脑卒中患者上肢运动神经元功能状态及与运动功能相关性研究

Clinical study on the correlation of the functional status of upper limb motor neurons with motor function in patients with stroke

目的探讨脑卒中患者上肢运动神经元功能状态与运动功能之间的相关性,为康复评定和功能预后判断提供指导。方法选取2020年11月—2021年1月于东南大学附属中大医院康复医学科住院的脑卒中患者。采用运动单位数目估计(motor unit number estimation,MUNE)和F波评估运动神经元功能状态,采用简式Fugl-Meyer评定量表(Fugl-Meyer Assessment,FMA)和改良Ashworth评分(Modified Ashworth Scale,MAS)评定患者上肢运动功能,并分析MUNE、F波相关参数与FMA评分和MAS评分的相关性。结果共纳入患者42例,合并患侧屈腕肌痉挛16例。42例脑卒中患者患侧拇短展肌MUNE低于健侧(t=-3.466,P=0.001),患侧不同形状F波计数比例明显低于健侧(Z=-5.583,P<0.001)。16例合并屈腕肌痉挛脑卒中患者的患侧F波波幅高于健侧(t=2.764,P=0.014),患侧F波潜伏期与健侧比较,差异无统计学意义(Z=-0.595,P=0.552)。42例脑卒中患者健患侧不同形状F波计数比例比值与FMA评分呈正相关(rs=0.377,P=0.014),健患侧MUNE比值与FMA评分无相关性(rs=0.104,P=0.513)。16例合并屈腕肌痉挛脑卒中患者的健患侧F波波幅比值与屈腕肌MAS评分呈正相关(rs=0.550,P=0.027)。结论脑卒中后偏瘫侧上肢功能性运动神经元数量减少和运动神经元兴奋性增高同时存在,并与运动功能和肌张力呈相关性。

Objective To explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.Methods The stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation(MUNE)and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment(FMA) and Modified Ashworth Scale(MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively. Results A total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side(t=-3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side(Z=-5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side(t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side(Z=-0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score(rs=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant(rs=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm,the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle(rs=0.550, P=0.027). Conclusion Stroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.