脑卒中恢复期软瘫患者上肢周围神经损伤与运动功能的相关性

doi:10.3969/j.issn.1006-9771.2020.11.015

摘要/Abstract

摘要：

目的通过神经电生理检查,评估脑卒中恢复期软瘫患者上肢周围神经损伤发生率,探讨上肢周围神经损伤与上肢运动功能之间的相关性,指导临床治疗及康复。方法 2015年12月至2019年10月,符合条件的脑卒中患者77例患侧上肢行运动神经传导、F波、皮肤交感反应(SSR)、针极肌电图(EMG)检查,采用简式Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。根据神经传导结果分为正常组和损伤组。结果损伤组共41例(53.25%)。损伤组FMA-UE评分低于正常组(t = 2.193, P < 0.05);F波振幅和出现率降低( t > 2.002, P < 0.05),SSR振幅和潜伏期明显下降( t > 3.140, P < 0.01),但损伤组F波出现率、SSR潜伏期均处正常参考值范围内。神经损伤数与FMA-UE评分负相关( r= -0.858, P < 0.001);线性回归分析显示,尺神经、桡神经、肌皮神经振幅是FMA-UE评分的影响因素(B > 0.317, P < 0.05)。结论脑卒中恢复期患者患侧上肢出现软瘫后,有可能出现上肢周围神经损伤,且与运动功能恢复有关;应尽量避免、及时治疗周围神经损伤。

关键词: 脑卒中, 恢复期, 软瘫, 运动功能, 上肢, 周围神经, 神经电生理

Abstract:

Objective To evaluate peripheral nerve injury in convalescent patients with peripheral paralysis after stroke, and explore the correlation between injured nerve and upper limb motor function.Methods From December, 2015 to October, 2019, 77 stroke patients were examined motor nerve conduction, F wave, skin sympathetic response (SSR) and electromyography (EMG) on the affected side upper limbs. They were divided into the normal group and the injured group, according to motor nerve conduction. They were assessed with simplified Fugl-Meyer Assessment-Upper Extremities (FMA-UE), and the correlation between the neuroelectrophysiological parameters and FMA-UE score was analyzed.Results There were 41 patients (53.25%) with peripheral nerve injury (injured group). FMA-UE score was less in the injured group than in the normal group (t = 2.193, P < 0.05), with lower amplitude and occurrence rate of F wave ( t > 2.002, P < 0.05), and lower amplitude and shorter latency of SSR ( t > 3.140, P < 0.01), although the occurrence rate of F wave and latency of SSR was in the reference range. There was correlation between numbers of injured nerves and FMA-UE score ( r= -0.858, P < 0.001). Multivariate linear regression analysis showed that the amplitudes of ulnar, radial and musculocutaneous nerves affected the FMA-UE score (B > 0.317, P < 0.05). Conclusion There may be peripheral nerves injury for patients with upper limb peripheral paralysis after stroke, which may impair the outcome of motor recovery, and need to be avoided and treated.

Key words: stroke, convalescence, peripheral paralysis, motor function, upper limb, peripheral nerves, neuroelectrophysiology

中图分类号:

R743.3

周昊,赵军,李冰洁,张宇,郭鸣. 脑卒中恢复期软瘫患者上肢周围神经损伤与运动功能的相关性[J]. 《中国康复理论与实践》, 2020, 26(11): 1333-1338.

ZHOU Hao,ZHAO Jun,LI Bing-jie,ZHANG Yu,GUO Ming. Correlation of Peripheral Nerve Injury to Motor Function of Upper Limb in Convalescent Patients with Peripheral Paralysis after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1333-1338.

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项目	正常组(n = 36)	损伤组(n = 41)	χ²/t值	P值
性别(n)			1.252	0.263
男	24	32
女	12	9
年龄(岁)	54.75±12.434	57.24±13.433	-0.841	0.403
卒中类型(n)			0.761	0.583
脑梗死	22	21
脑出血	14	20
FMA-UE评分	29.53±20.056	19.93±18.353	2.193	0.031
F波
潜伏期(ms)	23.16±1.561	22.68±5.742	0.511	0.611
振幅(mV)	6.10±2.068	4.94±2.866	2.002	0.049
出现率(%)	98.06±6.791	86.22±25.465	2.862	0.006
SSR
潜伏期(ms)	1146.90±434.107	574.53±699.502	3.140	0.004
振幅(mV)	1.36±1.009	0.25±0.401	3.388	0.007

失神经电位	有肌肉收缩	无肌肉收缩
有	9	10
无	58	73

组别	n	FMA-UE
A组	17	34.88±17.730
B组	24	9.33±9.201
t值		5.445
P值		< 0.001

神经	n	振幅(mV)	B	t值	P值	95%CI
尺神经	41	5.383±2.326	0.317	2.908	0.005	0.943~5.053
桡神经	35	3.598±1.436	0.369	3.264	0.002	2.212~9.214
肌皮神经	24	5.304±2.511	0.321	2.030	0.049	0.008~4.186
正中神经	41	4.942±2.866	0.186	1.701	0.093	-0.245~3.089
腋神经	24	5.113±2.700	0.099	0.572	0.570	-1.643~2.941