脑卒中后下肢功能与骨密度相关性的临床研究

Relationship between lower limb functions of stroke patients and bone mineral density

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)分别对其腰椎及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。

Objective To study the relationship between bone mineral density（BMD） and lower limb functions of stroke patients in the affected side and the unaffected side. Methods Totally 165 cases with first stroke onset were enrolled in the study, male 95 cases, female 129 cases, including cerebral infarction 129 cases, brain hemorrhage 36 cases. The patients were assessed when admitted within 14 days,at the 6th month and 12 th month after stroke using dual energy X ray absorptionmetry（DEXA） for the lumbar vertebrae and bilateral fumer neck. Barthal Index（BI） was used for activities of daily living, Functional Ambulation Category（FAC） for inferior extremity function and Berg balance test for balance score at the same time for each patient. Results The BI （43.7±13.2,59.4±29.0,75.9±42.3）, FAC（1.74±0.6,2.74±0.9,3.3± 1.8） and Berg score （29.8± 13.8,42.8± 10.3,46.9 ± 12.3） of the stroke patients after stroke within 14th day, 6th month and 12 th month had statistic difference（ P 〈0.05） The difference between the affected side and the unaffected side for the femur neck within 14th day（0. 817±0. 161） g/cm^2 , （0. 812〉0. 157） g/era2 had no statistic significance（ P 〉0.05）,nevertheless the difference of 6th month（0. 711 ±0. 179） g/cm2, （0. 789 ± 0. 169） g/cmz and 12 th month （0. 710±0. 167） g/cm2 , （0. 796±0. 183） g/cm2 had statistic difference（ P 〈0.05） For the BMD score of femur neck and lumbar spine,the difference between 14th day and 6th month or 12 th month had statistic difference（ P d0.05）,the score in comparison between 6th month and 12 th month had no statistic difference （ P 〈0.05） Pearson score of BMD and BI, FAC or Berg had statistic difference （ P 〈 0.05）. Conclusion Lumbar vertebrae and femur neck in both affected side and unaffected side after hemiparalysis suffer obvious loss in bone mass. BMD reduction mainly occurred within 6 months for the stroke patients, the affected side is more severe than the unaffected side,this accounts for the relationship between lower limb functions,activities of daily living, and balance ability.