高原环境下脑卒中偏瘫患者肘关节功能特征的横断面研究

Cross-Sectional Study on Functional Characteristics of Elbow Joints in Stroke Patients with Hemiplegia in Plateau Environments

摘要: 目的：脑卒中偏瘫患者常存在肘关节屈伸肌力失衡，表现为患侧峰力矩低于对侧，且屈肌痉挛模式突出。高原低氧环境可能会加剧脑卒中后神经功能损伤，但针对偏瘫患者肘关节生物力学特征的研究尚属空白。方法：本研究纳入30例高原地区(海拔 ≥ 2000 m)的脑卒中偏瘫患者，于肘关节低速(20˚/s)等速运动模式下采集其屈曲与伸直运动的峰力矩、峰力矩/体重比及屈伸肌峰力矩比；并对脑卒中后偏瘫患者的患侧峰力矩与基本信息、对侧峰力矩相关性进行分析。结果：高原地区脑卒中偏瘫患者的患侧肘关节屈、伸肌峰力矩及相对峰力矩均显著低于对侧(P < 0.05)，但患侧屈、伸肌峰力矩比值与对侧无显著差异(P > 0.05)；患侧肘关节屈肌峰力矩与性别、病程、对侧屈肌及伸肌峰力矩呈显著正相关(P < 0.05)，而伸肌峰力矩与年龄、性别、病程、BMI及对侧屈/伸肌峰力矩均无显著相关性(P > 0.05)。结论：高原脑卒中偏瘫患者的肘关节肌力损伤具有肘关节屈伸峰力矩同步减弱的特征，且病程及对侧肌力与患侧屈肌功能改善显著相关，需采取屈伸肌群同步强化康复策略。

Abstract: Objective: Stroke patients with hemiplegia often exhibit an imbalance in elbow flexion and extension muscle strength, characterized by lower peak torque on the affected side and prominent flexor spasticity. A high-altitude hypoxic environment may exacerbate post-stroke neurological impairment, yet research on the biomechanical characteristics of the elbow joint in hemiplegic patients under such conditions remains scarce. Methods: This study enrolled 30 hemiplegic stroke patients from high-altitude regions (≥2000 m above sea level). Peak torque (PT), peak torque-to-body weight ratio (PT/BW), and flexor-to-extensor peak torque ratio were measured during low-velocity (20˚/s) isokinetic elbow flexion and extension. Correlations between affected-side PT and demographic variables as well as contralateral PT were analyzed. Results: The affected side showed significantly lower PT and PT/BW in both flexion and extension compared to the unaffected side (P < 0.05). However, the flexor-to-extensor PT ratio did not differ significantly between sides (P > 0.05). Affected-side flexor PT correlated positively with gender, disease duration, and contralateral flexor and extensor PT (P < 0.05). In contrast, affected-side extensor PT showed no significant correlation with age, gender, disease duration, BMI, or contralateral PT (P > 0.05). Conclusion: Hemiplegic stroke patients in high-altitude settings demonstrate synchronous reduction in elbow flexor and extensor strength. Rehabilitation strategies should emphasize simultaneous strengthening of both muscle groups, given the significant association between affected-side flexor function and both disease duration and contralateral muscle strength.