卒中后偏瘫患者肘关节肌痉挛的肌动图评估

Mechanomyography Assessment of Elbow Spasticity in Hemiplegic Patients after Stroke

目的应用Spearman相关分析探讨肌动图(mechanomyography,MMG)在偏瘫患者上肢上臂肌痉挛等级评定中的应用价值。方法同一治疗师对29例脑卒中后偏瘫患者的患侧肘关节进行改良Ashworth量表(MAS)评估,同时用Delsys三轴无线加速度传感器记录患者被动屈肘和被动伸肘时肱二头肌和肱三头肌的肌动图MMG信号。其中,X轴为肌纤维纵向运动方向,Y轴为肌纤维横向振动方向,Z轴为与肌肉表面垂直的方向。分别计算肱二头肌、肱三头肌三轴MMG信号均方根值(root mean square,RMS),采用Spearman相关分析方法。结果经Spearman相关分析,发现MMG信号与MAS评分有相关性。被动屈肘时,肱二头肌X轴、Y轴、Z轴MMG RMS与MAS相关性有统计学意义(P<0.05),肱三头肌Z轴MMG RMS与MAS相关性有统计学意义(P<0.05);被动伸肘时,肱三头肌Y轴、Z轴MMG RMS与MAS相关性有统计学意义(P<0.05)。结论 MMG信号能客观的对脑卒中后偏瘫患者上肢肌痉挛等级进行评估,为科研和临床肌张力评估和痉挛的治疗提供一种定量化的手段。

Objective To evaluate the clinical usability of mechanomyography （MMG）in the evaluation of upper limb spasticity states of hemiplegia patients with Spearman recurrence.Methods The MMG signals from the 29 hemiplegia patients’biceps and tri-ceps were recorded with three dimensional wireless accelerometer（Trigno Wireless System,Delsys Inc）,when they extended or bent their elbow passively .At the same time,the physiotherapist assessed the modified Ashworth scale（MAS）of al the patients who par-ticipated in the study and would be divided them into four groups based on the MAS values.The MMG sensors were built with triaxial accelerometers named as X,Y and Z that represent the muscle fibers lengthwise movement,the cross movement and the vertical the muscle moving direction,respectively.The root mean square（RMS）value of the MMG signal was calculated for analysis.Spearman correlation analysis and multimode logistic regression also were used in the study for quantitative analysis.Results The results show that the relationship between the X,Y or Z axial MMG RMS of the biceps and MAS are statistical y relevant （P〈0.05）,but only Z ax-ial MMG RMS of the triceps muscle is statistical y related with MAS when the patients made passive elbow flexion（P〈0.05）.The Y or Z axial MMG RMS of triceps muscle was statistical y related with MAS when the patients made passive elbow extension（P〈0.05）. Conclusion MMG recording might be useful for the assessment of upper limb spasticity states of hemiplegia patients.Spearman analysis would be able to correctly identify different spasticity grade,which should be important for clinical management of spasticity.