2011年10月《Neurology》最新发表一项前瞻性观察性研究表明,严重卒中后15天内双腿可交叉的患者,预后更好,死亡率更低(Neurology. 2011;77:1453-1456)。
该研究旨在探讨双腿交叉是否能预测重度卒中患者的预后。研究入选34例严重卒中后15天内能双腿交叉的患者,并随机选择34例严重卒中后15天内不能交叉的患者。评价患者入院、交叉腿当天、出院及出院一年时的相关指标。
入院时,两组患者神经功能损伤、独立性及残疾程度相当。出院时,卒中后15天内双腿能交叉的患者相比不能交叉组神经功能更好,NIHSS评分分别为6.5和10.6(P=0.0026)。出院一年时,能交叉组1人死亡,不能交叉组18人死亡(P<0.001);前者残疾程度更轻,走路更少需要辅助,仅是中度残疾,而后者一般是重度残疾。
来自德国慕尼黑大学的研究人员Berend Feddersen指出,患者腿能交叉时是躺着且多数无意识。腿活动能力的恢复,在卒中康复中通常是第一步。手臂交叉,也许同样能预示好的卒中恢复,但因为发生太快以致于不容易引起医生或护士注意,而腿交叉则较容易观察到。
研究人员指出,下一步是进行大型研究比较腿交叉和传统方法(最常用的是NIHSS评分)预测卒中康复的准确性。如果能进一步证实这项研究结果,腿交叉实验也许能成为NIHSS评分之外预测卒中康复的一个更简单工具。
The crossed leg sign indicates a favorable outcome after severe stroke
Objective: We investigated whether crossed legs are a prognostic marker in patients with severe stroke.
Methods: In this controlled prospective observational study, we observed patients with severe stroke who crossed their legs during their hospital stay and matched them with randomly selected severe stroke patients who did not cross their legs. The patients were evaluated upon admission, on the day of leg crossing, upon discharge, and at 1 year after discharge. The Glasgow Coma Scale, the NIH Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI) were obtained.
Results: Patients who crossed their legs (n = 34) and matched controls (n = 34) did not differ in any scale upon admission. At the time of discharge, the GCS did not differ, but the NIHSS was better in crossed legs patients (6.5 vs 10.6; p = 0.0026), as was the mRS (3.4 vs 5.1, p < 0.001), and the BI (34.0 vs 21.1; p = 0.0073). At 1-year follow-up, mRS (2.9 vs 5.1, p < 0.001) and the BI (71.3 vs 49.2; p = 0.045) were also better in the crossed leg group. The mortality between the groups differed grossly; only 1 patient died in the crossing group compared to 18 in the noncrossing group (p < 0.001).
Conclusion: Leg crossing is an easily obtained clinical sign and is independent of additional technical examinations. Leg crossing within the first 15 days after severe stroke indicates a favorable outcome which includes less neurologic deficits, better independence in daily life, and lower rates of death