Wang Guo-Bao, Qiu Yan-Qun, Ying Ying, Yu Ai-Ping, Jiang Su, Jia Jie, Jia Xiaofeng, Xu Wen-Dong
Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China.
J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2140-2147. doi: 10.1016/j.jstrokecerebrovasdis.2019.04.006. Epub 2019 May 22.
Spastic arm paralysis after central neurological injury has a long-term effect on the patient's quality of life. Effective neurosurgical treatment for this dysfunction has been described in our previous studies. It is of great significance to determine a set of unified and concise clinical standards for motor function grading in the neurosurgical treatment and management.
We first conducted a retrospective study that included 51 hemiplegic patients from the Neurosurgery and Microsurgery outpatient database of Huashan Hospital. The neurosurgeons cooperated with rehabilitation experts to design and administer the new rating system (Hua-Shan Grading of Upper Extremity, H-S grading) after analyzing the scale scores and video records of these patients. We then randomly enrolled 64 patients with unilateral spastic arm paralysis after stroke or brain trauma. The Fugl-Meyer Assessment, the Ashworth scale and the new grading system were applied and analyzed to evaluate the participants' motor function.
Based on rehabilitation medicine scales and long-term follow-up, a feasible and concise grading system was applied that was based on the patients' characteristics and the examination experiences of neurosurgeons and rehabilitation experts in clinical practice. This method could effectively grade upper extremity motor function, usually in 3-5 minutes. A significant correlation was found between H-S grading and the Fugl-Meyer score by the Spearman test (r = .937, P < .01). The mean difference between any two levels of the new grading system was significant (P < .05). And good test-retest reliability, the Cronbach's alpha coefficient and the validity indices were presented. In addition, it was more sensitive to motor function compared with the Ashworth scale.
As a supplement to the classic scales, H-S grading was developed in the area of spastic hemiplegia treatment. It is standardized and simplified for patients in the chronic stage after central neurological injury.
中枢神经系统损伤后出现的痉挛性臂瘫对患者生活质量有长期影响。我们之前的研究已描述了针对这种功能障碍的有效神经外科治疗方法。确定一套统一且简洁的神经外科治疗与管理中运动功能分级的临床标准具有重要意义。
我们首先进行了一项回顾性研究，纳入了来自华山医院神经外科和显微外科门诊数据库的51例偏瘫患者。神经外科医生与康复专家合作，在分析这些患者的量表评分和视频记录后，设计并实施了新的评分系统（上肢华山分级，H-S分级）。然后，我们随机招募了64例中风或脑外伤后单侧痉挛性臂瘫的患者。应用Fugl-Meyer评估、Ashworth量表和新的分级系统对参与者的运动功能进行评估和分析。
基于康复医学量表和长期随访，应用了一种基于患者特征以及神经外科医生和康复专家临床实践检查经验的可行且简洁的分级系统。该方法可有效对上肢运动功能进行分级，通常在3至5分钟内完成。通过Spearman检验发现H-S分级与Fugl-Meyer评分之间存在显著相关性（r = .937，P < .01）。新分级系统任意两个级别之间的平均差异具有显著性（P < .05）。并且呈现出良好的重测信度、Cronbach's alpha系数和效度指标。此外，与Ashworth量表相比，它对运动功能更敏感。
作为经典量表的补充，H-S分级在痉挛性偏瘫治疗领域得以开发。它针对中枢神经损伤后慢性期的患者进行了标准化和简化。
