脛神經(jīng)小腿三頭肌運(yùn)動(dòng)分支選擇性麻醉阻滯對腦卒中痙攣性垂足責(zé)任肌篩選的研究.pdf

1、脛神經(jīng)小腿三頭肌運(yùn)動(dòng)分支選擇性麻醉阻滯對腦卒中痙攣性垂足責(zé)任肌篩選的研究摘要目的：通過脛神經(jīng)小腿三頭肌運(yùn)動(dòng)神經(jīng)分支選擇性麻醉阻滯，找出造成腦卒中痙攣性垂足患者的責(zé)任肌。方法：選擇30例腦卒中患者，應(yīng)用2％利多卡因?qū)紓?cè)進(jìn)行腓腸肌和比目魚肌運(yùn)動(dòng)分支神經(jīng)麻醉阻滯術(shù)，阻滯前后對肢體痙攣指標(biāo)包括牽張反射評分(stretchreflex，SR)、痙攣嚴(yán)重程度分級Ashworth評分、踝關(guān)節(jié)活動(dòng)角度(rangeofmotion，ROM)包括休息位R

2、OM(restrangeofmotion，rROM)、主動(dòng)背屈ROM(activerangeofmotion，AROM)和被動(dòng)背屈ROM(passirerangeofmotion，PROM)、足跖屈肌肌力以及下肢步行功能狀態(tài)指標(biāo)如lOm舒適和快速步行速度、步頻、3min步行距離、能量消耗指數(shù)(physicalconsumeindex，PCI)以及步長和足偏角進(jìn)行觀察。分別比較腓腸肌阻滯Iji『后、比目魚肌阻滯前后，以及腓腸肌運(yùn)動(dòng)分支阻滯

3、后和比目魚肌運(yùn)動(dòng)分支阻滯后上述指標(biāo)的變化和差異。結(jié)果：痙攣指標(biāo)SR評分、Ashworth評分、AROM和PROM在腓腸肌運(yùn)動(dòng)分支阻滯后較阻滯前均下降，差異有統(tǒng)計(jì)學(xué)意義，p值均O01，SR評分、Ashworth評分、rROM、AROM和PROM在比目魚肌運(yùn)動(dòng)分支阻滯后較阻滯前均下降，p值均O01；比目魚肌運(yùn)動(dòng)分支阻滯后痙攣指標(biāo)低于腓腸肌運(yùn)動(dòng)分支阻滯后，SR評分、AROM和PROM的P值均001，Ashworth評分、rRoMp值均005；

4、對于足跖屈肌肌力，腓腸肌運(yùn)動(dòng)分支阻滯后較阻滯前肌力下降，pO01，比目魚肌運(yùn)動(dòng)分支阻滯術(shù)后對肌力無影響，兩種阻滯方法比較p001；步行功能指標(biāo)腓腸肌運(yùn)動(dòng)分支阻滯后較阻滯前無統(tǒng)計(jì)學(xué)差異，比目魚肌運(yùn)動(dòng)分支阻滯后除3min步行距離較阻滯前無差異外，其余指標(biāo)均有提高，lOm快速步行速度、步頻的p值均O01，lOm舒適步行速度和PCI的p值均005；除3min步行距離兩種阻滯方法比較無統(tǒng)計(jì)學(xué)差異外，其余指標(biāo)比目魚肌運(yùn)動(dòng)分支阻滯后均高于腓腸肌運(yùn)動(dòng)分

5、支阻滯后，表現(xiàn)為lOm舒適步行速度的P值O05，lOm快速步行速度、步頻、能量消耗指數(shù)PCI的P值均001?；紓?cè)步長和足偏角在兩種阻滯方法術(shù)后較阻滯前差別均無統(tǒng)計(jì)學(xué)意義，兩種方法比較也均無統(tǒng)計(jì)學(xué)差異。結(jié)論：腓腸肌運(yùn)動(dòng)分支和比目魚肌運(yùn)動(dòng)分支利多卡因阻滯均能降低痙攣性足下垂患者的痙攣程度，但是比目魚肌運(yùn)動(dòng)分支阻滯較之腓腸肌運(yùn)動(dòng)分支阻滯更能改善患者Toevaluatethepredominantroleinpatientswithspasti

6、cequinusfootafterstroke：AclinicalstudyoftheeffectsofblockofmotornervebranchestothetricepssuraemuscleAbstractobjective：Toevaluatetheprominentroleofthetricepssuraemusclethroughselectiveanestheticblocksofmotornervebranchest

7、othetricepssuraemuscleonlowerlimbinpatientwithspasticequinusfootMethods：Thirtypatientswithstrokewereassessedbeforeandafterselectiveanestheticblockofthesuperiorsoleusnerveorthegastrocnemiusnerve，performedbylidocaineinject

8、ion，ClinicalassessmentsuchasSR(stretchreflex)、Ashworthscale、fROM(restrangeofmotion)、AROM(activerangeofmotion，)、PROM(passiverangeofmofion，)、strengthofplantarflexionmuscle、walkingspeedforlOm(atcosyspeedandvolantspeed，separ

9、ately)、cadence、walkingdistancefor3mins、PCI(physicalconsumeindex)、steplength、toeoutanglewereperformed30minsbeforeandaftereachmotorblockwedevidedintothreegroups，theyarepreoperativepostgastrocnemius、preoperativepostsoleus、p

10、ostgastrocnemius—postsoleusseparately，andwecompareddifferencesintheseindicatorsResults：Spasmindexsuchasstretchreflex，Ashworthscale，AROMandPROMwerealldecreasedinpostgastrocnemius，therewerestatisticallydifferencescomparedw

11、ithpreoperative，(PallO01)Stretchreflex，Ashworthscale，rROM，AROMandPROMwerealldecreasedinpostsoleus，(Pall001)；therearesignificantdifferencesbetweentwoblocksineachofthem，theyshowedthatonSR、AROMandPROMPaUO01，，onAshworth、rROM

12、PallO05：Plantarflexormusclestrengthdecreasedinpostgastrocnemius(pO01)butnotinpostsoleus，comparisonoftwoblocksp001；therewerenosignificantdifferencesonwalkingtargetsinpostgastroenemiusbuttherewerestatisticallydifferencesin

13、postsoleusexceptforwalkingdistancefor3minscomparedwithpreoperative，onwalkingspeedfor10matvolantspeedandcadencePallO01，onwalkingspeedfor10matcosyspeedandPCIPallO05Alsothereweresignificantdifferencebetweenthetwoblocksexcep