神经性瘫痪患者抗骨质疏松抗挛缩探究.docVIP

神经性瘫痪患者抗骨质疏松抗挛缩探究 　【摘要】目的探讨治疗和预防神经性瘫痪患者的骨质疏松症和关节挛缩的临床康复方法和理论，寻求抗骨质疏松抗挛缩的新途径。方法先后对两组各30例神经性瘫痪患者分别进行运动功能评价、骨密度测定及血钙血磷等生化测定，并用生物力学疗法进行康复治疗。结果两组神经性瘫痪患者骨密度均低于正常人。验证抗挛缩、抗骨疏松疗效，可用关节活动范围和徒手肌力检查进行评价。寻求到该评价法和生物力学疗法在抗关节挛缩与骨密度及血钙血磷等升华测定检验结果间的理化关系式。结论神经性瘫痪患者因失应力和钙丢失而造成骨质疏松和关节挛缩。抗关节挛缩是抗骨质疏松的关键；应尽早实行物理康复，用生物力学疗法调控钙磷代谢。 【关键词】神经性瘫骨质疏松挛缩异位骨化生物力学疗法超重力场 Studyofanti-osteoporosisandanti-contractureinpatientswithneurogenicparalysisZhangDaxin﹡,MaHaibo,DuanYunbo.*DepartmentofphysicalmedicineRehabilitation,China-JapanFriendshipHospital,Beijing100029 【Abstract】ObjectiveToassessthemethodsandtheoryoftreatmentandprevention,andtosearchtheneweffectiveapproachofanti-osteoporosis,anti-contractureandclinicophysicalrehabilitationinpatientswithneurogenicparalysis.MethodSixtypatientswithneurogenicparalysisweredividedintotwogroups(30ineach),theirkineticfunctionwasevalusated,bonemineraldensity(BMD),serumlevelsofcalciumandphosphorusweredetermined.Theabilitiesofanti-contractureandanti-osteoporoticfracturewereevaluatedwiththeparametersofjointmovingrangeandmuscularstrength.ResultsBMDinpatientswithneurogenicparalysisinbothgroupsissignificantlylowerthanthatinnormalcontrol.Theabilitiesofanti-contractureandanti-osteoporoticfracturewerecloselycorrelatedwithBMD,Serumlevelsofcalciumandphosphorus.ConclusionOsteoporosisandcontractureinpatientswithneurogenicparalysismaybeinducedbystressandcalciumloss.Atheoryofhigravitywasproposed.Earliertreatmentwithphysicalrehabilitationcanpreventthesepathogeneticprocesseseffectively.Biomechanicalmethodandrelatedtheoryofhigravitymightbeusefulindirectingthiseffectivetreatmentandothernewapproaches. 【Keywords】NeurogenicparalysisOsteoporosisContractureHeterotopicossification BiomechanicalHigravity 由周围神经、脊髓和脑中枢神经功能障碍导致的神经性瘫痪患者常出现骨质疏松症和关节挛缩[1]。为探索瘫痪康复理论和方法，我们先后系统地测定了两组各30例神经性瘫痪患者的骨密度（BMD）和血钙磷相关生化指标，如碱性磷酸酶（AKP）,25羟维生素D（25羟VD）和骨钙素（BGP），与其相应的运动功能评价指标进行比较。 资料和方法 1.对30例中枢神经性下肢瘫痪半年以上的第一组住院病人（年龄16~73岁，平均36岁，男性26例，女4例）进行骨矿盐单光子X线测定和患者血钙、磷、AKP和25羟VD测定，并参照各项临床通用正常值[2]进行比较。第二组是30例病程在半年之内的神经性偏