等速测试系统用于肢体痉挛量化评估的对照研究

Isokinetic testing system for quantitative evaluation of limb spasm

目的探索应用等速测试系统建立肢体痉挛的量化评估方法。方法选取2016年6月—2017年12月收治的脑卒中伴有痉挛的患者,MAS1级、1+级、2级、3级患者及正常对照组各10例,共计50例,手动测试改良Ashworth量表、改良Tardieu量表的X值、三倍痉挛状态量表、临床痉挛指数等指标,并应用等速测试系统,以5°/s和180°/s测试峰力矩(PT),被动伸肘所做的功(Work),并计算不同角速度下的Work差值。运用Spearman法对主观测试指标及等速指标进行相关分析。结果180°/s角速度下,PT、Work均与MAS、MTS的X值、TSS及CSI评分呈显著相关,相关系数在0.571~0.942(P<0.01),180°/s与5°/s的Work差值与MAS、MTS的X值、TSS及CSI评分呈显著相关,相关系数在0.459~0.848(P<0.01)。结论Work差值与MAS、MTS的X值、TSS、CSI显著相关,而Work差值从理论上能较好地反映痉挛的定义;提示可用该指标进行痉挛的测量。

Objective To apply isokinetic testing system for quantitative evaluation of limb spasticity.Methods Fifty stroke patients with limb spasm admitted from June 2016 to December 2017 were recruited,including cases of MAS1,grade 1+,grade 2 and grade 3 with 10 in each category;and 10 healthy subjects served as controls.Modified Ashworth scale (MAS),the X value of modified Tardieu scale (MTS),triple spasticity scale (TSS) and clinical spasticity index (CSI) were used for manual measurement.The peak torque (PT) and the work performed by passive elbow extension (Work) at 5°/s and 180°/s were tested with isokinetic test system,and the Work difference at different angular velocities was calculated.The correlation between subjective test index and isokinetic index was analyzed with Spearman method.Results At 180°/s angular velocity,there was a significant correlation of PT and Work with MAS,X value of MTS,TSS and CSI with correlation coefficient of 0.571-0.942 (P<0.01).The Work difference between 180°/s and 5°/s was significantly correlated with the MAS,X value of MTS,TSS and CSI score with correlation coefficient of 0.459-0.848 (P<0.01).Conclusion The Work difference value is significantly correlated with the MAS,X value of MTS TSS and CSI score;it is consistent with the definition of the response spasticity and can be used for measurement of the spasticity in patients.