偏瘫后肩痛的发病机制与临床康复评估的应用进展  

Pathogenesis of Hemiplegic Shoulder Pain and Advances in the Assessment of Clinical Rehabilitation(Review)

作　　者：黄毓洁 林有维 许若瑶 林强 麦子冬 郭明远[2] 陈泓鑫[2] HUANG Yu-jie;LIN You-wei;XU Ruo-yao;LIN Qiang;MAI Zi-dong;GUO Ming-yuan;CHEN Hong-xin(The Fifth Clinical School of GuangzhouMedical University Department of Rehabilitation Therapy,Guangzhou,Guangdong 511436;Department of RehabilitationMedicine,Key Laboratory of Biological Targeting Diagnosis,Therapy and Rehabilitation of Guangdong Higher Edu‐cation Institutes,The Fifth Affiliated Hospital of GuangzhouMedical University,Guangzhou,Guangdong 510700)

机构地区：[1]广州医科大学第五临床学院康复治疗学系,广东广州511436 [2]广州医科大学附属第五医院康复医学科,广东高校生物靶向诊治与康复重点实验室,广东广州510700

出　　处：《按摩与康复医学》2022年第22期59-65,共7页Chinese Manipulation and Rehabilitation Medicine

基　　金：国家级大学生创新创业训练计划(202110570016,202110570018);广州医科大学2021-2022年度大学生科技创新项目(2020A052,2020A053);广州市卫生健康科技一般引导项目(20221A011104);广东高校生物靶向诊治与康复重点实验室(2021KSYS009);广州市医学重点学科(2021-2023年)项目;广州市基础研究计划市校(院)联合资助基础与应用基础研究项目(202102010100)。

摘　　要：偏瘫后肩痛是脑卒中后常见的致残并发症之一,防治偏瘫后肩痛一直是脑卒中临床康复工作的重点,而有效防治的前提是明确偏瘫后肩痛的病理机制,但目前偏瘫后肩痛的病理机制尚不明确,且影响个体肩痛的因素复杂多样,为给予患者更精准有效的治疗,需全面探查其肩痛的原因。为了更好地指导临床上全面精准的评估偏瘫后肩痛,给予患者精准完善的治疗方案,本文综述了偏瘫后肩痛的发病机制和临床康复评定方法,包括病史采集、体格检查、临床功能量表评估(疼痛评估,上肢运动功能评估)等基础检查,以及针对不同病理机制的辅助检查(影像学检查、热力学检查、神经电生理检查、诊断性神经阻滞或注射),并综合比较了各项辅助检查的优缺点。其中,辅助检查相较于常规检查可提供更客观精确的诊断,有助于进一步明确偏瘫后肩痛的发病机制,为患者制定更加精准、个体化的治疗方案,缩短治疗进程。本文主要从多角度多层次分析各项评估工具在偏瘫后肩痛中的应用,为临床工作中形成规范性评定标准及流程提供参考。Hemiplegic shoulder pain(HSP) is one of the common disability complications after stroke, the prevention and treatment of post-hemiplegia shoulder pain has always been the focus of clinical rehabilitation of stroke, and the premise of effective prevention and treatment is to clarify the pathological mechanism of shoulder pain after hemiplegia, but the pathological mechanism of shoulder pain after hemiplegia is not clear, and the factors affecting individual shoulder pain are complex and diverse, in order to give patients more accurate and effective treatment, it is necessary to comprehensively explore the cause of shoulder pain. In order to better guide the comprehensive and accurate clinical assessment of shoulder pain after hemiplegia and to give patients a precise and perfect treatment plan, this paper reviews the pathogenesis of shoulder pain after hemiplegia and the clinical rehabilitation assessment methods, including basic examinations such as medical history collection, physical examination, clinical function scale assessment(pain assessment, upper limb motor function assessment), and auxiliary examinations for different pathological mechanisms(imaging examination, thermodynamic examination, neuroelectrophysiological examination, diagnostic nerve block or injection). The advantages and disadvantages of various auxiliary examinations are comprehensively compared. Among them, the auxiliary examination can provide a more objective and accurate diagnosis than the conventional examination, which can help further clarify the pathogenesis of shoulder pain after hemiplegia, formulate a more accurate and individualized treatment plan for patients, and shorten the treatment process. This paper mainly analyzes the application of various assessment tools in shoulder pain after hemiplegia from multiple angles and levels, and provides a reference for the formation of normative evaluation standards and processes in clinical work.

关 键 词：偏瘫后肩痛 发病机制 康复 评估 综述 

分 类 号：R441.1[医药卫生—诊断学]