文档介绍：痉挛状态(Spasticity)
痉挛是临床上很常见但处理起来却又颇不容易的一个难题。
因为对痉挛的概念还不是十分的清楚。
“spasticity”是来源于希腊语的“spastikos”, 意思是“ draw in”,即“收”、“紧缩”的意思。
几个容易混淆的概念
痉挛(Spasm): a sudden, violent, involuntary contraction of a muscle or a group of muscles, attended by pain and interference with function, producing involuntary movement and distortion.
痉挛状态(Spasticity):在Dorland‘s医用词典中的解释是伴随腱反射增强的肌张力增高状态。并不是某块肌肉的张力增高所致。它包括速度依赖性、“折刀”现象、协同运动(synkinesia)、姿势异常、腱反射增强,浅反射减弱,病理反射阳性及阵挛等。spasticity 最常见于脑血管意外、颅脑外伤、脑瘫和脑瘤等导致的锥体束损害的情况。
几个容易混淆的概念
强直(rigidity):Dorland‘s医用词典中的解释是:不正常的或病态的僵硬、不易弯曲。比较有权威的定义(国际分类)是:“在病人有意放松的情况下,以在关节作被动活动时始终存在的均匀不变的抵抗为特点的肌紧张形式”,rigidity是锥体外系损害后的表现,作为帕金森综合征的三大主要症状之一,肌张力增高的运动障碍,无巴氏征和生理反射亢进.
挛缩(contracture):acondition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibers. 肌肉、腱、韧带产生畸变或变形的瘢痕组织的持久性短缩
几个容易混淆的概念
阵挛(clonus):短暂或不自主的单个或多个肌肉收缩.(面肌抽搐)
痛性痉挛 (cramp) :  a painful spasmodic muscular contraction, especially a tonic .(破伤风、书写痉挛等)
Nathan(1973)对痉挛的描述:
“Spasticity is a condition in which stretch reflexes that are normally latent e obvious. The tendon reflexes have a lowered threshold to tap, the response of the tapped muscle is increased, and usually muscles besides the tapped one respond; tonic stretch reflexes are affected in the same way. ”
“痉挛是正常时处于潜伏状态的牵张反射显露出来的一种状态。腱反射对叩击的阈值降低,被叩击肌肉的反应性增加,其相邻肌肉也发生反应,张力性牵张反射也出现类似的现象。”
Nathan对痉挛的定义强调牵张反射的中枢性作用,包括位相性牵张反射(phasic stretch reflexes)和张力性牵张反射(tonic stretch reflexes)增加。
位相性牵张反射增加表现为腱反射活跃或亢进
张力性反射增加表现为检查者被动活动牵拉肌肉时的抵抗(肌张力)增加。
Lance(1980)对痉挛的描述是目前国际上普遍采用的痉挛定义:
. “A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as ponent of the upper motor neuron syndrome”