胸腰段脊髓损伤患者康复初期肩部超声异常表现及危险因素分析

Analysis of abnormal ultrasonic manifestations of shoulder and their risk factors in patients with thoracolumbar spinal cord injury during early rehabilitation

目的:观察胸腰段脊髓损伤患者康复初期的肩部超声表现,分析肩关节异常超声表现的危险因素。方法:纳入2019年1月~2021年1月于我院康复医学科就诊的病程不超过3个月的胸腰段脊髓损伤患者104例进行研究,其中男78例,女26例,年龄37.3±8.8岁(21~66岁)。收集患者性别、体重、身高、损伤平面、日常生活能力(activities of daily living,ADL)评分、康复介入时间等基本资料,计算患者的体质指数(body mass index,BMI),对患者进行肩痛视觉模拟量表(visual analogue scale,VAS)评分、肩部体格检查(physical examination of the shoulder scale,PESS)评分和双侧肩关节超声检查。根据超声影像评估标准分为超声正常组和超声异常组。归纳分析肩关节超声异常表现的具体类型,对两组进行基本资料、肩痛VAS评分和PESS评分比较,将存在统计学差异的指标采用多因素Logistic回归分析,分析超声异常表现的危险因素。结果:70例(67.3%)患者超声检查显示肩关节异常,最常见的三种肩部超声异常表现为:肱二头肌长头肌腱腱鞘周围积液(62例,88.6%)、三角肌下滑囊增厚(53例,75.7%)和冈上肌腱异常(44例,62.9%)。超声异常组PESS评分为8.3±6.3分,超声正常组为1.2±2.1分,有统计学差异(P<0.05)。超声异常组年龄38.8±9.0岁,病程44.4±13.1d,超声正常组年龄34.1±7.3岁,病程37.9±11.3d,有统计学差异(P<0.05),两组患者性别、体重、BMI、损伤平面、肩痛VAS评分、ADL评分、康复介入时间均无统计学差异(P>0.05)。多因素Logistic回归分析显示,年龄和病程是超声异常表现的危险因素。结论:肱二头肌长头肌腱腱鞘周围积液、三角肌下滑囊增厚和冈上肌腱异常是胸腰段脊髓损伤患者康复初期最常见的三种肩部超声异常表现。年龄偏大、病程较长的患者易发生超声异常表现。

Objectives:To describe the abnormal ultrasonic manifestations of shoulder in patients with thoracolumbar spinal cord injury at the initial stage of rehabilitation,and analyze the risk factors of abnormal ultrasonic manifestations.Methods:104 patients(78 males and 26 females)with a course of thoracolumbar spinal cord inury(SCI)of less than three months treated in the Department of Rehabilitation Medicine of our hospital were enrolled in this study,with an average age of 37.3±8.8 years old(ranged 21-66 years).Baseline characteristics data including gender,body mass index(BMI),injury level,activities of daily living(ADL)scale and time of rehabilitation intervention were collected,and visual analogue scale(VAS)of shoulder pain,physical examination of the shoulder scale(PESS),and the ultrasonic examination bilateral shoulder joints were evaluated.According to the ultrasonic imaging evaluation criteria,the patients were divided into normal ultrasonic manifestation group and abnormal ultrasonic manifestation group.The types of abnormal ultrasonic manifestations were summarized and analyzed,and the basic data,VAS and PESS scores were compared between groups.The indexes with statistical differences were analyzed with multivariate Logistic regression to obtain the risk factors for abnormal ultrasonic manifestations.Results:Abnormal shoulder joints were found in 70 cases(67.3%)under ultrasonic examinations,and the top three abnormal manifestations were biceps tendon effusion(62 cases,88.6%),subdeltoid-subacromial bursa thickening(53 cases,75.7%),and supraspinatus tendon abnormality(44 cases,62.9%).The PESS scores in abnormal ultrasonic manifestation group and normal ultrasonic manifestation group were 8.3±6.3 and 1.2±2.1,respectively,with a significant difference(P<0.05).In the abnormal ultrasonic manifestation group(70 cases),the average age of patients was 38.8±9.0 years and the course of disease was 44.4±13.1d,while in the normal ultrasonic manifestation group(34 cases),the patients were averaged 34.1±7.3 years with a course of disease of 37.9±11.3d.There were significant differences in age and course of disease between the two groups(P<0.05).There were no significant differences in gender,body weight,BMI,level of injury,VAS score,ADL score,time of rehabilitation interventoin between the two groups(P>0.05).Multivariate Logistic regression analysis showed that age and course of disease were the risk factors for abnormal ultrasonic manifestations.Conclusions:Biceps tendon effusion,subdeltoid-subacromial bursa thickening,and supraspinatus tendon abnormality are the three most common manifestations of ultrasonic shoulder abnormalities in patients with thoracolumbar spinal cord injury at early rehabilitation.Patients with older age and longer course of disease are prone to abnormal ultrasound manifestations.