Boninger M L, Cooper R A, Baldwin M A, Shimada S D, Koontz A
Department of Rehabilitation Science and Technology, University of Pittsburgh, PA 15213, USA.
Arch Phys Med Rehabil. 1999 Aug;80(8):910-5. doi: 10.1016/s0003-9993(99)90082-5.
Individuals who use manual wheelchairs are at high risk for median nerve injury and subsequent carpal tunnel syndrome (CTS). To gain a better understanding of the mechanism behind CTS in manual wheelchair users, this study examined the relation between (1) pushrim biomechanics and function of the median nerve, (2) pushrim biomechanics and subject characteristics, and (3) median nerve function and subject characteristics.
Case series.
Biomechanics laboratory and an electromyography laboratory.
Thirty-four randomly recruited individuals with paraplegia who use a manual wheelchair for mobility.
Subjects propelled their own wheelchair on a dynamometer at 0.9m/sec and 1.8m/sec. Bilateral biomechanical data were obtained using a force- and moment-sensing pushrim and a motion analysis system. Bilateral nerve conduction studies focusing on the median nerve were also completed.
Pearson's correlation coefficients between subject characteristics, median nerve conduction studies, and propulsion biomechanics; a regression model of nerve conduction studies incorporating subject characteristics and pushrim biomechanics.
Subject weight was significantly related to median nerve latency (r = .36, p = .03) and median sensory amplitude (r = -.43, p = .01). Height was also significantly related to median sensory amplitude (r = -.58, p = .01). Subject weight was significantly related to the peak resultant force applied to the pushrim (r = .59, p < .001). Height, weight, and weight-normalized pushrim forces were successfully incorporated into a linear regression model predicting median sensory amplitude (r = .63, p < .05) and mean median latency (r = .54, p < .05).
This study found subject weight to be related to pushrim forces and median nerve function. Independent of subject weight, pushrim biomechanics were also related to median nerve function. Through weight loss and changes in pushrim biomechanics, it may be possible to prevent median nerve injury in manual wheelchair users.
使用手动轮椅的个体有正中神经损伤及后续发展为腕管综合征（CTS）的高风险。为了更好地理解手动轮椅使用者发生CTS的机制，本研究考察了以下三方面的关系：（1）轮辋生物力学与正中神经功能；（2）轮辋生物力学与受试者特征；（3）正中神经功能与受试者特征。
病例系列研究。
生物力学实验室和肌电图实验室。
34名随机招募的截瘫个体，他们使用手动轮椅出行。
受试者在测力计上以0.9米/秒和1.8米/秒的速度推动自己的轮椅。使用力和力矩感应轮辋及运动分析系统获取双侧生物力学数据。还完成了针对正中神经的双侧神经传导研究。
受试者特征、正中神经传导研究与推进生物力学之间的皮尔逊相关系数；纳入受试者特征和轮辋生物力学的神经传导研究回归模型。
受试者体重与正中神经潜伏期显著相关（r = 0.36，p = 0.03）以及正中感觉神经动作电位波幅显著相关（r = -0.43，p = 0.01）。身高也与正中感觉神经动作电位波幅显著相关（r = -0.58，p = 0.01）。受试者体重与施加在轮辋上的合力峰值显著相关（r = 0.59，p < 0.001）。身高、体重和体重标准化的轮辋力成功纳入预测正中感觉神经动作电位波幅（r = 0.63，p < 0.05）和正中神经平均潜伏期（r = 0.54，p < 0.05）的线性回归模型。
本研究发现受试者体重与轮辋力及正中神经功能相关。独立于受试者体重之外，轮辋生物力学也与正中神经功能相关。通过减重及改变轮辋生物力学，有可能预防手动轮椅使用者的正中神经损伤。
