摘要
背景:中枢神经系统受损后,肌电图F波是检测损伤节段以下的腱反射和肌张力的有价值的手段。上运动神经元损伤所致的痉挛、僵硬和肌张力增高可以有F波放电的改变。然而,目前对脊髓损伤后F波的变化以及F波与损伤后节段以下肢体痉挛之间的关系尚不十分明确。目的:分析脊髓损伤患者F波的最小潜伏期、F波的出现率以及F波的时间离散度各指标与脊髓损伤后痉挛之间的相关性。设计:病例-对照观察。单位:华中科技大学同济医学院附属同济医院康复医学科。对象:于2002-06/2004-03在华中科技大学同济医学院附属同济医院康复医学科住院的外伤性脊髓损伤患者29例,为脊髓损伤组;另选取同期正常健康自愿受试者29例,为正常对照组。方法:采用Ashworth量表对脊髓损伤患者双下肢痉挛程度进行分级,评定患者双侧髋关节屈曲、膝关节屈曲和踝背屈的Ashworth分级。采用丹麦产的Kepoint1.5型肌电图仪进行F波的检测。记录双下肢胫神经F波的最小潜伏期、F波的最大潜伏期和F波的出现率,计算F波的时间离散度(即为F波的最大潜伏期与F波的最小潜伏期之间的差值)以及F波的平均出现率。主要观察指标:比较各指标在脊髓损伤患者和正常人之间的差异并分析脊髓损伤患者痉挛与F波的时间离散度、F波的出现率以及F波的最小潜伏期之间的相关性。结果:纳入患者29例和正常对照者29例,均进入结果分析。①脊髓损伤患者F波的时间离散度值比正常对照者高,两者比较差异非常显著眼分别为(9.2±1.9),(6.7±1.0)ms,P<0.0001演。②脊髓损伤患者F波的出现率比正常对照者低,两者比较差异显著眼分别为(84.5±6.2)%,(89.5±5.7)%,P<0.05演。③脊髓损伤患者F波的最小潜伏期比正常对照者高,两者比较差异无显著性穴P>0.05雪。④脊髓损伤患者F波的时间离散度与痉挛Ashworth评分之间呈线性正相关(r=0.79031,P<0.0001);脊髓损伤患者F波的出现率与痉挛Ashworth评分之间呈线性正相关(r=0.74203,P<0.0001);脊髓损伤患者F波的最小潜伏期与痉挛Ashworth评分之间无明显相关性(r=0.08168,P>0.05)。结论:F波的时间离散度和F波的出现率可以作为脊髓损伤患者电生理评价的敏感性指标,用于评价脊髓损伤患者的痉挛程度。
BACKGROUND：. After the damage of central nervous system, F-waves of electromyography is the valuable way for detecting tendon reflex and muscular tension below injured segment. The increase of spasm, stiffness and muscular tension induced by upper motor neuron injury can revoke change of F-waves. However, change of F-waves after spinal injury, and relationship between F-waves and spasm of lower limb after injury are still unclear at present.
OBJECTIVE： To analyze the correlation of minimal latency, occurrence rate and every index of dispersion-time degree of F-waves with pest-injured spinal cord spasm in patients with spinal injury.
DESIGN： Case-control observation.
SETTING： Department of Rehabilitative Medicine, Tonal Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.
PARTICIPANTS： Totally 29 patients with traumatic spinal cord injury, who were hospitalized at Department of Rehabilitative Medicine, Tongji Hospital Affiliated to Tonal Medical College, Huazhong University of Science and Technology between June 2002 and March 2004, were selected as spinal injury group. Another 29 normal healthy volunteers were enrolled as normal control group in the same period.
METHODS： Spasm level of both lower extremities in patients with spinal injury was graded with Ashworth scale to assess flexion of both coax, flexion of knee joint and Ashworth grade of dorsiflexion of ankle. F-waves was detected with Kepeintl.5 type EMG instrument produced by Denmark. Minimal latency, maximal latency and occurrence rate of F-waves of tibial nerve of both lower extremities were recorded. The discrete-time degree （difference value of maximal latency of F-waves and minimal latency of F-waves） and mean occurrence rate of F-waves were calculated.
MAIN OUTCOME MEASURES： The difference of each index between patients with spinal injury and normal persons was compared and the correlation of spasm with discrete-time degree, occurrence rate and minimal latency of F-waves in patients with spinal injury was analyzed.
RESULTS： A total of 29 patients and 29 normal persons were involved in the result analysis. ①The discrete-time degree of F-waves in patients with spinal injury was higher than that in the normal persons, which had significant difference [（9.2±1.9）, （6.7±1.0） ms, P 〈 0.000 1]. ②The occurrenee rate of F-waves in patients with spinal injury was lower than that in normal persons, which had significant difference [（84.5±6.2）%, （89.5±5.7）%, P 〈 0.05]. ③The minimal latency of F-waves in patients with spinal injury was higher than that in normal persons, which had insignificant difference （ P 〉 0.05）. ④The discrete-time degree of F-waves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth （r=0.790 31, P 〈 0.000 1 ）. The occurrence rate of F-waves in patients with spinal injury had positive correlation linearly with score of spasm Ashworth （r=0.742 03, P 〈 0.000 1 ）. The minimal latency of F-waves in patients with spinal injury had insignificant correlation with score of spasm Ashworth （r=0.081 68, P 〉 0.05）.
CONCLUSION： The discrete-time degree and occurrence rate of F-waves can be used as sensitive index to evaluate eleetrophysiology in patients with spinal injury so as to assess the level of spasm in patients with spinal injury.
出处
《中国临床康复》
CSCD
北大核心
2006年第20期170-172,共3页
Chinese Journal of Clinical Rehabilitation
