肘前臂托和传统肩吊带治疗脑卒中后肩关节半脱位的随机交叉研究

A randomized crossover study of elbow-forearm support and traditional shoulder sling in the treatment of shoulder subluxation after stroke

目的采用自身随机交叉对照研究方法,分析和比较基于3D打印的肘前臂托(3D法)和传统肩吊带(传统法)对脑卒中后肩关节半脱位(GHS)的即时复位效果。方法选取8例符合入组条件的脑卒中后偏瘫伴GHS患者,依次进行2个阶段的佩戴矫形器治疗,每个阶段随机佩戴肘前臂托和传统肩吊带,30 min/次,2个阶段间隔24 h。所有患者检查6次肩关节X线正位片(分别是佩戴前健侧和患侧以及患侧2种矫形器每次佩戴即刻和佩戴30 min后),分别测量肩峰下缘至肱骨头中心的垂直距离(VD)和水平距离(HD)。2次佩戴结束后,对2种矫形器患者和家属进行满意度问卷调查。结果患者佩戴即刻和佩戴30 min后与同一方法佩戴前比较,VD和HD均有明显改善(P<0.05);但3D法的VD改善更加明显(P<0.01)。VD和HD在佩戴即刻和佩戴30 min后,不同方法之间的差异均有统计学意义(P<0.05),受试者对肘前臂托(3D法)的满意度更高。结论基于3D打印的肘前臂托和传统肩吊带对GHS都具有即时复位效果,但肘前臂托复位效果更明显,患者及其家属的使用满意度更高。

Objective To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation(GHS)after a stroke.Methods Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours.Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment.The vertical(VD)and horizontal(HD)distances from the lower edge of the acromion to the center of the humeral head were measured.The satisfaction of the patients and their relatives was surveyed.Results The average VD and HD improved significantly more after wearing the elbow forearm support.Moreover,the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation,but the elbow forearm support is more effective and gives greater satisfaction.