比较脊髓损伤患者在轮椅倾翻和后倾角度下坐骨结节处的肌肉和皮肤灌注。
Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury.
机构信息
Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.
出版信息
Arch Phys Med Rehabil. 2013 Oct;94(10):1990-6. doi: 10.1016/j.apmr.2013.03.027. Epub 2013 Apr 18.
OBJECTIVE
To compare the efficacy of wheelchair tilt-in-space and recline on enhancing muscle and skin perfusion over the ischial tuberosities in people with spinal cord injury (SCI).
DESIGN
Repeated-measures and before-after trial design.
SETTING
University research laboratory.
PARTICIPANTS
Power wheelchair users with SCI (N=20).
INTERVENTIONS
Six combinations of wheelchair tilt-in-space and recline angles were presented to participants in a random order. The testing protocol consisted of a baseline 5 minutes sitting with no tilt/recline and 5 minutes positioned in a tilted and reclined position at each of 6 conditions, including: (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline.
MAIN OUTCOME MEASURES
Muscle and skin perfusion were assessed by near-infrared spectroscopy and laser Doppler flowmetry, respectively.
RESULTS
Muscle perfusion was significantly increased at 25° and 35° tilt-in-space when combined with 120° recline, and skin perfusion was significantly increased at 3 tilt-in-space angles (15°, 25°, 35°) when combined with 120° recline and at 35° tilt-in-space when combined with 100° recline (P<.05). Even in the positions of increased muscle perfusion and skin perfusion (25° and 35° of tilt-in-space combined with 120° of recline), the amount of muscle perfusion change was significantly lower than the amount of skin perfusion change (P<.05).
CONCLUSIONS
Our results indicate that a larger angle of tilt-in-space and recline is needed to improve muscle perfusion compared with skin perfusion. A position of 25° tilt-in-space combined with 120° recline is effective in enhancing muscle and skin perfusion of weight-bearing soft tissues at the ischial tuberosities.
目的
比较轮椅倾斜空间和后倾对增强脊髓损伤（SCI）患者坐骨结节处肌肉和皮肤灌注的效果。
设计
重复测量和前后试验设计。
地点
大学研究实验室。
参与者
使用动力轮椅的 SCI 患者（N=20）。
干预措施
参与者以随机顺序接受 6 种轮椅倾斜空间和后倾角度的组合。测试方案包括基线 5 分钟无倾斜/后倾坐姿，以及在 6 种条件下各 5 分钟倾斜和后倾位置，包括：（1）15°倾斜空间和 100°后倾，（2）25°倾斜空间和 100°后倾，（3）35°倾斜空间和 100°后倾，（4）15°倾斜空间和 120°后倾，（5）25°倾斜空间和 120°后倾，（6）35°倾斜空间和 120°后倾。
主要观察指标
分别采用近红外光谱和激光多普勒流量仪评估肌肉和皮肤灌注。
结果
25°和 35°倾斜空间与 120°后倾相结合时，肌肉灌注显著增加，3 个倾斜空间角度（15°、25°、35°）与 120°后倾相结合时皮肤灌注显著增加，35°倾斜空间与 100°后倾相结合时皮肤灌注也显著增加（P<.05）。即使在肌肉灌注和皮肤灌注增加的位置（25°和 35°的倾斜空间与 120°的后倾），肌肉灌注的变化量也明显低于皮肤灌注的变化量（P<.05）。
结论
我们的结果表明，与皮肤灌注相比，需要更大的倾斜空间和后倾角度来改善肌肉灌注。25°倾斜空间与 120°后倾相结合的位置可有效增强坐骨结节承重软组织的肌肉和皮肤灌注。
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