偏瘫肩半脱位康复评定与放射学测量研究

Shoulder subluxation in hemiplegia:A comparison of rehabilitation assessment and radiologic measurement

目的：比较康复评定与放射学测量在偏瘫肩半脱位评定中的应用价值。方法：偏瘫肩半脱位３７例，平均年龄６０．１±１１．５岁，分为低张组和高张组。用Ｆｕｇｌ－Ｍｅｙｅｒ和Ｂｒｕｎｎｓｔｒｕｍ量表评定患侧上肢功能，测量双侧肩峰下间隙，肩峰肱骨外上髁距，摄双肩正位和后斜位片，用ｔ检验和Ｓｐｅａｒｍａｎ相关性检验。结果：两组患者疼痛发生率、Ｂｒｕｎｎｓｔｒｕｍ分期、双侧肩峰下间隙、肩峰外上髁距差异有非常显著性（Ｐ＜０．０１）；放射学测量双侧肱骨头的水平和垂直移位、肱骨绝对外展角差异有显著性（Ｐ＜０．０５）；肌张力与肩峰下间隙呈负相关，简易测量和放射学测量方法明显相关（ｒ＝０．３３６～０．３６４，Ｐ＜０．０５）。结论：触诊法、简易测量和放射学检查均可用于偏瘫肩半脱位的评定，其中肩峰肱骨外上髁距具有定性和定量双重作用，且方法简单，值得在康复评定中应用。

Objective:To assess the shoulder subluxation in hemiplegic patients and compared the difference and relationship between the rehabilitation assessment and radiological measurement.Methods:37 hemiplegic patients with shoulder subluxation(22 males and 15 females,28 to 72 years of age;60.1±11.5 averagely) were detected from those who were admitted into our department and divided into low-tone(n=19) and high-tone(n=18) group.Fugl-Meyer Movement Scale and Brunnstrum Recovery Stage were used to assess the function of upper limb.Subhumeral space of the affected side was palpated and compared to the opposite side.Distance from the acromion to epicondylus lateralis humeri was measured.The X-rays of each shoulder(0 and 45) was taken.Results:There were significant differences in the pain incidence and stages of Brunnstrum, both subhumeral space,distance from the acromion to epicondylus lateralis humeri and radiologic measurement(absolute abduction angle of humeri)(P<0.01) in two groups.It was negative correlation between the muscle-tone and subhumeral space.Conclusion:Shoulder subluxation of hemiplegia can be identified with either palpation,distance test or radiologic measurement,but the first two methods are simple,practical,and effective method for rehabilitation assessment.