脑卒中后遗症期肢体瘫痪对偏瘫侧和健侧肢体骨密度的影响

目的 探讨脑卒中后遗症期肢体瘫痪对偏瘫侧和健侧肢体骨密度的影响.方法 采用双能x线骨密度仪（美国产LUNAR）和定量超声检查仪（DBM Sonic 1200）联合测定45例单侧偏瘫患者（男28例、女17例）骨密度,对比两侧桡骨、股骨颈、跟骨骨密度变化.结果 偏瘫后遗症期患侧桡骨骨密度和超声波传导速度显著低于健侧,差异有统计学意义（P＜0.05）,但患侧股骨颈、跟骨骨密度和超声声速与健侧相比无明显差异（P＞0.05）.结论 偏瘫患者的骨量变化随偏瘫时间呈现规律性及阶段性变化.脑卒中后遗症期患侧上肢骨质丢失明显,应加强上臂康复功能训练以减少骨钙丢失.     

脑卒中后下肢功能与骨密度相关性的临床研究

目的 研究卒中后偏瘫患者健侧与患侧股骨颈及腰部骨密度(bone mineral density)与下肢功能之间的相关性.方法 首次发病脑卒中患者165例,男95例,女70例,其中脑梗死129例,脑出血36例.于患者发病14天内及病后6个月及12个月,应用双能X线骨吸收测量仪(dual energy X ray absorptionmetry,DEXA)分别对其腰椎度双侧股骨近段进行骨密度检测.同时评定Barthel指数(Barthel Index,BI)评估患者日常生活能力,应用功能性运动量表评分(Functional Ambulation Category,FAC)评估下肢功能,应用Berg平衡功能评分评估平衡功能.结果 发病14天内、6个月及12个月BI(43.7±13.2)分、(59.4±29.0)分、(75.9±42.3)分;FAC(1.7±0.6)分、(2.7±0.9)分、(3.3±1.8)分及Berg(29.8±13.8)分、(42.8±10.3)分、(46.9±12.3)分,差异有统计学意义(P＜0.05);发病14天内股骨颈骨密度患侧与健侧(0.817±0.161)g/cm2、(0.812±0.157)g/cm2之间差异无统计学意义(P＞0.05),发病后6个月股骨颈骨密度(0.711±0.179)g/cm2、(0.789±0.169)g/cm2及12个月(0.710±0.1670)g/cm2、(0.796±0.183) g/cm2患侧骨密度较健侧减低(P＜0.05);患侧股骨颈不同阶段骨密度比较:发病14天较发病6个月及12个月,患侧骨密度均有减低(P＜0.05),发病6个月较12个月骨密度值无明显变化(P＞0.05);健侧不同阶段股骨颈骨密度及腰椎骨密度无明显变化(P＞0.05).骨密度与BI、FAC及Berg评分相关,即各时期骨密度与患者日常生活能力相关(P＜0.05).结论 偏瘫后腰椎及健侧与患侧股骨颈骨量均减少,主要发生在6个月内,患侧较健侧严重,且与下肢功能、日常生活能力及平衡能力相关.     

康复介入时机对脑卒中偏瘫患者骨密度的影响

目的脑卒中导致的偏瘫可引起继发性骨质疏松,及时给予康复治疗有可能防止骨量进一步丢失。本文探讨不同介入时机的康复训练对脑卒中偏瘫患者骨密度的影响。方法根据开始康复治疗时间的不同,将2010年1～12月在我院康复医学科住院治疗的60例男性脑卒中偏瘫患者分为早训组和晚训组,每组各30例。按病情阶段不同采用相应的康复治疗措施。分别在患者入院时和入院1个月后采用双能X线骨密度仪测定双侧股骨颈骨密度。结果各组健侧、患侧股骨颈骨密度进行训练前后自身对照比较,早训组基本无变化,晚训组稍有升高,但无统计学差异(P>0.05)。早训组患侧股骨颈骨密度在训练前后均略低于健侧,但无统计学差异(P>0.05)。晚训组患侧股骨颈骨密度在训练前后均显著低于健侧(P<0.05)。组间比较:晚训组健侧股骨颈骨密度始终略低于早训组健侧,但无统计学差异(P>0.05);晚训组患侧股骨颈骨密度始终略低于早训组患侧,且差异有统计学意义(P<0.05)。结论康复治疗的早期介入可以防止脑卒中偏瘫患者骨量的进一步丢失,长期治疗能否促进骨量恢复有待进一步研究。     

