超声在脑卒中后偏瘫患者肩痛中的临床应用价值

Clinical Application Value of Ultrasound in Shoulder Pain of Patients with Hemiplegia after Stroke

目的:分析脑卒中后偏瘫患者肩周软组织的超声表现,探讨肩痛患者的超声表现与Brunnstrom分期的相关性,分析脑卒中后偏瘫肩痛(hemiplegic shoulder pain,HSP)的可能原因,为HSP的个体化诊疗提供一定的参考依据。方法:选择2018年1月-2019年6月笔者所在医院住院脑卒中偏瘫患者28例,根据是否发生肩痛,将其分为肩痛组(13例)和无肩痛组(15例)。所有患者均进行肩周软组织的肌骨超声检查,应用Brunnstrom分期评定上肢运动功能,分析肩痛超声表现与Brunnstrom分期的相关性。结果:肩痛组上肢运动功能不良发生率高于非肩痛组,差异有统计学意义(P<0.05)。两组性别、年龄、病程、卒中类型及偏瘫侧别比较差异无统计学意义(P>0.05)。肩痛组肱二头肌长头腱腱鞘病变、冈上肌腱病变发生率高于非肩痛组,差异有统计学意义(P<0.05)。肩痛组三角肌下滑囊扩张程度、盂肱关节下方关节囊增厚程度均大于非肩痛组,差异有统计学意义(P<0.05)。相关性分析显示,三角肌下滑囊扩张程度、盂肱关节下方关节囊增厚程度与Brunnstrom分期呈负相关(P<0.05)。结论:肩周超声异常表现与肩痛有关,超声可用于诊断卒中患者偏瘫侧肩关节的病变,为个性化指导康复治疗提供依据。

Objective:To analyze the ultrasonic manifestations of perishoulder soft tissue in patients with hemiplegia after stroke,and to explore the correlation between the ultrasonic manifestations and Brunnstrom stage in patients with shoulder pain,and to analyze the possible causes of hemiplegic shoulder pain (HSP) after stroke,so as to provide some reference for the individualized diagnosis and treatment of HSP.Method:A total of 28 patients with stroke hemiplegia in our hospital from January 2018 to June 2019 were selected and divided into the shoulder pain group (13 cases) and the non-shoulder pain group (15 cases) according to whether shoulder pain occurred.All patients were examined by musculoskeletal ultrasound of perishoulder soft tissue.Upper limb motor function was evaluated by Brunnstrom stage.The correlation between ultrasonic manifestations of shoulder pain and Brunnstrom stage was analyzed.Result:The incidence of upper limb motor dysfunction in the shoulder pain group was higher than that in the non-shoulder pain group,and the difference was statistically significant (P<0.05).There were no statistically significant differences between the two groups in gender,age,course of disease,stroke type and hemiplegic side (P>0.05).The incidence of tendon sheath lesion of long head of biceps brachii and supraspinatus tendon lesion in the shoulder pain group were higher than those in the non-shoulder pain group,and the differences were statistically significant (P<0.05).The dilatation degree of deltoid slide capsule and the thickening degree of glenoid capsule under glenoid joint in the shoulder pain group were higher than those in the non-shoulder pain group,and the differences were statistically significant (P<0.05).The correlation analysis showed that the dilatation degree of deltoid slide capsule and the thickening degree of glenoid capsule under glenoid joint were negatively correlated with Brunnstrom stage (P<0.05).Conclusion:Abnormal manifestations of perishoulder ultrasound are related to shoulder pain.Ultrasound can be used to diagnose the lesion of the shoulder joint on the side of hemiplegia in stroke patients,so as to provide basis for personalized guidance of rehabilitation treatment.