脊髓损伤病人的运动功能评定

Evaluation of Motor Function of the Spinal Cord in Patients With Spinal Coed Injury

目的脊髓损伤（ＳＣＩ）病人的分级多采用Ｆｒａｎｋｅｌ分级标准，我们根据２６０例ＳＣＩ病人的观察，认为对病人活动功能影响最大的是运动功能与排尿功能，且上肢与下肢评级标准不尽相同，从而对分级提出改进意见。方法本组２６０例，伤后观察时间达１以上者１５６例，占６０％。损伤部位：Ｃ３－４～Ｔ１９０例，Ｔ２－１０３７例，Ｔ１１～Ｌ＿１１０５例，Ｌ２３２８例。脊髓损伤类型：完全截瘫１６９例，不全截瘫６４例，中央脊髓损伤１６例，脊髓半侧损伤５例，圆锥损伤６例。上肢运动功能目的为持物，其分级是参考Ｍｏｂｅｒｇ，Ｚａｎｃｏｌｌｉ，Ｆｒｅｅｈａｆｅｒ等手功能重建的分级而提出的。下肢之目的为移动躯体，以可用拐步行为Ｃ级进行分级。结果上肢运动功能分级：Ａ．仅能屈时，５例；Ｂ．可屈肘与伸腕、肌力Ⅲ级，１６例；Ｃ．除屈肘、伸腕Ⅲ级外，还可屈腕或伸指或伸时或屈指，肌力Ⅱ～Ⅲ级，１４例；Ｄ．上肢肌肉除手内在肌外，均恢复至Ⅲ级，２６例；Ｅ．上肢各肌力均在Ⅲ级以上，基本完全恢复功能，２５例。４例不详。下肢运动功能：Ａ．下肢各肌肌力０级，１３９例（５６．５％）；Ｂ．有１～３块肌肉肌力Ⅰ～Ⅱ级，１０例；Ｃ．股四头肌、股内收肌肌力Ⅲ级，１６例；Ｄ．下?

Objective To modify the Frankel's classification for evaluation of paraplegias. MethodMotor function were evaluated in 260 patients with spinal cord injury (SCI). Of those, 156 patients werefollowed up for a period of over one year. The distribution of injured segments was C3-4 T1 in 90, T2-10 in 37,T11￣L1 in 105 and L2,3 in 28 cases. The type of spinal cord injury were classified as complete spinal cord injuryin 169, incomplete in 64, central syndrome in 16, Brown-Sequard syndrume in 5, conus injury in 6. Theevaluation of the motor function in upper limbs were referred to the reconstruction of the function in hand byMoberg, Zancolli and Freehafer. While in lower limbs, the ability of walking is used as the base of gradirig.Results Motor function in upper limbs were classified as A in 5, B in 16, C in 14, D in 26 and E in 25.Motor function in lower limbs were classified as A in 139, B in 10, C in 16, D in 61 and E in 20. Sphinctorcontrol was classified as A incontinence of urine in 6, B refiexive urination but hyperreflex and squeezemanagement may be need in 10, C reflexive urination in 139, D rerflexive urination with a little of sensationor contrtol in 67 and E normal controlled urination in 28. In this series, 56 cervical spinal cord injuriesclassified as Frankel A were evaluated as A in 14, B in 14, C in 26, D in 1 and E in 1 by the modifiedgrading system. Couclijs'-on The modified ciassification is more accurate to reflect the motor function inupper limbs. In evaluation of cervical spinal cord injury, the motor fonction of upper and lower limbs andsphinctor should be used. While in evaluation of lumbar cord or cauda equina lesions, the motor function oflower limbs and sphinctor should be used.