脑卒中偏瘫患者继发骨质疏松症的特点

背景脑卒中及脑损伤所致偏瘫后易造成继发性骨质疏松,其骨密度值和骨矿含量是预测骨质疏松骨折的危险性的有效参数.目的通过对偏瘫患者骨密度值及骨矿含量的测定与分析,探讨偏瘫患者骨质疏松发生的特点.设计病例分析.对象选择1999-03/2002-05在北京博爱医院神经康复科住院的偏瘫患者156例.男87例,女69例;年龄17～65岁,平均年龄(47.0±5.3)岁;病程19 d～1年,平均病程(5.0±3.5)个月;疾病类型脑梗死89例,脑出血67例;瘫痪侧别左侧79例,右侧77例.方法所有患者使用LUNAR双能X射线骨密度仪从头部至足部进行全身扫描,测量骨密度和骨矿含量.主要观察指标①不同病程偏瘫患者中骨质疏松发生率.②不同部位瘫痪患者的骨矿含量.结果156例患者全部进入结果分析.①病程在3～6个月骨质疏松发生率最高(44%,16/36),病程在9～12个月骨质疏松发生率最低(21%,7/33),总体骨质疏松发生率为31%(48/156).②病程在3个月内47例患者中有9例为弛缓性瘫,均患有骨质疏松,其中2例发生骨折.病程3～6个月36例患者中有3例为弛缓性瘫,也患有骨质疏松.③上肢患侧的骨矿含量明显低于健侧[(154.76±43.91)g,(172.59±43.78)g,(t=3.591,P＜0.001)].下肢患侧的骨矿含量与健侧基本接近[(463.41±309.28)g,(464.11±86.45)g,(t=0.027,P＞0.05)].结论偏瘫患者的骨量变化随偏瘫时间的不同有不同的变化.上肢患侧的骨矿含量低,下肢患侧骨矿含量接近正常,这是由于下肢较早的进行功能锻炼,说明骨量的大小与运动有密切关系.     

脑卒中患者骨密度变化及其影响因素

目的:研究脑卒中患者骨密度(BMD)变化及影响因素。方法:采用双能X线BMD仪对32例脑卒中患者(卒中组)患侧股骨和10例健康人(对照组)股骨进行BMD及T分值检测,分析影响BMD变化的可能因素。结果:卒中组患者BMD明显低于对照组(P0.01);回归分析显示,卒中组患者患侧股骨颈(Neck)BMD与性别呈负相关,三角区(Ward)BMD与病程呈负相关(均P0.05);大转子(GT)BMD与性别呈正相关(P0.01),与病程呈负相关(均P0.01)。T分值分析中,GT有相关的影响因素为性别,即男性T分值高于女性。结论:脑卒中患者患侧股骨BMD明显下降;性别和病程与BMD改变密切相关,是主要影响因素。     

成年人骨密度、骨量、体重、年龄、身高、脂肪含量相互关系的研究

目的 :研究成年人骨密度、骨量、体重、年龄、身高、脂肪含量间的相互关系及其价值。方法 :对 5 85例19岁以上就诊及健康查体者的身高、骨密度及全身成分进行测定 ,骨密度及全身成分分析数据通过双能X线骨密度仪 (DEXA)测量获得 ,对骨密度、骨量、体重、年龄、身高、脂肪含量结果进行研究及统计分析。结果 :骨密度、骨量、体重两两间呈正相关关系 (P <0 0 0 1) ,骨密度、骨量、体重与年龄间呈负相关 ,与身高间呈正相关关系 ;男性骨密度与脂肪含量呈负相关关系 ;男、女骨量与脂肪含量间无相关关系 ;体重与脂肪含量呈正相关关系 (P <0 0 0 1)。结论 :骨密度、骨量、体重三者是相互关联的 ,年龄、身高是影响三者的因素之一。了解上述指标对防治骨质疏松症、肥胖症等方面有重要的意义。     

