综合康复治疗对创伤性脊髓损伤后肌痉挛的影响

目的：观察颈、胸段创伤性脊髓损伤后肌痉挛患者综合康复治疗疗效及病程对康复疗效的影响。方法：根据其病程将30例颈、胸段创伤性脊髓损伤后肌痉挛患者分为早期组和晚期组，并分别给予运动治疗、热疗及气压式四肢血液循环促进装置等综合康复治疗，治疗前、后采用改良的Ashworth痉挛评分法(Modified Ashworth Scale，MAS)评定。结果：两组患者治疗前、后MAS评分差异均有显著性意义(t=16．170，P&;lt;0．0001；t=6．00，P&;lt;0．0001)，并且早期组疗效优于晚期组(t=-5．014，P&;lt;0．01)。结论：对于创伤性脊髓损伤后肌痉挛应尽早采取综合康复治疗。     

综合康复治疗对脊髓损伤后肌痉挛的影响

目的 观察颈、胸段脊髓损伤后肌痉挛患者经过综合康复治疗后的疗效，以及患者病程对康复治疗效果的影响。方法 将30例颈、胸段脊髓损伤后肌痉挛患者根据其病程分为早期组和晚期组，并分别给予运动治疗、热疗及气压式四肢血液循环促进装置等综合康复治疗，治疗前、后进行MAS评定。结果 2组患者治疗前、后MAS评分差异有显著性意义，并且早期组疗效优于晚期组。结论 对于脊髓损伤后肌痉挛应尽早采取综合康复治疗。     

创伤性脊髓损伤并发肌痉挛的康复护理

目的总结创伤性脊髓损伤并发肌痉挛的康复护理效果。方法对35例创伤性脊髓损伤并发肌痉挛患者,根据病程分为早期组22例和晚期组13例,在药物治疗的同时给予体位护理、运动训练及物理治疗等康复护 理;1月后采用改良Ashworth痉挛评分法观察两组患者痉挛状态,并进行比较。结果两组患者康复护理后肌痉挛程度较护理前有所改善,且早期组疗效优于晚期组。结论创伤性脊髓损伤并发肌痉挛患者早期实施康复护理,能有效缓解肌痉挛,促进康复。     

温泉水疗对改善胸段不完全性脊髓损伤患者肌痉挛的疗效观察

目的 观察胸段不完全性脊髓损伤后肌痉挛患者经过温泉水疗结合康复治疗后的疗效.方法 将25例胸段不完全性脊髓损伤后肌痉挛患者分为治疗组(15例)和对照组(10例),对照组应用常规康复疗法,治疗组在常规康复疗法基础上加温泉水疗.治疗前,后进行改良的Ashworth痉挛评分法(MAS)评定.结果 两组患者治疗后MAS评分较治疗前有非常显著性差异(P<0.01),并且治疗组疗效优于对照组(P<0.05).结论 温泉水疗能有效改善胸段不完全性脊髓损伤后肌痉挛.     

康复护理在创伤性脊髓损伤并发肢体肌痉挛患者中的应用

目的:探讨康复护理在创伤性脊髓损伤并发四肢肌痉挛患者中的应用方法及效果。方法:将68例颈、胸段脊髓损伤患者随机分为康复组和对照组各34例,康复组采用早期综合康复护理方法,包括正确肢体摆放、关节ROM运动、牵张训练等;对照组采用骨科常规护理措施。在护理前及护理后1、2个月对两组患者采用改良Ashwoorth评分法进行肢体肌痉挛程度及护理期间并发症发生情况评定。结果:康复组并发症发生情况少于对照组,康复组护理后痉挛评分明显低于护理前及对照组护理后(P0.01),康复组护理有效率明显高于对照组(P0.01)。结论:对创伤性脊髓损伤并发四肢肌痉挛患者实施综合康复护理能有效减轻或缓解肌痉挛,促进患者康复。     

