痉挛型脑性瘫痪患儿下肢H反射变化及其评价肢体痉挛的可靠性

目的探讨痉挛型脑性瘫痪(脑瘫)患儿下肢H反射变化及其评价肢体痉挛的可靠性,探讨痉挛型高肌张力定量评估的客观指标。方法选取本院2010年1月-2011年12月神经康复科收治的50例痉挛型脑瘫患儿为脑瘫组。男33例,女17例。另选取20例健康儿童作为健康对照组。男11例,女9例。应用美国Nicolet公司生产的VikingⅣD型肌电图仪进行H反射测定,对脑瘫组和健康对照组儿童H反射潜伏期、波幅及最大H波与最大M波百分比(Hmax/Mmax,H/M)进行比较。对脑瘫组患儿痉挛侧下肢进行改良综合痉挛量表(CSS)评分,并与H波幅、H/M值进行相关性分析。结果脑瘫组患儿H反射潜伏期为(18.87±2.94)ms,H波幅为(4.21±2.85)μV,H/M值为35.24±16.32;健康对照组儿童H反射潜伏期为(23.20±1.98)ms,H波幅为(2.34±1.53)μV,H/M值为14.23±6.36。脑瘫组患儿H波潜伏期缩短,H波幅增大,H/M值增高,与健康对照组比较差异均有统计学意义(Pa<0.05)。脑瘫组患儿下肢CSS评分为(7.75±2.27)分,与H波幅呈正相关(r=0.562,P<0.05),与H/M值亦呈显著正相关(r=0.904,P<0.01),其线性方程为Y=8.425X-30.021。结论 H反射可作为痉挛型脑瘫患儿痉挛下肢运动神经元兴奋性的量化指标。

H Reflex Changes in Lower Extremities in Spastic Cerebral Palsy Children and Reliability Analysis of H Reflex Evaluating Limb Spasm

Objective To explore H reflex changes in lower extremities in children with spastic cerebral palsy(CP) and to analyze the reliability of H reflex evaluating limb spasm in order to seek the objective index for quantitative evaluation of spastic high muscular tension. Methods Fifty cases of spastic CP children from Jan.2010 to Dec.2011 in Department of Neurology,Children′s Hospital of Zhengzhou,were collected as CP group,including 33 males and 17 females.Another 20 cases of healthy children were selected as healthy control group,including 11 males and 9 females.H reflex latency,amplitude and percentage of Hmax/Mmax(H/M) were determined and compared between CP group and healthy control group by using electromyogram instrument-Viking ⅣD(Nicolet Company,USA).Composite spasticity scale(CSS) score of lower extremities in CP group was evaluated and the correlation analysis between CSS score and H reflex amplitude,and percentage of H/M were calculated. Results The H reflex latency,amplitude and percentage of H/M in CP group were(18.87±2.94) ms,(4.21±2.85) μV,35.24±16.32,respectively.The H reflex latency,amplitude and percentage of H/M in healthy control group were(23.20±1.98) ms,(2.34±1.53) μV,14.23±6.36,respectively.The H reflex latency decreased,amplitude and percentage of H/M increased in CP group,and the differences were statistically significant compared with those in the healthy control group(Pa<0.05).CSS score of children in CP group was 7.75±2.27,and was positively correlated with H reflex amplitude(r=0.562,P<0.05) and percentage of H/M(r=0.904,P<0.01),and the linear equation was Y= 8.425X-30.021. Conclusion H reflex can be used as quantitative indicators of motor neurons excitabilities of lower extremity in spastic CP children.