老年脑卒中偏瘫患者的三维步态分析

目的探讨老年偏瘫患者的步态特点。方法采用三维步态分析仪对22例老年偏瘫患者进行步态分析。结果老年偏瘫患者的双侧下肢站立相百分比增大,健侧较患侧明显,摆动相百分比减小,步频减小;步长、跨步长及步速减小;头部前倾,躯干基本保持直立位;患侧上肢较健侧上肢的肩关节、肘关节角度变化范围缩小(P<0.05);患侧肩关节屈曲内收、肘关节屈曲角度较健侧增大(P<0.05);患侧髋膝踝关节角度变化范围较健侧缩小(P<0.05)。结论老年偏瘫患者步行功能下降,上肢痉挛,步行时出现视觉代偿。     

偏瘫患者继发性骨质疏松的探讨

目的　探讨偏瘫患者继发性骨质疏松发生的特点 ,为预防和治疗骨质疏松提供依据。方法　使用LUNAR双能X线骨密度仪 ,对 1 56例住院治疗的偏瘫患者的骨密度及骨矿含量进行测定 ,并对测定结果进行统计学分析。结果　偏瘫后 3～ 6个月骨质疏松发生率最高 ,达 44 .4% ,9～ 1 2个月骨质疏松发生率最低 ,为 2 1 .1 % ,总体骨质疏松发生率为 30 .8% ;弛缓性瘫比痉挛性瘫的偏瘫患者更易发生骨质疏松 ;患侧上肢的骨矿含量与健侧上肢相比 ,差异有显著性 (P <0 .0 0 1 ) ,患侧上肢明显低于健侧上肢 ;患侧下肢的骨矿含量与健侧下肢相比 ,差异无显著性 (P >0 .0 5)。结论　偏瘫患者的骨量随偏瘫时间的不同而有不同的变化 ,这种变化是有规律的 ,且骨量减少是可逆转的 ;早期行康复训练可预防骨质疏松的发生 ;充分掌握偏瘫患者的骨质情况非常重要。     

在糖尿病肾病过程中血清骨保护素及骨密度的变化

背景:目前人们对糖尿病肾病过程中所致肾性骨病骨保护素的关系仍不清楚.目的:探索2型糖尿病肾病过程中患者骨密度、血清骨保护素水平的变化及其间的相关性.方法:选择2型糖尿病患者104例,根据肾小球滤过率将患者分为5组:单纯糖尿病组、肾脏轻,中,重度损伤组、肾衰竭组.选择健康体检者20名为对照组.采用双抗体夹心酶联免疫吸附法(ELISA)测定受试者血清骨保护素水平.采用全自动生化分析仪检测血清钙、磷、碱性磷酸酶、肌酐、尿素氮及糖化血红蛋白.采用双能X射线骨密度仪测定正位L_(2～4)的骨密度.观察受试者骨密度、骨保护素水平及其与各指标的多元回归相关分析.结果与结论:糖尿病肾病患者血清骨保护素水平明显高于健康对照人群(P<0.05),肾脏轻,中,重度损伤组、肾衰竭组患者骨密度明显低于健康对照人群(P<0.05,P<0.01,P<0.001).总体来说,肾功能越差,骨保护素水平越高,骨密度越低.糖尿病肾病患者骨保护素水平与骨密度呈负相关(R=-0.497,P<0.01),与糖尿病病程(r=0.566,P<0.01)、血清肌酐水平(r=0.772,P<0.01)、尿素氮水平(r=0.708,P<0.01)、磷水平(r=0.329,P<0.01)、全段甲状旁腺激素水平(r=0.702,P<0.01)呈正相关,与血清钙水平呈负相关(r=-0.505,P<0.01).提示糖尿病肾病过程中随肾脏功能的恶化,骨保护素水平升高,骨密度降低,骨保护素水平与骨密度呈负相关,与糖尿病病程、血清肌酐水平、尿素氮水平、磷水平、全段甲状旁腺激素水平呈正相关,与血清钙水平呈负相关.     

脑卒中后偏瘫患者骨量丢失特征分析

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。     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周后使用三维步态分析仪器检测并获得两组患者的步态参数。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。     

Prevention of secondary osteoporosis postmenopause in hemiplegia

OBJECTIVES: To study secondary osteoporosis postmenopause in women with hemiplegia and to show the therapeutic effects of etidronate and how osteoporotic conditions relate to the activities of daily living (ADL). DESIGN: Eighty-one postmenopausal women with hemiplegia were admitted within 6 mo of their first cerebrovascular accident. The bone mineral density (BMD) and biochemical markers of bone turnover were measured at the time of admission. Forty women (treatment group) received a 2-wk administration of etidronate. Forty-one women (control group) were not administered etidronate. RESULTS: After completing a 3-mo rehabilitation program, BMD levels were remeasured. ADL was evaluated by FIM. The low ADL group had a larger decrease in BMD than the high ADL group. For the control group, the BMD rate of change on the paretic side of the femoral neck was -9.6%/3 mo for the low ADL group. BMD loss was reduced significantly by the administration of etidronate for the low ADL group. CONCLUSIONS: Results indicate that ADL corresponds to the progression of osteoporosis in postmenopausal women with hemiplegia and that increasing the level of ADL will reduce the progression of osteoporosis. Use of etidronate has also been proven to have a suppressive effect on the BMD decrease in women.     

