摘要
目的:比较脑卒中后偏瘫患者患侧肢体与健侧肢体、健康人股骨近端骨密度,分析患侧肢体运动能力、病程、日常生活活动能力与股骨近端骨密度关系。方法:选择2001-12/2004-12在抚顺市第三医院神经内科住院的脑卒中后偏瘫患者115例(患者组),男76例,女39例;病程≥6个月62例,<6个月53例。Brunstrom分期Ⅰ～Ⅱ期,Ⅲ～Ⅳ期,Ⅴ～Ⅵ期患者分别为21,38,56例。日常生活活动能力佳组72例(Barthel指数≥40分),日常生活活动能力差组43例(Barthel指数<40分)。排除常年服用激素或其他各种影响骨代谢药物者。选择常年在本院作健康体检的正常人和本院职工或家属98人为对照组,男51人,女47人。采用双能X线骨密度仪测定患者组患侧、健侧和对照组,不同病程、不同Brun-strom分期、不同生活活动能力患者患侧股骨近端骨密度。结果:按意向处理分析,进入结果分析脑卒中后偏瘫患者115例,健康人98人。①患者组的患侧股骨颈、大转子和Ward三角的骨密度值明显低于对照组和健侧犤(0.75±0.19),(0.58±0.16),(0.54±0.17)g/cm2;(0.85±0.16),(0.71±0.14),(0.63±0.16)g/cm2;(0.81±0.16),(0.69±0.17),(0.60±0.18)g/cm2,t=1.937～2.841,P<0.05～0.01犦。②病程长组患肢股骨颈和大转子骨密度明显低于病程短组犤(0.73±0.15),(0.57±0.16)g/cm2;(0.80±0.19),(0.71±0.20)g/cm2,t=2.031,2.329,P<0.05犦。③BrunnstromⅠ～Ⅱ期患者患肢股骨颈、大转子和Ward三角骨密度均明显低于Ⅲ～Ⅳ期和Ⅴ～Ⅵ期患者犤(0.73±0.21),(0.56±0.15),(0.53±0.18)g/cm2;(0.80±0.20),(0.69±0.18),(0.60±0.14)g/cm2;(0.81±0.19),(0.72±0.21),(0.60±0.11)g/cm2,t=2.195～2.392,P<0.05犦。④日常生活活动能力差组患侧股骨颈、大转子和Ward三角骨密度明显低于日常生活活动能力能力佳组犤(0.74±0.18),(0.59±0.15),(0.53±0.16)g/cm2;(0.82±0.20),(0.71±0.17),(0.59±0.19)g/cm2,t=2.209～2.346,P<0.05犦。结论:脑卒中后偏瘫患者常出现骨量丢失表现;患侧肢体股骨近端骨密度低于健康人和健侧;患侧肢体运动能力越差、病程越长、日常生活活动能力越差,股骨近端骨密度越低。
AIM:To study the femoral proximal bone mineral density among the affected and unaffected limbs of patients with post-stroke hemiplegia and healthy people,and analyze the associations of the motor ability of the affected limb,disease course and activities of daily life with the femoral proximal bone mineral density.METHODS:Totally 115 patients with post stroke hemiplegia(patient group,76 males and 39 females),who were hospitalized in the Department of Neurology,Fushun Third Hospital between December 2001 and December 2004,were involved in the study;The disease course was ≥ 6 months in 62 cases,and < 6 months in 53 cases;Brunstrom staging was I to II,III to IV,V to VI in 21,38 and 56 cases respectively;the activities of daily life was good in 72 cases(Barthel index ≥ 40 points) and bad in 43 cases(Barthel index< 40 points). The patients,who took hormone or other drugs that had influence on bone metabolism all around the years,were excluded.Ninety eight healthy subjects,who always undertook physical examination in this hospital,and the employees of this hospital or their relatives were taken as controls(control group,51 males and 47 females).The femoral proximal bone mineral density of the affected and unaffected limbs of the patients and the normal controls was determined with the dual energy X ray absorptiometry,and those of the affected limb of patients with different disease course,different Brunstrom staging and different activities of daily life were also determined.RESULTS:According to intention to treat analysis,115 patients with post stroke hemiplegia and 98 healthy people were involved in the analysis of results.① The values of bone mineral density at neck of femur,greater trochanter and Ward triangle of the affected limb in the patient group were obviously lower than those in the control group and unaffected side in the patient group[(0.75± 0.19),(0.58± 0.16),(0.54± 0.17) g/cm2;(0.85± 0.16),(0.71± 0.14),(0.63± 0.16) g/cm2;(0.81± 0.16),(0.69± 0.17),(0.60± 0.18) g/cm2,t=1.937 to 2.841,P< 0.05 to 0.01].② The values of bone mineral density at neck of femur and greater trochanter of the affected limb were obviously lower in the longer disease course group than in the shorter disease course group[(0.73± 0.15),(0.57± 0.16) g/cm2;(0.80± 0.19),(0.71± 0.20) g/cm2,t=2.031,2.329,P< 0.05].③ The values of bone mineral density at neck of femur,greater trochanter and Ward triangle of the affected limb were markedly lower in patients of Brunnstrom Ⅰ to Ⅱ stages than those of Ⅲ to Ⅳ and Ⅴ to Ⅵ stages[(0.73± 0.21),(0.56± 0.15),(0.53± 0.18)g/cm2;(0.80 ± 0.20),(0.69± 0.18),(0.60± 0.14)g/cm2;(0.81± 0.19),(0.72 ± 0.21),(0.60± 0.11)g/cm2,t=2.195 to 2.392,P< 0.05].④ The values of bone mineral density at neck of femur,greater trochanter and Ward triangle of the affected limb in the bad activities of daily life group were remarkably lower than those in the good activities of daily life group[(0.74 ± 0.18),(0.59± 0.15),(0.53± 0.16)g/cm2;(0.82± 0.20),(0.71 ± 0.17),(0.59± 0.19)g/cm2,t=2.209 to 2.346,P< 0.05].CONCLUSION:Patients with post stroke hemiplegia usually manifest by the loss of bone mass;The femoral proximal bone mineral density of the affected limb is lower than that of healthy people and the unaffected limb;The worse the motor ability of the affected limb,or the longer the disease course,or the worse the activities of daily life,the lower the femoral proximal bone mineral density.
出处
《中国临床康复》
CSCD
北大核心
2005年第19期163-165,共3页
Chinese Journal of Clinical Rehabilitation
