以定量肌電圖評估痙攣上肢注射肉毒桿菌毒素後之療效—初步研究報告

Quantitative EMG Evaluation in Spastic Upper Extremity after Botulinum Toxin Injection-A Preliminary Report

黃巧雯(Chiao-Wen Hwang) ； 呂慶祥(Ching-Hsiang Lu) ； 許培德(Pei-Te Sheu) ； 許雅雯(Ya-Wen Hsu) ； 蔡昆守(Kun-Shou Tsai) ； 王志龍(Ji-Long Wang)

《台灣復健醫學雜誌》 32卷4期 (2004/12) Pp. 195-201

https://doi.org/10.6315/2004.32(4)04

摘要

中風患者的上肢肌肉張力增強是相當常見的併發症，注射肉毒桿菌毒素可降低中風患者上肢的痙攣，其效果評估多採日常生活功能量表、關節活動度或修正阿胥渥茲量表(modified Ashworth Scale)進行，本研究嘗試利用定量肌電圖來評估中風患者痙攣上肢注射肉毒桿菌毒素後之療效，並與傳統評估方法作一相關性的探討。
本研究收集二十位慢性中風病患為研究對象，所有注射皆在肌電圖導引下進行，效果評估項目包括患側上肢肘關節、腕關節、掌指關節、近端指間關節、遠端指間關節的修正阿胥渥茲量表評分加總、快速關節活動度、慢速關節活動度、布朗史東(Brunnstrom)分期（包括上肢近側與遠側）。並記錄肌電圖轉折數-電位分析法之參數。在注射後4周、12週時重複測量上述參數。
結果顯示注射肉毒桿菌毒素後4周時及12周時，肌電圖檢查發現靜止時平均動作電位、自主最大收縮時動作電位、每秒轉折數皆較注射前有明顯的降低，同時修正阿胥渥茲量表分數在注射後也有明顯下降。注射4周後，肘關節與腕關節的快速活動度與慢速活動度皆有顯著增加，但在12周時此效應便減弱。而手指關節及掌指關節的快速活動度與慢速活動度不論是在4周或12周時增加並不明顯。以布朗史東分期評估上肢的痙攣動作型態在注射前後則無明顯變化。比較傳統評估方法與肌電圖數據分析得到的相關係數大於0.7，顯示有高度相關。
研究結論為定量肌電圖確可作為中風患者注射肉毒稈菌毒素評估療效的工具，並與傳統的評估方法有高度相關性。

關鍵字

定量肌電圖 ； 中風 ； 痙攣 ； 肉毒桿菌毒素

並列摘要

Spasticity of the upper limb muscles is a common complication following stroke. Injection of botulinum toxin can decrease upper limb spasticity. The effects of botulinum toxin treatment are usually evaluated by activities of daily living, range of motion (ROM), or modified Ashworth scale. However, in this study, we evaluated the effect of botulinum toxin injection by quantitative EMG, and investigated the relationship between EMG and conventional evaluation methods.
Twenty patients with chronic stroke-related spasticity of the upper limb muscles received botulinum injections. All injections were guided by EMG. Outcome measures included total modified Ashworth scale score on the elbow, wrist, metacarpal joints, proximal interphalangeal joints, and the distal interphalangeal joints of the affected side; fast and slow ROM, and Brunnstrom stages (including proximal and distal). Parameters of EMG turns-amplitude analysis were also recorded. The above parameters were re-evaluated at 4 and 12 weeks following the initial injection.
After 4 and 12 weeks of botulinum toxin treatment, average resting amplitudes, voluntary maximal contraction amplitudes, number of turns per second, and modified Ashworth scale scores all significantly decreased. The fast and slow elbow and wrist joint movements were significantly improved after 4 weeks of injection. However, only a minimal effect was noted during week 12. The fast and slow range of motion of interphalangeal and metacarpal joints showed only marginal improvements after 4 and 12 weeks of treatment. No significant alterations in the limb movement pattern were observed by Brunnstrom stages. The correlation coefficient of conventional assessment and EMG analysis data was greater than 0.7, which indicated a significant correlation.
In conclusion, quantitative EMG is a suitable tool for evaluating the effect of botulinum toxin treatment in patients with stroke-related chronic spasticity in the upper limbs. EMG was highly correlated with the conventional assessment methods.

並列關鍵字

quantitative electromyography ； stroke ； spasticity ； botulinum toxin