QCT評(píng)估三級(jí)康復(fù)對(duì)腦卒中患者骨量與肌肉變化的影響
發(fā)布時(shí)間：2018-10-18 09:23
【摘要】：目的:用定量CT作為隨訪手段,評(píng)價(jià)三級(jí)康復(fù)治療對(duì)延緩急性腦卒中患者骨質(zhì)疏松、肌肉萎縮的療效。方法:收集2015年5月到2016年12月就診于貴州醫(yī)科大學(xué)附屬醫(yī)院首次發(fā)病的急性腦卒中患者,排除肝腎功能不全、充血性心衰、呼吸功能衰竭、活動(dòng)性肝病、惡性腫瘤、惡性高血壓并控制不佳、認(rèn)知功能障礙不能配合治療者、四肢癱瘓、住址偏遠(yuǎn)無(wú)法隨訪、既往有癡呆史、精神疾病史或聾、啞病人。分為實(shí)驗(yàn)組10例、對(duì)照組10例,實(shí)驗(yàn)組接受系統(tǒng)三級(jí)康復(fù)治療,對(duì)照組未在任何醫(yī)院進(jìn)行過(guò)系統(tǒng)康復(fù)治療�？祻�(fù)治療方法:(1)良肢位的擺放;(2)關(guān)節(jié)活動(dòng)度的訓(xùn)練;(3)自我主動(dòng)、被動(dòng)運(yùn)動(dòng);(4)動(dòng)作轉(zhuǎn)移訓(xùn)練;(5)基本的日常生活活動(dòng)訓(xùn)練;(6)抑制軀干和肢體痙攣的訓(xùn)練;(7)上肢功能訓(xùn)練;(8)平衡訓(xùn)練;(9)下肢主動(dòng)運(yùn)動(dòng)和分離運(yùn)動(dòng)誘發(fā)訓(xùn)練;(10)步行訓(xùn)練;(11)加強(qiáng)日常生活能力訓(xùn)練;(12)矯形器;(13)環(huán)境改造。QCT測(cè)量方法:使用德國(guó)西門子公司SIEMENS 128排SOMATOM Definition AS+螺旋CT掃描儀在治療前、治療后3月末及治療后6月末對(duì)患者進(jìn)行腰椎(L1-3)、股骨頸及大腿中段肌肉的QCT掃描。并上傳至QCT后處理軟件(QCT Pro)測(cè)量患者3個(gè)時(shí)間點(diǎn)腰椎(L1-3)、股骨頸的骨密度值(BMD)及大腿中段肌肉橫截面積。統(tǒng)計(jì)學(xué)方法:所有數(shù)據(jù)采用EXCEL和SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)整理和統(tǒng)計(jì)分析。計(jì)量資料采用sx?表示。對(duì)于計(jì)量資料不同時(shí)間的比較采用重復(fù)測(cè)量資料的方差分析。等級(jí)資料應(yīng)用Wilcoxon秩和檢驗(yàn)。統(tǒng)計(jì)學(xué)上檢驗(yàn)水準(zhǔn)為α0.05,顯著性水平為P0.05。結(jié)果:(1)治療前后對(duì)比:兩組患者治療前后腰椎、雙側(cè)股骨頸BMD值與雙側(cè)大腿肌肉橫截面積對(duì)比均具有統(tǒng)計(jì)學(xué)意義(P0.05);(2)腰椎組間對(duì)比:兩組間腰椎BMD值對(duì)比具有統(tǒng)計(jì)學(xué)意義(P0.05);(3)股骨頸組間對(duì)比:兩組間偏癱側(cè)股骨頸BMD值對(duì)比具有統(tǒng)計(jì)學(xué)意義(P0.05),而健側(cè)BMD值對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(4)股骨頸組內(nèi)健、患側(cè)對(duì)比:實(shí)驗(yàn)組健、患側(cè)對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組健、患側(cè)對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05);(5)大腿中段肌肉橫截面積組間對(duì)比:兩組間偏癱側(cè)、健側(cè)大腿中段肌肉橫截面積對(duì)比均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(6)大腿中段肌肉橫截面積組內(nèi)健、患側(cè)對(duì)比:實(shí)驗(yàn)組健、患側(cè)對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組健、患側(cè)對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)三級(jí)康復(fù)治療不可避免、但可延緩患者肢體結(jié)構(gòu)的降低,對(duì)腦卒中偏癱患者進(jìn)行早期、全程的康復(fù)治療很有必要;(2)康復(fù)過(guò)程中應(yīng)該進(jìn)行必要的影像學(xué)檢查監(jiān)測(cè)患者肢體結(jié)構(gòu)的變化,預(yù)防因肢體結(jié)構(gòu)減低所致的并發(fā)癥。
[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 偽 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.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R816.1
本文編號(hào)：2278695
[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 偽 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.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R816.1
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