闭链运动训练对脑卒中偏瘫肩痛和肩关节稳定性的效果:基于超声的评定  

Effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint stability in stroke patients:a study with ultrasound

作　　者：林昌盛 曹妤 王彤[1] 戴文俊 侯红[1] 胡翠琴[1] 包士雷 庞素芳 LIN Changsheng;CAO Yu;WANG Tong;DAI Wenjun;HOU Hong;HU Cuiqin;BAO Shilei;PANG Sufang(Jiangsu Province Hospital,Nanjing,Jiangsu 210029,China;Xining First Medical Group,Xining,Qinghai 810002,China)

机构地区：[1]江苏省人民医院,江苏南京市210029 [2]西宁市第一人民医院,青海西宁市810002

出　　处：《中国康复理论与实践》2025年第3期264-273,共10页Chinese Journal of Rehabilitation Theory and Practice

基　　金：西宁市科技计划项目(No.2021-M-23);南京市重点临床专科资助课题(No.2019060002);江苏省医学重点学科项目(No.XK201110)。

摘　　要：目的观察闭链运动训练对脑卒中偏瘫肩痛和肩关节稳定性的治疗作用,探讨偏瘫肩痛与肩关节稳定性的关系。方法选取2020年10月至2023年1月江苏省人民医院脑卒中偏瘫肩痛患者52例,随机分为对照组(n=26)和试验组(n=26)。两组均接受常规康复治疗,试验组给予肩关节闭链运动训练。治疗前后,采用视觉模拟量表(VAS)、Fugl-Meyer评定量表上肢部分(FMA-UE)评定;采用肌骨超声测量肩峰-肱骨大结节间距(AGT)、肩峰-肱骨小结节间距(ALT)、肩峰-肱骨头间距(AHD)和冈上肌厚度(SST)评估肩关节稳定性,对试验组肩痛与肩关节稳定性的改善程度进行相关性分析。结果对照组脱落2例,试验组脱落2例。干预后,两组VAS和FMA-UE评分显著改善(|t|>5.214,P<0.001),试验组更优(|t|>2.087,P<0.05)。试验组AGT、ALT、AHD和SST显著改善(|t|>4.187,P<0.001),试验组AGT、ALT和AHD优于对照组(|t|>2.155,P<0.05)。试验组VAS评分改善程度与FMA-UE、AGT和ALT改善程度相关(r>0.434,P<0.05)。结论肩关节闭链运动训练可显著提高肩关节稳定性,缓解肩周疼痛,有效改善脑卒中后偏瘫肩痛患者上肢功能。偏瘫肩痛与肩关节动静态稳定性相关。Objective To investigate the effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint stability in stroke patients,and to explore the relationship between hemiplegic shoulder pain and shoulder joint stability.Methods A total of 52 stroke patients with hemiplegic shoulder pain in Jiangsu Province Hospital from October,2020 to January,2023 were selected,and were randomly divided into control group(n=26)and experimental group(n=26).Both groups received conventional rehabilitation therapy,while the experimental group additionally underwent closed-chain exercise training for shoulder joint.Pain severity and motor function were assessed using Visual Analog Scale(VAS)and Fugl-Meyer Assessment-Upper Extremities(FMA-UE)before and after intervention.Musculoskeletal ultrasound was used to measure acromion-greater tuberosity distance(AGT),acromion-lesser tuberosity distance(ALT),acromiohumeral distance(AHD)and supraspinatus thickness(SST)to evaluate shoulder joint stability.Correlation analysis was conducted on the improvements in shoulder pain and shoulder joint stability in the experimental group.Results Two cases in the control group and two in the experimental group dropped down.Both groups showed significant improvements in VAS and FMA-UE scores after intervention(|t|>5.214,P<0.001),and the scores improved more in the experimental group than in the control group(|t|>2.087,P<0.05).The experimental group also showed significant improvements in AGT,ALT,AHD and SST(|t|>4.187,P<0.001),with AGT,ALT and AHD being superior to those in the control group(|t|>2.155,P<0.05).The difference of VAS score in the experimental group was correlated with the difference of FMA-UE,AGT and ALT after intervention(r>0.434,P<0.05).Conclusion Closed-chain shoulder exercise training can significantly improve shoulder joint stability while alleviating shoulder pain,and effectively enhancing upper limb function in stroke patients with hemiplegic shoulder pain.Hemiplegic shoulder pain is correlated with shoulder joint s

关 键 词：脑卒中 偏瘫肩痛 闭链运动 肩关节稳定性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]