Determinants of walking function after stroke: differences by deficit severity

OBJECTIVES: To investigate the relationship of cardiovascular fitness (Vo(2)peak), neurologic deficits in balance and leg strength, and body composition to ambulatory function after stroke and to determine whether these relationships differ between those with milder versus more severe gait deficits. DESIGN: Cross-sectional correlation study. SETTING: Outpatient clinic of an academic medical center. PARTICIPANTS: Seventy-four people (43 men, 31 women; mean age +/- standard deviation, 64+/-10y) with chronic hemiparetic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thirty-foot (9.1-m) walk velocity, 6-minute walk distance, Vo(2)peak, Berg Balance Scale score, bilateral quadriceps eccentric torque, total and regional lean mass, and percentage of fat mass. RESULTS: Short-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, percentage of body fat, and paretic lean mass but not with nonparetic lean mass. Long-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, and paretic lean mass but not with percentage of body fat or nonparetic lean mass. Stepwise regression showed that cardiovascular fitness, balance, and paretic leg strength were independently associated with long-distance walking (r(2)=.60, P<.001). Variance in long-distance walking was largely explained by balance for those who walked more slowly (<.48m/s) for short distances (r(2)=.42, P<.001) and by cardiovascular fitness for those who walked more quickly (>.48m/s) for short distances (r(2)=.26, P=.003). CONCLUSIONS: Short-distance walking after stroke is related to balance, cardiovascular fitness, and paretic leg strength. Long-distance walking ability differs by gait deficit severity, with balance more important in those who walk more slowly and cardiovascular fitness playing a greater role in those who walk more quickly. Improved understanding of the factors that predict ambulatory function may assist the design of individualized rehabilitation strategies across the spectrum of gait deficit severity in those with hemiparetic stroke.     

绝经妇女身体软组织重量与骨密度的相关性

目的 :探讨绝经后妇女身体软组织重量和骨密度 (BMD)之间的关系。方法 :选择 6 2例绝经期健康日本妇女 ,应用双能X 线法 (Dexa)测定其第 2～ 4腰椎、双侧股骨转子间和桡骨中、下 1/ 3交界处BMD ,同时测定身体肌肉组织 (TLM)和脂肪组织 (TFM )重量 ,并对软组织重量与身体各部位的BMD进行相关性分析。结果 :全身TLM重量及体重与正位腰椎BMD呈正相关 (r =0 .4 5及 0 .35 ) ,而TFM百分比与腰椎、股骨转子间和桡骨远端BMD呈负相关 (r=- 0 .17)。随着年龄增长 ,BMD呈下降趋势 ,6 0岁组与 5 0及 70岁组比较差异有显著性 (分别P <0 .0 1,P <0 .0 5 )。结论 :身体内软组织重量中TLM重量、体重与全身各部位的BMD有相关性 ,其中体重和TLM重量与腰椎BMD的相关性较好 ,TFM重量与BMD的相关性不明显。     