康复护理措施对脊髓损伤肌痉挛的干预效果

目的探讨康复护理对脊髓损伤(SCI)肌痉挛的干预效果。方法将60例SCI肌痉挛患者按康复方法的不同分为观察组(n=30)和对照组(n=30)。全面系统康复评定后,对照组给予物理治疗、矫形器治疗、药物治疗等常规综合康复治疗;观察组在对照组的基础上采用康复护理措施干预。2组治疗前、后进行改良Ashworth量表(MAS)及疗效评定。结果 Ashworth评分:2组治疗前比较差异无统计学意义(P>0.05),2组治疗后较治疗前明显降低(P<0.001),治疗后观察组低于对照组(P<0.05)。痉挛频率分级:治疗前2组痉挛比较差异无统计学意义(Z=0.507,P=0.612,P>0.05),治疗后观察组低于对照组(Z=2.452,P=0.014,P<0.05)。观察组疗效优于对照组(P<0.05)。结论常规综合康复治疗加康复护理能有效改善SCI肌痉挛,减轻患者的痛苦,提高患者的生活质量。更多还原     

抗痉挛治疗改善脊髓损伤患者肌痉挛状态：30例效果分析

目的:脊髓损伤后往往造成一定程度的肌痉挛,探索康复治疗对颈、胸段脊髓损伤患者肌痉挛的作用及临床疗效.方法:1998-01/2004-06深圳市龙岗中心医院康复科收治的脊髓损伤患者30例,采用以抗痉挛治疗为主的方法治疗,治疗前、后进行功能评定.结果:治疗前Ashworth无评分、美国脊髓损伤学会运动指数、Barthel指数分别为3.10&;#177;0.22,51.42&;#177;12.33,36.16&;#177;17.21;治疗后3项指数分别为1.60&;#177;0.43,65.19&;#177;14.70,61.23&;#177;19.01;治疗前后比较,差异有非常显著性意义(P＜0.01).结论:以抗痉挛为主的康复治疗方法可有效地改善截瘫患者的肌痉挛状态,并促进肢体运动功能的恢复.     

抗痉挛治疗改善脊髓损伤患者肌痉挛状态:30例效果分析

目的:脊髓损伤后往往造成一定程度的肌痉挛,探索康复治疗对颈、胸段脊髓损伤患者肌痉挛的作用及临床疗效。方法:1998-01/2004-06深圳市龙岗中心医院康复科收治的脊髓损伤患者30例,采用以抗痉挛治疗为主的方法治疗,治疗前、后进行功能评定。结果:治疗前Ashworth无评分、美国脊髓损伤学会运动指数、Barthel指数分别为3.10±0.22,51.42±12.33,36.16±17.21;治疗后3项指数分别为1.60±0.43,65.19±14.70,61.23±19.01;治疗前后比较,差异有非常显著性意义(P<0.01)。结论:以抗痉挛为主的康复治疗方法可有效地改善截瘫患者的肌痉挛状态,并促进肢体运动功能的恢复。     

神经肌肉本体感觉促进疗法联合综合康复治疗胸腰段脊髓损伤并不全截瘫83例

目的:观察神经肌肉本体感觉促进疗法(PNF)与综合康复治疗胸腰段脊髓损伤并不全截瘫的疗效。方法:胸腰段脊髓损伤并不全截瘫患者83例分为2组,对照组41例采用常规综合康复治疗,观察组42例采用PNF联合综合康复治疗;随访6~21个月,比较2组治疗前后Frankel分级、感觉评分、运动评分及Barthel指数(BI)。结果:2组治疗前Frankel分级、感觉评分、运动评分及BI差异无统计学差异(P0.05);2组治疗后Frankel分级、感觉评分、运动评分及BI情况均较同组治疗前明显改善(P0.05);观察组改善程度大于对照组(P0.05)。结论:PNF联合综合康复疗法治疗胸腰段脊髓损伤并不全截瘫,疗效优于单纯综合康复治疗。     

