肩峰下撞击综合征38例临床症状体征分析

A clinical analysis of 38 cases of subacromial impingement syndrome

目的 探讨判断肩峰下撞击综合征的严重程度，即肩袖是否撕裂的可靠的检查方法。方法 对 1999年 2月～ 10月间， 38例诊断为肩峰下撞击综合征的患者的临床资料进行总结。结果 对肩峰下撞击综合征的检查中，阳性率较高的有 :疼痛弧 33例 (阳性率 86.8％ )，大结节压痛 36例 (94.7％ )，前撞击征 33例 (86.8％ )，侧撞击征 36例 (94.7％ )， 60°～ 90°外展抗阻试验阳性 37例 (97.4％ )，牵拉试验阳性 35例 (92.1％），冈上肌试验阳性 32例 (84.2％ )，封闭试验阳性 37例 (97.4％ )。 30°外展抗阻试验及夜间疼痛在肩袖撕裂与未撕裂患者间阳性率差异有显著性意义（ P 0.05)。结论 侧撞击征、 60°～ 90°外展抗阻试验、牵拉试验与封闭试验、大结节压痛、前撞击征、冈上肌试验及疼痛弧等对肩峰下撞击综合征的诊断有很高的阳性率。 30°外展抗阻试验及夜间疼痛在肩袖撕裂与未撕裂患者间阳性率差异有显著性意义 ,而力弱在肩袖撕裂与未撕裂患者间差异无显著性意义。

Objective To investigate a reliable physical examination methods for assessing the severity of subacromial impingement syndrome (SIS). Methods Thirty- eight cases of SIS encountered from February to Octomber in 1999 were reviewed. Results Signs of higher positive rate consisted of painful arc in 33 cases(sensitivity 86.8％ ), tenderness of great tuberosity in 36 (94.7％ ), anterior impingement sign in 33(86.8％ )， lateral impingement sign in 36(94.7％ )， 60°－ 90° abduction against resistance test in 37(97.4％ )， traction test in 35(92.1％ )， supraspinatus test in 32(84.2％ ) and subacromial injection block test in 37(97.4％ ). 30° abduction against resistance test and night pain are significantly different between cuff tear and no tear group(P0.05). Conclusion Lateral impingement sign， 60°－ 90° abduction against resistance test， traction test， are as sensitive as those of painful arc, tenderness of great tuberosity, anterior impingement sign, supraspinatus test and subacromial injection block test. 30° abduction against resistance test and night pain are significantly different between cuff tear and no tear group.