影响左侧偏瘫患者上肢功能预后的相关因素分析

目的探讨影响左侧偏瘫患者上肢功能和日常生活活动(ADL)能力等康复疗效的相关因子。方法对64例脑卒中左侧偏瘫患者进行常规康复训练1个月,治疗前采用简易智能状态检查表(MMSE)、洛文斯顿认知成套测验(LOTCA)、运动保持困难量表(MI)、Schenkenberg等分线段、Albert划线、字母删除试验等量表进行认知功能评测,并于治疗前和治疗后采用Brunnstrom运动功能分期、上田敏偏瘫手指功能评定表、偏瘫上肢能力评定表、改良Barthel指数(MBI)等量表,对患者进行肢体功能及ADL能力评分。应用多元逐步回归分析分析上述因素与上肢功能和ADL能力恢复程度之间的关系。结果患者上肢功能的恢复程度与训练前的LOTCA思维运作能力评分呈明显正相关(P<0.01);手指功能的恢复程度与训练前的MI呈明显负相关(P<0.01);手的实用性恢复程度与训练前的LOTCA的思维运作能力及ADL评分呈明显正相关(P<0.01);ADL的恢复程度与LOTCA的思维运作能力量表得分及病变部位呈明显正相关(P<0.01),与Schenkenberg等分线段量表得分呈明显负相关(P<0.01)。结论康复训练前的LOTCA思维运作能力、Schenkenberg等分线段量表、ADL、MI功能等评分,对卒中后左侧偏瘫患者上肢功能的预后有预测作用。     

Bone mineral density of metatarsus in hemiplegic subjects.

The cortical bone mineral density (BMD) of the first metatarsus was measured using computed x-ray densitometry in 84 hemiplegic subjects (35 men and 49 postmenopausal women) and 49 healthy age-matched controls (23 men and 26 postmenopausal women), and the determinants of paralysis-induced cortical osteopenia were investigated. In the hemiplegia group, ages were 63.9 +/- 9.8 yr (mean +/- standard deviation) for men and 66.6 +/- 11.0 yr for women. The duration of hemiplegia was 25.3 +/- 19.8 mo for men and 26.0 +/- 26.3 mo for women. The Brunnstrom stage (lower limb) was 4.0 +/- 1.1 for men and 3.8 +/- 1.4 for women. The walking ability, evaluated by walking score, was 3.6 +/- 1.3 (range, 1-5) for men and 3.2 +/- 1.5 (range, 1-5) for women. The time since menopause was 14.8 +/- 10.0 yr. The age and time since menopause were similar in the hemiplegia and control groups. On the paralyzed side, the BMD of men and women in the hemiplegia group was significantly lower than that of the control group on the nondominant side (by 6.1% and 11.6%, respectively). In hemiplegic men, Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.418 and r = 0.349, respectively). In hemiplegic women, on the other hand, age, duration of hemiplegia, and years since menopause showed a significant negative correlation to the BMD (r = -0.260, r = -0.478, and r = -0.506, respectively), and Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.526 and r = 0.406, respectively). These findings suggest that the determinant of metatarsal cortical BMD loss on the paralyzed side of the hemiplegic subject might be different according to gender. That is, although the degree of paralysis and walking ability could be a determinant of metatarsal cortical BMD loss on the paralyzed side of hemiplegic men, additional factors such as age, duration of hemiplegia, and years since menopause could play an important role in the determination of metatarsal cortical BMD loss in postmenopausal hemiplegic women.     

Body composition after stroke

The aim of this study was to compare the body composition, including lean tissue mass, fat tissue mass, and bone mineral content, of the paretic leg with that of the nonaffected leg in patients with stroke and to evaluate the effects of time since stroke, spasticity, and motor recovery on the body composition specifically within the first year after stroke. Thirty-five stroke patients with mean age and standard deviation of 62.69+/-9.54 years were included in the study. A full physical examination including Brunnstrom motor recovery and modified Ashworth spasticity scale was performed. Fat tissue mass (grams), lean tissue mass (grams), and bone mineral content (grams) of both the paretic and nonaffected lower extremities were obtained from the total body scans determined by using dual-energy X-ray absorptiometry (Lunar DPX-PRO). Lean tissue mass and bone mineral content of the paretic side were found to be significantly lower than those of the nonaffected side (P<0.05). A significant correlation was found between the lean tissue mass and bone mineral content of both the paretic and nonaffected legs after adjusting for age and weight (P=0.000, r=0.679; P=0.000, r=0.634, respectively). Bone mineral content and lean tissue mass of both the paretic and nonaffected sides showed a significant negative correlation with time since stroke in patients with stroke for < or =1 year (P<0.05). A higher lean tissue mass and bone mineral content were found in patients with moderate to high spasticity in comparison with patients with low or no spasticity (P<0.05). Stroke causes loss of lean tissue mass and bone mineral content prominently in the paretic side. The loss increases with increasing time since stroke. Spasticity seems to help in preventing the loss of bone mineral content and lean tissue mass.     

