调整肩肱节律治疗肩峰下撞击综合征与肩袖损伤的疗效分析  

Effect analysis of adjusting scapulohumeral rhythm in the treatment of subacromial impingement syndrome and rotator cuff injury

作　　者：赵琛[1] 廖涛[1] 刘太[1] 阎俊蒲 周红[1] 雷爽[1] Zhao Chen;Liao Tao;Liu Tai;Yan Junpu;Zhou Hong;Lei Shuang(Clinic Department of Tend Injuries,Sichuan Orthopedic Hospital,Chengdu 610041,China;Sichuan Energyou Sports Medicine Center,Chengdu 610041,China)

机构地区：[1]四川省骨科医院筋伤科,成都610041 [2]四川省骨科医院运动医疗中心,成都610041

出　　处：《中华肩肘外科电子杂志》2024年第1期49-55,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：四川省中医药管理局科学技术研究专项课题任务书(2020LC0183)。

摘　　要：目的对非手术治疗的肩峰下撞击综合征与肩袖损伤患者,探讨它们不同的肩肱节律特点,进而开展针对性的康复锻炼。通过肩肱节律调整达到缓解肩关节疼痛,恢复运动功能,为肩痛患者的非手术治疗方案提供参考。方法选取2022年1月至2022年12月于四川省骨科医院就诊康复的肩关节疼痛患者共122例,其中,肩峰下撞击综合征组43例、未到手术指征的肩袖损伤组40例、对照组39例。开展为期12周的针对性的康复锻炼。记录两组患者治疗前、治疗后患者的肩肱节律(肩胛骨启动角度)、视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会评分(American shoulder elbowsurgeons’form,ASES)与肩关节外展活动度的测试数据,并进行统计学比较。结果(1)肩峰下撞击综合征组与肩袖损伤组其肩肱节律的启动角度不同,肩峰下撞击综合征组晚于肩袖损伤组(P<0.05);经过肩肱节律调整后,两组的肩肱节律有明显改善,而对照组无变化。(2)肩峰下撞击综合征组与肩袖损伤组,经过肩肱节律调整后,外展角度变化有显著改变(P<0.05),而对照组无变化。(3)VAS评分与ASES评分在治疗后,三组均有显著改变(P<0.05)。结论肩峰下撞击综合征与肩袖损伤的肩肱节律表现不一致,对其做肩肱节律评估,并针对性地进行肩肱节律改善和康复锻炼,可显著缓解肩关节疼痛,并改善肩关节功能。Background Subacromial impingement syndrome is the reduction of the subacromial space caused by various reasons,mainly by tenderness at the acromion,pain during shoulder abduction,and loss or weakness of the shoulder girdle muscles and function.New perspectives suggest that"impingement"represents a cluster of painful symptoms and potential mechanisms,and the description of shoulder impingement has evolved into"impingement-related shoulder pain"rather than a pathological anatomical diagnosis itself.Further development can lead to the loss of normal shoulder joint function or substantial structural damage.Rotator cuff injury is characterized by substantial pathological changes that primarily occur in the shoulder cuff tendon portion,belonging to the category of bursa terminalis diseases,mainly due to the repetitive rotational movement of the greater tubercle of the humerus,especially abduction,and continuous friction with the coracoid and acromion ligaments.After rotator cuff injury occurs,the main clinical manifestations include pain,accompanied by limited shoulder function activity,affecting the shoulder joint function of the injured person,and causing an impact on routine work and life,with a relatively high recurrence rate.During shoulder joint movement,the tissue between the humeral head and the acromion may be repeatedly compressed,which may lead to damage and degeneration of the subacromial bursa and supraspinatus tendon,even tendon rupture,resulting in pain,weakness,and functional limitations.Rotator cuff injury may develop from degeneration of the supraspinatus tendon under shoulder impingement.In the non-surgical treatment of these two conditions,physical therapy is an important method,and a large number of studies have shown that physical therapy can improve symptoms of shoulder impingement syndrome and rotator cuff injury.By actively performing muscle strength training,stability training,and neuro-muscular control training,the goal is to alleviate pain and restore shoulder joint activity and function.Wh

关 键 词：肩袖损伤 肩峰下撞击综合征 肩肱节律 

分 类 号：R684[医药卫生—骨科学]