旋转训练对脊髓损伤患者痉挛的疗效

目的探讨旋转训练对脊髓损伤后患者肌痉挛的影响。方法 2010年7月~2015年7月,38例脊髓损伤后痉挛的住院患者随机分为治疗组(n=19)和对照组(n=19)。两组均给予常规肢体康复训练,治疗组在肢体康复训练后加旋转训练。治疗前和治疗后6周,采用改良Ashworth量表、内收肌角、直腿抬高角、改良Barthel指数进行评定。结果治疗后,两组改良Ashworth量表评分(Z-2.286,P0.05)、内收肌角(t5.6121,P0.001)、直腿抬高角(t5.1677,P0.001)、改良Barthel指数评分(t-6.7428,P0.001)较治疗前改善,治疗组优于对照组(P0.05)。结论旋转训练配合康复训练能减轻脊髓损伤后患者痉挛,改善关节活动度和提高日常生活活动能力。     

局部振动治疗对脊髓损伤患者下肢痉挛及自理能力的疗效分析

目的：观察局部振动治疗对脊髓损伤患者下肢肌张力及日常生活能力的影响。方法：将64例脊髓损伤患者随机分为观察组和对照组各32例。对照组患者仅进行系统康复训练,观察组患者在接受系统康复训练的基础上给予双下肢振动治疗。治疗前后采用改良Ashworth量表（MAS）和改良Barthel指数(MBI)量表对2组患者痉挛程度及日常生活活动能力进行评定。结果：治疗后,2组MAS评分均较治疗前明显降低（P<0.05）,但观察组降低更加显著（P<0.05）;2组MBI评分亦较治疗前明显提高（P<0.05）,但2组间比较差异无统计学意义。结论：振动治疗可改善脊髓损伤患者肌痉挛,但对患者日常生活活动能力及转移能力改善证据不足。     

早期功能锻炼对脊髓损伤患者骨质疏松的预防作用

目的探讨早期肢体被动功能锻炼对脊髓损伤患者骨质疏松的预防作用。方法将26例外伤性脊髓损伤所致截瘫患者随机分为实验组和对照组,每组13例,实验组进行早期肢体功能锻炼,对照组按照外伤瘫痪患者护理常规进行。常规x线片观察两组患者锻炼前后（入组时和4个月后）腰椎及股骨近端的松质骨密度变化,同时分别检测两组患者锻炼前后（入组时和4个月后）血清碱性磷酸酶、血钙、尿Ca／Cr及尿羟脯氨酸含量。结果腰椎及股骨近端的松质骨密度实测值与入组时比较,锻炼后（4个月后）两组均有下降趋势,但均无统计学意义（P〉0．05）,两组间差异也无统计学意义（P〉0．05）。与入组时比较,锻炼后（4个月）实验组血清碱性磷酸酶无统计学差异（P〉0．05）,血钙、尿Ca／Cr及尿羟脯氨酸均有统计学意义（P〈0．05）;对照组血清碱性磷酸酶血钙、尿Ca／Cr及尿羟脯氨酸均无统计学意义（P〉0．05）。锻炼后（4个月）两组间除血清碱性磷酸酶差异无统计学意义（P〉0．05）,血钙、尿Ca／Cr及尿羟脯氨酸差异均有统计学意义（P〈0．05）。结论早期肢体功能锻炼对脊髓损伤患者骨质疏松具有一定的预防作用。     

Decrease of hypertonia after continuous passive motion treatment in individuals with spinal cord injury

