脑卒中偏瘫肩痛患者的超声图像表现

Sonography findings in patients with stroke hemiplegic shoulder pain: a pilot study

目的:通过超声检查以及临床查体,明确脑卒中患者偏瘫肩痛(HSP)的原因,并分析超声表现与肩痛视觉模拟量表(VAS)评分之间的关系。方法:选取56例首次发生脑卒中偏瘫的患者进行研究,根据VAS评分分为肩痛组及非肩痛组,所有患者均行双侧肩关节超声检查。临床检查包括Brunnstrom分期、Ashworth分级、肩关节半脱位及被动关节活动度(PROM)。结果:肩痛组患者肩关节半脱位发生率较非肩痛组高(51.4%vs 23.8%),两组比较差异有显著性意义(P<0.05)。超声显示,肩痛组患者冈上肌病变(54.3%)和肩峰下—三角肌下滑囊(SA-SD)积液(45.7%)与非肩痛组相比差异有显著性意义(P<0.05)。相关性分析可见冈上肌病变及肩峰下滑囊积液与偏瘫肩痛之间具有明显的相关性。结论:肩袖损伤是脑卒中患者偏瘫后肩痛的原因之一,冈上肌损伤及肩峰下滑囊病变同肩痛的程度有关。

Objective： To identify the etiology of hemiplegic shoulder pain （HSP） by musculoskeletal sonography and clini- cal examinations, and to determine the correlation between sonography findings and visual analogue scale （VAS） scores in patients with HSP. Method： Fifty-six patients with hemiplegia following the first cerebrovascular accident were recruited. On the basis of VAS scores, the patients were divided into 2 groups, patients with VAS≥4 were categorized with hemiplegic shoulder pain （HSP） group （n=35）, and those with VAS 〈4 were allocated to the hemiplegic no shoulder pain（HNSP） group （n=21）. Both shoulders of each patient were examined by musculoskeletal sonogra- phy. Clinical examination included Brtmnstrom stage, Ashworth grade, Shoulder subluxation and passive range of motion（PROM）. Result： Shoulder subluxation was more frequent in HSP group than in HNSP group （51.4% vs 23.8%）, there was significantly different between two groups （P 〈 0.05）. The sonography findings demonstrated that supraspina- ms tendinopathy and subacromial-subdeltoid（SA-SD） bursa hydrops were significantly more in HSP patients than in HNSP patients （54.3% vs 45.7%）, and there was significant difference in two groups （P〈0.05）. HSP correlated significantly with supraspinatus tendinopathy and SA-SD bursa hydrops. Conclusion： The causes of HSP was complicated. Rotator cuff injury was found to be a possible cause of HSP, supraspinatus tendinopathy and SA-AD bursopathy were related to the severity of HSP.