Oka Nobuyuki, Sugiyama Hiroshi, Kawasaki Teruaki, Mizutani Kotaro, Matsui Masaru
Department of Rehabilitation Medicine, Minami-kyoto National Hospital.
Rinsho Shinkeigaku. 2005 Mar;45(3):207-10.
Falling accidents are predisposing factors in worsening the quality of life. Causes of falls included gait and balance problems, visual disorder, cognitive impairment and drugs. However, falls in neuropathic patients are not often investigated. We studied the actual condition and causes of falls associated with neuropathy. One hundred and ninety-three patients (122 males and 71 females, ages 57 +/- 15 years) with neuropathy were selected for evaluation. In all patients, more than half a year had passed since the onset of symptoms and the present condition was considered comparatively stable. We divided the patients into 2 groups: falling or non-falling. Patients experiencing accident accompanied by external injury once or more in the past year, or patients who answered "often fell" (1 time or more per month) on flat ground or in their residence comprised the fall group. The severity of disease was evaluated by modified Rankin Scale (0 to 5). The relationship between falls and neuropathic symptoms (proximal muscle weakness, distal muscle weakness, aching or numbness, and the position and vibration sensory loss) was statistically examined. The distribution of patients in the fall group according to modified Rankin Scale of neuropathy was scale 5: 0/0 (0%), scale 4: 5/36 (14%), scale 3: 24/72 (33%), scale 2: 7/56 (13%), and scale 1: 1/19 (5%). There were six fractures among all patients. Regarding the etiology, the fall group showed a high level of axonal neuropathies (44%). On analysis according to condition and symptoms in the patients with a score of 2, 3, or 4 who demonstrated a high rate of falls, there was a strong correlation between deep sensory loss and fall (p < 0.05). However, as independent factors, there were no correlations between falling and proximal muscle weakness, distal muscle weakness or aching numbness, respectively. We thought it necessary to add ataxic gait resulting from deep sensory loss to one of the fall risks.
跌倒事故是导致生活质量下降的诱发因素。跌倒的原因包括步态和平衡问题、视力障碍、认知障碍以及药物因素。然而，神经性疾病患者的跌倒情况却常常未得到充分研究。我们对与神经病变相关的跌倒实际情况及原因进行了研究。选取了193例神经病变患者（男性122例，女性71例，年龄57±15岁）进行评估。所有患者自症状出现起已过去半年以上，且目前病情被认为相对稳定。我们将患者分为两组：跌倒组和非跌倒组。过去一年中发生过一次或多次伴有外伤的意外事故的患者，或在平地或住所中回答“经常跌倒”（每月1次或更多次）的患者构成跌倒组。采用改良Rankin量表（0至5分）评估疾病严重程度。对跌倒与神经病变症状（近端肌肉无力、远端肌肉无力、疼痛或麻木以及位置觉和振动觉丧失）之间的关系进行了统计学检验。根据神经病变的改良Rankin量表，跌倒组患者的分布情况为：5级：0/0（0%），4级：5/36（14%），3级：24/72（33%），2级：7/56（13%），1级：1/19（5%）。所有患者中有6例发生骨折。就病因而言，跌倒组中轴索性神经病变的比例较高（44%）。对跌倒发生率较高的2分、3分或4分患者，根据病情和症状进行分析，发现深度感觉丧失与跌倒之间存在强烈相关性（p<0.05）。然而，作为独立因素，跌倒与近端肌肉无力、远端肌肉无力或疼痛麻木之间分别不存在相关性。我们认为有必要将深度感觉丧失导致的共济失调步态列为跌倒风险之一。
