脑卒中早期患者肩部病变损伤及其与肢体功能的相关性研究

The study of shoulder lesion and injury in stroke patients of early stage and its correlation with the function of hemiplegic extremity

目的:通过超声检查的方法对脑卒中早期的肩部病变和损伤进行分析,并研究其与脑卒中患者患侧上肢功能状态之间的相关性。方法:60例脑卒中早期肩痛患者根据患侧上肢Brunnstrom分期不同分为两组,运动功能低下组44例患者,运动功能良好组16例患者,两组患者均进行患肩超声检查和被动关节活动度的测量。结果:脑卒中患者肩部软组织病变和损伤总的发生率为76.7%(n=46),其中肩峰下-三角肌下滑囊积液或炎症的发生率最高,为41.7%(n=25),肱二头肌长头肌腱腱鞘积液或炎症的发生率为30%(n=18),肩袖肌腱炎的发生率为16.7%(n=10),肩袖损伤(部分撕裂或全层撕裂)的发生率为21.7%(n=13)。脑卒中患者的肩部病变损伤程度与其患侧上肢运动功能分期之间差异无显著性意义上的相关性(P>0.05)。不同肩部病变程度患者之间的肩关节被动关节活动度差异存在显著性(P<0.05)。结论:脑卒中早期患者的肩部病变损伤发生率很高,其病变程度与患侧上肢的运动功能分期无关,但不同肩部病变对肩关节被动活动度的影响程度不同。早期及时了解脑卒中患者的肩部病变,并给予有效的治疗措施,有利于卒中患者上肢功能的康复。

Objective： To clarify the shoulder lesion and injury using sonography and to evaluate the relationship between sonographic findings and function of hemiplegic extremity in stroke patients of early stage. Method： Sixty patients were divided into two groups according to Brunnstrom stage of hemiplegic extremity. Of which, 44 patients were in the poor function group and 16 patients were in the good function group.All the patients received ultrasound examination and passive range of motion（PROM）measurement of their hemiple- gic shoulder. Result：The total occurrence rate of shoulder lesion and injury was 76.7%（n=46）.The occurrence rate of sub- acromial-subdeltoid bursal hydrops or bursitis was 41.7%（n=25）. The occurrence rate of hydrops or inflamma- tion of long head of biceps tendon sheath was 30% （n= 18）. The occurrence rate of tendinitis of rotator cuff was 16.7% （n=10）. The occurrence rate of tear leision and injury （partial or complete） of rotator cuff was 21.7%（n= 13）.There was no statistical correlation between motor function stage of hemiplegic extremity and se- verity of leision and injury sonographic findings（P〉0.05）. There were significant differences in PROM of hemi- plegic shoulder among patients with different severities of shoulder lesion and injury（P〈0.05）.Conclusion： The occurrence rate of shoulder lesion and injury after stroke of early stage was very high. There was no correlation between the severity of shoulder lesion and injury and the motor function stage of hemiple- gic extremity. The shoulder lesion and injury can affect PROM of hemiplegic shoulder. For the function rehabil- itation of upper extremity of stroke hemiplegic patients it is beneficial to find the shoulder lesion and injury earlier and administer effective therapy. Author＇s address Dept. of Rehabilitation Medicine, Peking University Third Hospital,Beijing, 100191