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使用ActiGait®系统对33例中枢性足下垂患者进行腓总神经电刺激后的长期结果。

Long-term results following electrical stimulation of the peroneal nerve using the ActiGait® system in 33 patients with central drop foot.

作者信息

Martin Daniel, Patriciu Andrei, Schulz Anne-Kathrin, Schackert Gabriele

机构信息

Department of Neurosurgery, Technische Universität Dresden, Dresden, Germany.

nstim Services GmbH Vienna, Vienna, Austria.

出版信息

Innov Surg Sci. 2021 Jan 6;6(1):20191003. doi: 10.1515/iss-2019-1003. eCollection 2021 Jan.

DOI:10.1515/iss-2019-1003
PMID:33506100
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7790182/
Abstract

OBJECTIVE

Direct electrical stimulation of the peroneal nerve, using the implantable ActiGait® system, enables a therapy of the centrally caused drop foot, to improve the gait of the patients. In this paper, we present long-term results at 36-month follow-up post implantation.

METHOD

A total of 33 patients, 27 stroke and six multiple sclerosis (MS) patients, suffering from spastic drop foot were implanted in our center and assessed in terms of gait endurance, speed, risk of fall, and life quality at baseline and 36 months following implantation.

RESULTS

The six min gait endurance test increased significantly from 202 ± 41 m without walking aids to 380 ± 30 m (p=0.038), while using the implant. Moreover, the time in the gait speed measured over 20 m decreased from 31.8 ± 10.2 s without to 18.5 ± 4.6 s by using the ActiGait® system (p=0.039). Similarly, gait steadiness, measured by the Timed Up and Go (TUG) test improved by 36.6%, with patients demonstrating a reduced time from 18.6 ± 5.5 to 11.2 ±  3.8 s (p=0.041) upon implant activation. Most importantly, 31 of 33 patients reported remarkable improvements of their quality of life following direct electrical nerve stimulation.

CONCLUSION

Our findings confirm previously published efficacy data at 12 months after implantation and underline the long-lasting effect of the ActiGait® system.

摘要

目的

使用可植入式ActiGait®系统直接电刺激腓总神经,能够对中枢性足下垂进行治疗,改善患者步态。在本文中,我们展示了植入后36个月的长期随访结果。

方法

本中心共纳入33例患有痉挛性足下垂的患者,其中27例为中风患者,6例为多发性硬化(MS)患者,并在基线期及植入后36个月对其步态耐力、速度、跌倒风险和生活质量进行评估。

结果

在使用该植入装置时,6分钟步态耐力测试结果从无辅助行走时的202±41米显著提高至380±30米(p = 0.038)。此外,使用ActiGait®系统时,20米步态速度测试时间从无辅助时的31.8±10.2秒降至18.5±4.6秒(p = 0.039)。同样,通过计时起立行走测试(TUG)测量的步态稳定性提高了36.6%。激活植入装置后,患者完成测试的时间从18.6±5.5秒减少至11.2±3.8秒(p = 0.041)。最重要的是,33例患者中有31例报告在直接电神经刺激后生活质量有显著改善。

结论

我们的研究结果证实了先前发表的植入后12个月疗效数据,并强调了ActiGait®系统的长期效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0f0/7790182/9d121d489d72/iss-06-20191003-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0f0/7790182/aaa3dc63a3b2/iss-06-20191003-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0f0/7790182/9d121d489d72/iss-06-20191003-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0f0/7790182/aaa3dc63a3b2/iss-06-20191003-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0f0/7790182/9d121d489d72/iss-06-20191003-g002.jpg

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本文引用的文献

1
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J Neurosurg. 2017 May;126(5):1685-1690. doi: 10.3171/2016.4.JNS1660. Epub 2016 Jul 1.
2
Restoration of ankle movements with the ActiGait implantable drop foot stimulator: a safe and reliable treatment option for permanent central leg palsy.使用ActiGait植入式垂足刺激器恢复踝关节活动:永久性中枢性腿部麻痹的一种安全可靠的治疗选择。
J Neurosurg. 2016 Jan;124(1):70-6. doi: 10.3171/2014.12.JNS142110. Epub 2015 Jul 24.
3
New Therapeutic Option for Drop Foot with the ActiGait Peroneal Nerve Stimulator--a Technical Note.
ActiGait腓总神经刺激器为足下垂提供的新治疗选择——技术说明
World Neurosurg. 2015 Dec;84(6):2037-42. doi: 10.1016/j.wneu.2015.06.074. Epub 2015 Jul 9.
4
Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.踝足矫形器对线和足板长度对脑卒中后偏瘫成年人步态的影响。
Arch Phys Med Rehabil. 2009 May;90(5):810-8. doi: 10.1016/j.apmr.2008.11.012.
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A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in poststroke hemiplegia.一项关于植入式双通道腓总神经刺激器对中风后偏瘫患者步行速度和活动能力影响的随机对照试验。
Arch Phys Med Rehabil. 2007 Aug;88(8):971-8. doi: 10.1016/j.apmr.2007.05.002.
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Leg muscle activation patterns of sit-to-stand movement in stroke patients.中风患者从坐到站动作中腿部肌肉的激活模式。
Am J Phys Med Rehabil. 2004 Jan;83(1):10-6. doi: 10.1097/01.PHM.0000104665.34557.56.
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People with stroke living in the community: Attention deficits, balance, ADL ability and falls.居住在社区中的中风患者:注意力缺陷、平衡能力、日常生活活动能力及跌倒情况。
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Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait.踝足矫形器对偏瘫步态时空参数及能量消耗的影响。
Clin Rehabil. 2003 Jul;17(4):368-72. doi: 10.1191/0269215503cr622oa.
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