偏瘫早期肩部超声影像评估及肩痛预测的研究  

A study on evaluation of sonographic findings of hemiplegic shoulders at the early stage and prediction of hemiplegic shoulder pain

作　　者：张芳[1] 姚玲玲 沈华良[2] 吴强[1] 龚剑秋[1] ZHANG Fang;YAO Lingling;SHEN Hualiang(Department of Rehabilitation,Shaoxing People’s Hospital,Shaoxing,Zhejiang,312000)

机构地区：[1]绍兴市人民医院康复医学科,浙江省绍兴市312000 [2]绍兴市人民医院超声影像科

出　　处：《中国康复医学杂志》2025年第2期248-253,共6页Chinese Journal of Rehabilitation Medicine

基　　金：浙江省卫生健康科技计划青年创新人才项目(2022RC276);浙江省康复医学会临床科研基金项目(2021KF005)。

摘　　要：目的:应用超声影像评估偏瘫早期患者肩部影像,预测导致偏瘫早期肩痛(HSP)的主要影响因素。方法:选取2021年6月至2022年12月在我院住院治疗的偏瘫早期患者88例。根据疼痛视觉模拟评分(VAS)将患者分为3组:偏瘫肩痛1组(HSP-1):VAS评分≥4分;偏瘫肩痛2组(HSP-2):VAS评分=1—3分;非偏瘫肩痛(HNSP):VAS评分=0分。记录患者年龄、性别、偏瘫侧、卒中类型、发病时间、并发症、偏瘫肩前屈肌力、肌张力及VAS,应用肌骨超声检查患侧肱二头肌长头肌腱、冈上肌腱、冈下肌腱、肩胛下肌腱、肩峰下-三角肌下滑囊、盂肱关节和肩锁关节肌骨影像,应用相关统计软件分析。结果:71例(80.7%)偏瘫早期患者肩部超声影像异常,25例(28.4%)是轻微病变,46例(52.3%)肌骨超声影像异常明显,20例(22.7%)VAS评分≥4分偏瘫肩痛患者均有异常超声影像。偏瘫早期肩部最常见的超声病变为肱二头肌长头肌腱病变(35.23%)、肩峰下-三角肌下滑囊炎(19.32%)和冈上肌腱病变(15.90%)。偏瘫早期肩痛的显著预测因子为肌腱炎、冈上肌腱撕裂和异常超声影像总和。结论:偏瘫患者在早期存在偏瘫肩部软组织损伤,偏瘫早期肩痛的主要影响因素为肌腱炎、冈上肌腱撕裂和超声病变总和≥2个,建议偏瘫患者早期行肩部超声影像检查,可行早期干预,避免肩痛发生、发展。Objective:To evaluate the sonographic findings of hemiplegic shoulders,to determine the significant predictors of hemiplegic shoulder pain(HSP)at the early stage.Method:88 patients with early hemiplegia from hospital during June 2021 to December 2022 were recruited.Age,sex,hemiplegic side,type and duration of stroke,complications,anteflexion strength and tension of the hemiplegic shoulder,visual assessment scale(VAS)were recorded.Sonographic examination was performed to assess the long head of the biceps tendon,supraspinatus tendon,infraspinatus tendon,subscapularis tendon,subacromial-subdeltoid bursa,glenohumeral joint and acromioclavicular joint.According to the VAS score,the patients were divided into 3 groups.Patients with VAS≥4 were classified as hemiplegic shoulder pain 1(HSP-1)group,those with VAS<4 and≥1 were classified as hemiplegic shoulder pain 2(HSP-2)group,and the remaining patients with VAS=0 were classified as hemiplegic non-shoulder pain(HNSP)group.Result:There were abnormal sonographic findings in 71(80.7%)patients’shoulders in hemiplegia side.25(28.4%)patients were slight abnormal results.46(52.3%)patients were obvious abnormal sonographic findings.20(22.7%)patients whose VAS score were≥4 had abnormal sonographic findings.The most common patholo gies in early hemiplegic shoulders were abnormalities of the long head tendon of the biceps brachii(35.23%),subacromial-subdeltoid bursitis(19.32%)and supraspinatus lesions(15.90%).The significant predictors for HSP in early hemiplegic patients were tendinitis,supraspinatus tendon tear and sum of sonographic abnormalities.Conclusion:Stroke patients may have soft tissue injuries of the hemiplegic shoulders at the early stage.The significant predictors for HSP in early hemiplegic patients were tendinitis,supraspinatus tendon tear and sum of sonographic abnormalities(≥2).Shoulder sonography is recommended as it can accurately identify soft tissue injuries associated with HSP,and provide a basis for developing the appropriate rehabilitation program

关 键 词：偏瘫 肩痛 超声 卒中 

分 类 号：R742.3[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]