OBJECTIVE: To examine the effect of ankle continuous passive motion on the reflex excitability and overall hypertonia of calf muscles in individuals with chronic spinal cord injury and without physical disabilities. DESIGN: Two-way repeated measure experimental design. SETTING: Inpatient rehabilitation department in general hospital. SUBJECTS: The spinal cord injury group comprised eight individuals with chronic complete spinal cord injury and the control group comprised eight healthy people without physical disabilities. An additional eight healthy people were recruited as the sham group. INTERVENTIONS: Each subject received 60 min of continuous passive motion on the ankle joint. MAIN MEASURES: The H-reflex of the soleus muscle was elicited by tibia nerve stimulation just before, immediately after, and 10 min after continuous passive motion. The Modified Ashworth Scale (MAS) score at the ankle joint was recorded for the spinal cord injury group just before and 10 min after continuous passive motion therapy. RESULTS. After 60 min of continuous passive motion of the ankle joint, the H-reflex amplitude at the soleus muscle was depressed in individuals with and without spinal cord injury (77.46 +/- 32.64%, P = 0.047 and 51.76 +/- 26.74% of initial, P<0.0001, respectively). This depression persisted up to 10 min after continuous passive motion only in individuals without spinal cord injury. In individuals with spinal cord injury, the median of MAS scores decreased from 2 to 1.25 after continuous passive motion. CONCLUSION: Sixty minutes of continuous passive motion of the ankle joint decreased reflex excitability and overall hypertonia in people with or without spinal cord injury. The depression of overall hypertonia persisted longer than the reflex excitability in people with spinal cord injury.     

不同运动训练强度对不完全性SCI患者痉挛程度和BDNF浓度的影响

目的:观察不同运动强度对不完全性脊髓损伤(SCI)患者下肢痉挛程度和血清脑源性神经营养因子(BDNF)表达的影响.方法:60例不完全性SCI患者,随机分成A、B、C3组,每组各20例.A组为常规康复治疗对照组;B组为低运动强度训练组:在常规康复治疗的基础之上,加用MOTOmed智能运动训练仪对下肢进行低强度运动训练;C...     

Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.

OBJECTIVE: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. DESIGN: Multicentre longitudinal study. SUBJECTS: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. METHODS: Assessments at the start of active rehabilitation (n=212), 3 months later (n=143), at discharge (n=191) and 1 year after discharge (n=143). RESULTS: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. CONCLUSION: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.     

重组人红细胞生成素对大鼠脊髓损伤后神经细胞及其因子凋亡的影响

背景在脊髓损伤中,除了创伤造成的直接损伤外,脊髓局部还将发生一系列的继发性病理改变.有研究显示重组人红细胞生成素能抑制细胞凋亡和炎症反应,具有神经保护作用.目的通过观察大鼠脊髓损伤段神经细胞凋亡及相关因子的表达,探讨重组人红细胞生成素对脊髓损伤的保护作用.设计随机对照实验.单位华中科技大学同济医学院附属协和医院骨外科实验室和同济医学院病理科.对象实验于2003-09/2004-05在华中科技大学同济医学院附属协和医院骨外科实验室和同济医学院病理科进行.雌性成年SD大鼠30只,随机分成4组,①空白组6只,只暴露脊髓,不损伤.②损伤组8只,脊髓损伤,不用药物.③治疗A组8只,脊髓损伤,仅用重组人红细胞生成素.④治疗B组8只,脊髓损伤,联合应用重组入红细胞生成素和β-七叶皂甙钠.方法①动物模型制作24只大鼠应用改良的Allen方法致脊髓中度损伤.②给药治疗A组于术后1,3,5,8,11d应用重组人红细胞生成素300 U/(kg·d).治疗B组应用重组人红细胞生成素剂量时间同治疗A组,β-七叶皂甙钠0.1 mg/kg,1次/d,连用11d.空白组及损伤组尾静脉推注等容量生理盐水.③神经功能判断在造模后1和12 d分别由同一个实验者进行功能评分记录.行为观察参照改良的Gale神经功能行为分析法评估,0分为严重障碍,6分为正常.斜板试验观察大鼠抓握能力决定斜板角度的大小,反映神经功能恢复情况.④组织学检查大鼠术后12 d处死.取损伤段脊髓标本切片做苏木精-伊红染色.⑤神经细胞凋亡因子bcl-2,bax,fas检测取标本做免疫组织化学染色,计数显微镜高倍视野内染色呈棕色的阳性细胞,计算阳性率.⑥凋亡神经细胞检测采用原位末端标记法计算凋亡指数(凋亡细胞核数/总细胞核数).各指标检测结果进行组内和组间比较.主要观察指标①神经功能行为学评分及斜板实验结果.②损伤段脊髓组织学观察结果.③神经细胞凋亡因子检测结果.④凋亡神经细胞检测结果.结果①神经功能行为学评分及斜板实验结果1和12 d空白组无显著差异.损伤组12 d斜板角度显著大于1 d时(P＜0.05).治疗A和B组12 d行为评分及斜板角度值均显著大于1 d时(P＜0.05),且显著大于损伤组P＜0.05).②损伤段脊髓组织学观察结果损伤组损伤段变细,脊髓内有大部分坏死和大量胶质细胞增生;治疗A,B组大多数神经组织正常,治疗B组组织结构优于A组.③神经细胞凋亡因子检测结果损伤组bax,fas凋亡阳性细胞明显多于治疗A,B组[损伤组(25.75±3.37)%和(41.37±2.83)%,治疗A组(19.87±3.56)和(26.00±3.29)%,治疗B组(12.00±2.97)和(17.50±2.20)%,P＜0.05];bcl-2显著低于治疗A,B组[(9.75±1.83)%,(14.63±2.83)%,(21.63±5.34)%,P＜0.05].④凋亡神经细胞检测结果损伤组细胞凋亡指数明显高于治疗A,B组(50.75±5.39,34.75±3.01,24.00±3.46,P＜0.05).结论细胞凋亡是脊髓损伤后神经元死亡的一种重要方式.重组人红细胞生成素能抑制脊髓神经细胞凋亡,对损伤脊髓的神经功能具有保护作用.     

