指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化

doi:10.3969/j.issn.1006-9771.2022.02.011

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (2): 204-211.doi: 10.3969/j.issn.1006-9771.2022.02.011

指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化

何紫艳^1a,唐晓晓^1a,田亚星^1a,姜凡^1b,阚秀丽^1a,沈显山^1a,毛晶^1a,徐军^1a,刘学^1b,吴建贤^1a,吴婷婷²,洪永锋^1a()

1.安徽医科大学第二附属医院,a.康复医学科;b超声科,安徽合肥市 230601
2.安徽医科大学附属口腔医院,安徽合肥市 230001

收稿日期:2021-09-09 修回日期:2022-01-18 出版日期:2022-02-25 发布日期:2022-03-09
通讯作者: 洪永锋 E-mail:hy_feng@163.com
作者简介:何紫艳(1996-),女,汉族,安徽黄山市人,硕士研究生,医师,主要研究方向：神经康复。
基金资助:
安徽医科大学校级课题临床科学基金项目(2020xkj196)

Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation

HE Ziyan^1a,TANG Xiaoxiao^1a,TIAN Yaxing^1a,JIANG Fan^1b,KAN Xiuli^1a,SHEN Xianshan^1a,MAO Jing^1a,XU Jun^1a,LIU Xue^1b,WU Jianxian^1a,WU Tingting²,HONG Yongfeng^1a()

1. a. Department of Rehabilitation Medicine; b. Ultrasonography Department, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
2. Stomatologic Hospital, Anhui Medical University, Hefei, Anhui 230001, China

Received:2021-09-09 Revised:2022-01-18 Published:2022-02-25 Online:2022-03-09
Contact: HONG Yongfeng E-mail:hy_feng@163.com
Supported by:
Clinical Science Foundation Project of Anhui Medical University(2020xkj196)

摘要/Abstract

摘要：

目的观察指部徒手感觉刺激(MDSS)前后脑卒中患者偏瘫侧手指屈、伸肌张力以及超声剪切波弹性成像(SWE)的变化规律。方法 2020年4月至6月,选取在安徽医科大学第二附属医院康复医学科住院的51例脑卒中偏瘫患者,对偏瘫侧5个手指的甲床、末节指骨两侧进行MDSS,刺激强度为能引起伸指但不致明显疼痛的最小强度,两次刺激间隔5~10 s。分别于MDSS前、MDSS后即刻采用改良Ashworth量表(MAS)评估偏瘫侧指浅屈肌、指深屈肌、拇长屈肌、指伸肌肌张力,低肌张力记作-1级;同时以SWE技术检测上述四组肌群中的剪切波速度(SWV)。结果 MDSS后,脑卒中患者四组肌群的MAS评级均显著降低(|Z| > 2.843, P < 0.001)。各肌群初始MAS评级为0和-1时,MDSS前后SWV均无显著性差异(t < 1.052, P > 0.05)。各肌群初始MAS评级为1~3时,MDSS后SWV均降低(t > 2.672, P < 0.05)。MDSS前后各肌群SWV与MAS评级均呈正相关(r > 0.334, P < 0.05)。结论 MDSS可有效、迅速、安全地降低脑卒中患者偏瘫侧手部肌群痉挛并促进主动伸指。SWE可客观、定量评估脑卒中偏瘫患者手部肌群肌张力。

关键词: 脑卒中, 痉挛, 指部徒手感觉刺激, 超声剪切波弹性成像, 改良Ashworth量表

Abstract:

Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

Key words: stroke, spasticity, manual digitorum sensory stimulation, shear-wave elastography, modified Ashworth Scale

中图分类号:

R743.3

何紫艳,唐晓晓,田亚星,姜凡,阚秀丽,沈显山,毛晶,徐军,刘学,吴建贤,吴婷婷,洪永锋. 指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化[J]. 《中国康复理论与实践》, 2022, 28(2): 204-211.

HE Ziyan,TANG Xiaoxiao,TIAN Yaxing,JIANG Fan,KAN Xiuli,SHEN Xianshan,MAO Jing,XU Jun,LIU Xue,WU Jianxian,WU Tingting,HONG Yongfeng. Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 204-211.

图/表 5

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肌张力	评级	指浅屈肌		指深屈肌		拇长屈肌		指伸肌
肌张力	评级	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后
低张力	-1	2.218±0.288	2.133±0263^a	2.385±0.431	2.373±0.185^b	2.365±0.191	2.390±0.042^c	2.623±0.489	2.550±0.785^d
MAS	0	2.761±0.560	2.562±0.210^e	2.521±0.483	2.420±0.565^f	2.585±0.417	2.515±0.476^g	2.742±0.549	2.645±0.463^h
	1	3.587±0.348	2.609±0.597ⁱ	3.499±1.051	2.484±0.488^j	3.708±0.570	2.671±0.621^k	3.934±0.738	2.808±0.543^l
	1⁺	4.285±1.034	2.713±0.283^m	4.021±0.417	2.467±0.605ⁿ	-	-	4.845±0.530	2.850±0.679^o
	2	4.497±1.155	2.947±0.760^p	3.631±0.965	2.704±0.708^q	4.278±0.774	2.903±0.889^r	5.396±0.714	3.451±0.702^s
	3	4.929±1.030	3.256±0.731^t	3.731±1.089	2.895±0.832^u	5.530±0.636	3.340±0.438^v	5.295±0.615	3.920±0.679^w
	4	-	-	-	-	-	-	-	-
F值		11.329	-	3.765	-	26.385	-	20.962	-
P值		< 0.001	-	0.006	-	< 0.001	-	< 0.001	-

指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化

Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation

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项目	MDSS前		MDSS后
项目	r值	P值	r值	P值
指浅屈肌	0.780	< 0.001	0.552	< 0.001
指深屈肌	0.494	< 0.001	0.334	0.017
拇长屈肌	0.829	< 0.001	0.493	< 0.001
指伸肌	0.847	< 0.001	0.371	0.007

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