脑病变的部位及大小与Brunnstrom偏瘫恢复阶段及痉挛程度的关系

目的 探讨脑病变的部位及大小与Brunnstrom偏瘫阶段及痉挛程度的关系。方法 36例患者，男26例。女10例；年龄16-70岁；左侧脑病变17例。右侧19例；脑血肿17例。脑梗死及脑皮质软化灶19例。结果 脑皮质受损部位患者呈跳跃式恢复，痉挛主要表现为不能伸腕，指及踝背屈障碍，当上肢伸肌功能恢复后，屈肌痉挛消失；顶叶受损（病变体积为30-50cm^3)患者残留症状为不能并指，分指，对掌运动及踝自主背屈障碍；内囊部分病变患者主要表现为肢体远端痉挛。痉挛期与分离期重叠出现。即出现伸腕，指运动时，屈腕，指肌及屈拇长肌仍有痉挛现象存在；内囊大部分或完全病变患者，痉挛表现在四肢所有关节，运动功能恢复较差。结论 脑病变部位及大小不同，痉挛程度不同，痉挛程度与运动训练疗效关系密切。均有助于判断患者康复后期日常生活活动能力及运动功能恢复状况。

The relationship of the size and location of cerebral lesion with Brunnstrom stages and spasticity in hemiplegic patients

Objective To investigate the relationship of the size and location of cerebral lesion with Brunnstrom stages and spasticity. Methods Seventeen cases of cerebral haematoma and 19 cases of cerebral infarction and soften focus were recruited in this study. All the patients were given rehabilitation intervention according to their conditions. Two weeks after the spasticity emerged, the patients were measured by using Barthel index, Brunnstrom stages, and modified Ashworth Scale. Results In patients with cerebral cortex lesions, spasticity occurred in wrist and finger flexors, and plantar flexors of ankle. Spasticity of the flexors of the upper limbs disappeared with the recovery of extension movement. In some patients, the recovery did not follow the Brunnstrom stages. Poor recovery of motor function was found in the patients with frontoparietal lobe injury. In some patients with lesions of partial internal capsule and basal ganglia, the spasticity often occurred in the distal parts of the limbs, and a overlap of spasticity and isolation movement stages often existed. In patients with severe lesion of the internal capsule, severe spasticity appeared in all joints of limbs. Conclusion The results showed that different sites and sizes of cerebral lesions led to different degrees of spasticity, which was closely related to the recovery of motor functions.