QCT评估三级康复对脑卒中患者骨量与肌肉变化的影响

发布时间：2018-10-18 09:23

【摘要】：目的:用定量CT作为随访手段,评价三级康复治疗对延缓急性脑卒中患者骨质疏松、肌肉萎缩的疗效。方法:收集2015年5月到2016年12月就诊于贵州医科大学附属医院首次发病的急性脑卒中患者,排除肝肾功能不全、充血性心衰、呼吸功能衰竭、活动性肝病、恶性肿瘤、恶性高血压并控制不佳、认知功能障碍不能配合治疗者、四肢瘫痪、住址偏远无法随访、既往有痴呆史、精神疾病史或聋、哑病人。分为实验组10例、对照组10例,实验组接受系统三级康复治疗,对照组未在任何医院进行过系统康复治疗。康复治疗方法:(1)良肢位的摆放;(2)关节活动度的训练;(3)自我主动、被动运动;(4)动作转移训练;(5)基本的日常生活活动训练;(6)抑制躯干和肢体痉挛的训练;(7)上肢功能训练;(8)平衡训练;(9)下肢主动运动和分离运动诱发训练;(10)步行训练;(11)加强日常生活能力训练;(12)矫形器;(13)环境改造。QCT测量方法:使用德国西门子公司SIEMENS 128排SOMATOM Definition AS+螺旋CT扫描仪在治疗前、治疗后3月末及治疗后6月末对患者进行腰椎(L1-3)、股骨颈及大腿中段肌肉的QCT扫描。并上传至QCT后处理软件(QCT Pro)测量患者3个时间点腰椎(L1-3)、股骨颈的骨密度值(BMD)及大腿中段肌肉横截面积。统计学方法:所有数据采用EXCEL和SPSS 21.0统计软件进行数据整理和统计分析。计量资料采用sx?表示。对于计量资料不同时间的比较采用重复测量资料的方差分析。等级资料应用Wilcoxon秩和检验。统计学上检验水准为α0.05,显著性水平为P0.05。结果:(1)治疗前后对比:两组患者治疗前后腰椎、双侧股骨颈BMD值与双侧大腿肌肉横截面积对比均具有统计学意义(P0.05);(2)腰椎组间对比:两组间腰椎BMD值对比具有统计学意义(P0.05);(3)股骨颈组间对比:两组间偏瘫侧股骨颈BMD值对比具有统计学意义(P0.05),而健侧BMD值对比无统计学意义(P0.05);(4)股骨颈组内健、患侧对比:实验组健、患侧对比无统计学意义(P0.05),对照组健、患侧对比有统计学意义(P0.05);(5)大腿中段肌肉横截面积组间对比:两组间偏瘫侧、健侧大腿中段肌肉横截面积对比均无统计学意义(P0.05);(6)大腿中段肌肉横截面积组内健、患侧对比:实验组健、患侧对比无统计学意义(P0.05),对照组健、患侧对比有统计学意义(P0.05)。结论:(1)三级康复治疗不可避免、但可延缓患者肢体结构的降低,对脑卒中偏瘫患者进行早期、全程的康复治疗很有必要;(2)康复过程中应该进行必要的影像学检查监测患者肢体结构的变化,预防因肢体结构减低所致的并发症。
[Abstract]:Objective: to evaluate the effect of three-level rehabilitation therapy on delaying osteoporosis and muscular atrophy in patients with acute stroke by quantitative CT. Methods: from May 2015 to December 2016, patients with acute stroke who were first diagnosed in the affiliated Hospital of Guizhou Medical University, were excluded from liver and kidney insufficiency, congestive heart failure, respiratory failure, active liver disease and malignant tumor. Malignant hypertension with poor control, cognitive dysfunction can not be combined with treatment, quadriplegia, remote address can not be followed up, the past history of dementia, mental illness or deafness, dumb patients. There were 10 cases in the experimental group and 10 cases in the control group. The experimental group was treated with three levels of systemic rehabilitation, while the control group was not treated with systematic rehabilitation in any hospital. Rehabilitation treatment methods: (1) placement of good limb position; (2) training of joint motion; (3) self-initiative, Passive movement; (4) movement transfer training; (5) basic daily life training; (6) training to inhibit torso and limb spasm; (7) upper limb function training; (8) balance training; (9) lower extremity active movement and separation exercise induction training; (10) walking training; (11) Strengthen daily living ability training; (12) orthosis; (13) environmental modification. QCT measurement method: use SIEMENS 128 SOMATOM Definition AS helical CT scanner, before treatment, QCT scans of lumbar spine (L1-3), femoral neck and middle thigh muscles were performed at the end of 3 months after treatment and 6 months after treatment. The lumbar vertebrae (L1-3), bone mineral density (BMD) of femoral neck and midthigh muscle cross-sectional area were measured at three time points (L1-3) by QCT post-processing software (QCT Pro). Statistical method: all data were collected and analyzed by EXCEL and SPSS 21 1.0 software. Sx? is used to measure the data To indicate. Analysis of variance (ANOVA) of repeated measurement data was used to compare measurement data at different time. The rank data were tested by Wilcoxon rank sum test. Statistically, the test level was 伪 0.05 and the significant level was P0.05. Results: (1) comparison before and after treatment: two groups of patients before and after treatment of lumbar spine, The BMD value of bilateral femoral neck and the cross-sectional area of bilateral thigh muscle were statistically significant (P0.05); (2). The comparison of lumbar BMD value between two groups was statistically significant (P0.05); (3): the comparison of femoral neck of hemiplegic side between two groups was significant (P0.05); (3). The contrast of BMD value was statistically significant (P0.05), while the BMD value of healthy side had no statistical significance (P0.05); (4). Side contrast: the experimental group health, the affected side contrast has no statistical significance (P0.05), the control group healthy, the affected side contrast has the statistical significance (P0.05); (5) thigh muscle cross sectional area contrast: two groups between hemiplegia side, There was no significant difference in cross sectional area of middle thigh muscle in healthy side (P0.05); (6). In the affected side, there was no significant difference between the healthy group and the affected side (P0.05). The contrast between the control group and the affected side was statistically significant (P0.05). Conclusion: (1) Three-stage rehabilitation therapy is inevitable, but it can delay the reduction of limb structure of patients with hemiplegia, and it can be used in the early stage of stroke patients with hemiplegia. (2) the necessary imaging examination should be carried out to monitor the changes of limb structure in order to prevent the complications caused by the reduction of limb structure.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R816.1

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