放散式体外冲击波对脑卒中患者下肢痉挛及三维步态参数的效果研究

摘要 目的：观察放散式体外冲击波对脑卒中偏瘫患者下肢痉挛,步态时空、对称性参数以及运动学参数的影响。 方法：选取40例符合入选标准的脑卒中偏瘫患者,将其随机分为试验组及对照组,每组20例。试验组进行常规康复治疗和患侧下肢放散式体外冲击波治疗（每周2次）,连续3周,对照组进行常规治疗和安慰性冲击波治疗。分别于治疗前、第三周全部治疗结束后使用三维步态分析仪器检测并获得两组患者的步态参数。同时比较两组患者治疗前后腘绳肌、股四头肌、小腿三头肌改良Ashworth分级（MAS）评分,以及患侧下肢的Fugl-Meyer（FMA）评分。 结果：在第三周治疗结束后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相、踝关节最大背屈角度、踝关节最大跖屈角度均较治疗前明显提高（P<0.05）,步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、患侧健侧摆动相比值均较治疗前明显减小（P<0.05）。组间对比显示,治疗后试验组患者步幅、步频、步速、步态周期、步长偏差、踝关节最大背屈角度、踝关节最大跖屈角度均优于对照组（P<0.05）。治疗后试验组腘绳肌、股四头肌、小腿三头肌MAS评分及患侧下肢FMA评分均较治疗前改善(P<0.05),并优于对照组(P<0.01,P<0.05)。 结论：放散式体外冲击波能有效改善脑卒中偏瘫患者步态时空、运动学、对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。同时可以降低患侧下肢的痉挛,提高下肢运动功能。     

Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients

OBJECTIVE: To determine if skeletal muscle atrophy and greater fat deposition within the muscle are present in the hemiparetic limb of chronic (>6 mo) hemiparetic stroke patients. DESIGN: Cross-sectional study. SETTING: Hospital-based research center. PARTICIPANTS: Sixty patients (47 men, 13 women; mean age +/- standard deviation, 65+/-9 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent a total body scan by dual-energy x-ray absorptiometry to determine percentage of body fat, total lean mass, fat mass, and lean mass of the paretic and nonaffected legs, thighs, and arms. Thirty patients received computed tomography (CT) scans of their midthigh to determine muscle area, subcutaneous fat, and low-density lean tissue, as a measure of fat within the muscle area, of the paretic and nonaffected midthigh. RESULTS: Patients were deconditioned (VO(2)peak: 1.2+/-0.3 L/min) with a percentage of body fat of 31.4%+/-9.8% and total lean mass of 51.4+/-9.1 kg. Lean mass of the paretic leg and thigh were 4% and 3% lower than the nonaffected leg (P<.001), but leg fat was not different. Arm lean mass of the paretic side was 7% lower than the nonaffected side, whereas arm fat was not different. CT studies showed that midthigh muscle area was 20% lower in the paretic limb than in the nonaffected leg (P<.001), midthigh subcutaneous fat was similar, and midthigh low-density lean tissue showed a trend to be 3% higher in the paretic leg (P=.06). The ratio of midthigh low-density lean tissue to muscle area was higher in the paretic leg (P<.001), which indicates a greater intramuscular fat relative to muscle area in the affected limb. CONCLUSIONS: Our results show hemiparetic skeletal muscle atrophy and more fat within the muscle, factors that may contribute to functional disability and increased cardiovascular disease risk in chronic hemiparetic stroke patients.     

Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke

OBJECTIVES: To determine the test-retest reliability over 2 separate days for weight-bearing ability during standing tasks in individuals with chronic stroke and to compare the weight-bearing ability among 5 standing tasks for the paretic and nonparetic limbs. DESIGN: Prospective study using a convenient sample. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: Fifteen community-dwelling stroke individuals with moderate motor deficits; volunteer sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Weight-bearing ability as measured by the vertical ground reaction force during 5 standing tasks (rising from a chair, quiet standing, weight-shifting forward, backward, laterally). RESULTS: The weight-bearing ability was less for the paretic limb compared with the nonparetic limb, but the intraclass correlation coefficients were high (.95-.99) for both limbs between the 2 sessions for all 5 tasks. The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks. In addition, the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent. Large asymmetry was evident when rising from a chair, with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N. The weight-bearing ability during all 5 tasks correlated with one another (r range,.56-.94). CONCLUSIONS: Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke. We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-stand tasks presents a challenge to the motor systems of individuals with stroke, which may account for the poor balance that is often observed in these individuals.