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北大核心CSCD

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。

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

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.