Thilmann A F, Fellows S J, Ross H F
Neurologische Klinik, Alfried Krupp Krankenhaus, Essen, Germany.
J Neurol Neurosurg Psychiatry. 1991 Feb;54(2):134-9. doi: 10.1136/jnnp.54.2.134.
The resistance of the relaxed ankle to slow displacement over the joint movement range was measured on both sides of a group of hemiparetic stroke patients, in whom spasticity had been established for at least one year and who showed no clinical signs of contractures. The ankle joints of the age-matched normal subjects were flexible over most of the movement range, showing dramatically increasing stiffness only when the foot was dorsiflexed beyond 70 degrees, with a neutral range between 90-100 degrees, and a less dramatic increase in stiffness during plantarflexion. Hemiparetic patients showed identical curves to the normal subjects on the "healthy" side, ipsilateral to the causative cerebral lesion, but were significantly stiffer in dorsiflexion on the contralateral side, without change in the minimum stiffness range or during plantarflexion. Therefore significant changes in passive biomechanical properties occur at the affected ankle of hemiparetic subjects, predominantly as the result of a loss of compliance in the Achilles tendon, although an increase in the passive stiffness of the triceps surae may also occur. The contribution of these changes to the locomotor disability of hemiparetic patients is discussed.
在一组偏瘫性中风患者两侧测量了踝关节在关节活动范围内对缓慢位移的松弛阻力，这些患者的痉挛已持续至少一年且无挛缩的临床体征。年龄匹配的正常受试者的踝关节在大部分活动范围内都很灵活，仅在足背屈超过70度时才显示出明显增加的僵硬，中立范围在90 - 100度之间，跖屈时僵硬增加不明显。偏瘫患者在与致病脑损伤同侧的“健康”侧显示出与正常受试者相同的曲线，但对侧背屈时明显更僵硬，最小僵硬范围或跖屈时无变化。因此，偏瘫受试者患侧踝关节的被动生物力学特性发生了显著变化，主要是由于跟腱顺应性丧失，尽管腓肠肌三头肌的被动僵硬也可能增加。讨论了这些变化对偏瘫患者运动障碍的影响。
