超声测量法用于脑卒中后偏瘫侧肩关节半脱位相关性评估的临床意义  

Ultrasonography in evaluation of shoulder subluxation on the hemiplegia side after stroke

作　　者：丁宇超 杜宏艳[1] 董燕[1] DING Yuchao;DU Hongyan;DONG Yan(Department of Rehabilitation Medicine,Hospital of Zhejiang PAP,Hangzhou 310051,China)

机构地区：[1]武警浙江省总队医院康复中心

出　　处：《浙江医学》2019年第20期2215-2217,2221,共4页Zhejiang Medical Journal

基　　金：浙江省医药科研卫生项目(2017KY562)

摘　　要：目的 探讨超声测量法用于脑卒中后偏瘫侧肩关节半脱位相关性评估的临床意义.方法 选取脑卒中后偏瘫侧肩关节半脱位患者60例,采取超声测量法记录双侧肩峰-肱骨大结节间距(AGTD).分析肩关节半脱位距离(患侧AGTD-健侧AGTD)、肩关节半脱位比(SSR,患侧AGTD/健侧AGTD)与患侧上肢Brunnstrom分期、肩痛、肩关节被动活动度之间的相关性.结果 60例患者肩关节半脱位距离为(1.21±0.52)cm,SSR为1.74±0.39.肩关节半脱位距离与患侧上肢Brunnstrom分期呈较弱的负相关(rs=-0.270,P<0.05),SSR与患侧上肢Brunnstrom分期未见相关(P>0.05).肩痛组、无肩痛组肩关节半脱位距离分别为(1.27±0.50)、(0.97±0.61)cm,差异无统计学意义(P>0.05).肩关节半脱位距离与被动前屈、外展、外旋、内旋时出现疼痛的角度均未见相关(均P>0.05);SSR与被动前屈、外展、外旋均未见相关(均P>0.05),但与被动内旋呈较弱的负相关(r=-0.392,P<0.05).结论超声测量法安全、便捷,该法测定的脑卒中后偏瘫侧肩关节半脱位距离与患侧上肢Brunnstrom分期存在较弱的相关性,但与肩痛未见相关.Objective To assess the application of ultrasonography in evaluation of the shoulder subluxation on hemiplegia side after stroke.Methods Sixty stroke patients with glenohumeral subluxation were enrolled in the study.The bilateral acromiohumeral greater tuberosity distance(AGTD)was measured by ultrasound.The difference between AGTD of the affected side and the healthy side was defined as subluxation distance.AGTD on the infected side divided by AGTD on the healthy side was defined as shoulder subluxation ratio(SSR).Correlation between subluxation distance,SSR and upper limb Brunnstrom classification,shoulder pain and range of motion was analyzed.Results The average subluxation distance was(1.21±0.52)cm;the average SSR was 1.74±0.39cm.There was a weak correlation between subluxation distance and Brunnstrom classification of upper limb on affected side(r=-0.270,P<0.05),while no correlation was found between SSR and Brunnstrom classification(P>0.05).There was no significant difference in the average subluxation distance between shoulder pain and non-pain groups[(1.27±0.50)cm vs.(0.97±0.61)cm,P>0.05].There was no correlation between the subluxation distance and the angle of pain during passive flexion,abduction,external rotation and internal rotation(P>0.05).There was no correlation between SSR and passive pronation,abduction and pronation(P>0.05),but there was a weak negative correlation between SSR and passive pronation(r=-0.392,P<0.05).Conclusion Ultrasonography is safe and convenient for evaluation of shoulder subluxation in stroke patients.Based on the ultrasound measurement,glenohumeral subluxation after stroke is weakly correlated with upper limb Brunnstrom classification of affected side,but no correlation is found with shoulder pain.

关 键 词：脑卒中 肩关节半脱位 超声 肩痛 

分 类 号：R68[医药卫生—骨科学]