximal and distal muscles of the upper limb in healthy and post-stroke individuals[J].Conf Proc IEEE Eng Med Biol Soc,2016(2016):335-339.