脊髓损伤患者康复期生存质量的研究

目的：测量脊髓损伤患者住院康复期的生存质量,以及康复治疗对脊髓损伤患者生存质量的影响,探讨改善脊髓损伤患者生存质量的干预方式。方法：91例符合入选标准的住院康复期的脊髓损伤患者,分为综合康复组和传统康复组;100例符合入选标准的骨关节疾患非脊髓损伤需要康复治疗的患者作为对照组。结果：脊髓损伤患者26—50岁占57.14%,损伤原因交通事故、高处坠落、重物砸伤占73.63%。比较生存质量总分及各领域得分,脊髓损伤患者明显低于骨关节疾患非脊髓损伤患者(P<0.05)。治疗前后比较,综合康复组和传统康复组生存质量总分、生理领域得分、环境领域得分均有所提高(P<0.05),但心理领域得分有所下降,社会领域得分差异无显著性意义。治疗前后生存质量总分、生理领域得分综合康复组比传统康复组提高更明显(P<0.05)。治疗后两组BI均有明显提高（P<0.01）,综合康复组比传统康复组改善更明显（P<0.05）。结论：脊髓损伤患者以青壮年为主,康复期脊髓损伤患者的生存质量比骨关节疾患非脊髓损伤人群低。现代康复治疗技术与传统中医相结合的综合康复治疗能更有效地提高康复期脊髓损伤患者的日常生活活动能力及生存质量。     

Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison

OBJECTIVE: To compare demographics, injury characteristics, and functional outcomes of patients with neoplastic spinal cord compression with those with traumatic spinal cord injuries. DESIGN: A prospective 5-yr comparison was undertaken comparing 34 patients with neoplastic spinal cord compression with 159 patients with traumatic spinal cord injury. RESULTS: Patients with neoplastic spinal cord compression were significantly older, more often female, and unemployed than patients with traumatic spinal cord injury. Neoplastic spinal cord compression presented more often with paraplegia involving the thoracic spine, and injuries were more often incomplete compared with traumatic spinal cord injury. Patients with neoplastic spinal cord compression had a significantly shorter rehabilitation length of stay compared with those with traumatic spinal cord injury. The neoplastic group had significantly lower FIM change scores. Both groups had similar FIM efficiencies and discharge to home rates. CONCLUSIONS: Patients with neoplastic spinal cord compression have different demographic and injury characteristics but can achieve comparable rates of functional gains as their traumatic spinal cord injury counterparts. Although patients with traumatic injuries achieve greater functional improvement, patients with neoplasms have a shorter rehabilitation length of stay and comparable FIM efficiencies and home discharge rates.