肌骨超声引导下精准康复治疗对脑卒中偏瘫肩痛患者的临床疗效分析

Analysis of the clinical effect of musculoskeletal ultrasound guided precision rehabilitation on patients with post-stroke hemiplegic shoulder pain

目的探讨肌骨超声引导下精准康复治疗在脑卒中偏瘫肩痛患者中的临床效果。方法100例脑卒中偏瘫肩痛患者为研究对象,采用简单化随机法分为对照组和观察组,每组50例。对照组患者采用常规康复训练,观察组在对照组的基础上实施肌骨超声引导下精准康复治疗。比较两组患者肌骨超声检查结果(肩轴病变、肩峰-三角肌下滑囊病变、肱二头肌肌腱病变、肩锁关节病变情况)、临床疗效、视觉模拟评分法(VAS)评分、Fugl-Meyer肢体运动功能评定量表(FMA)评分、改良Barthel指数(MBI)评分。结果观察组患者的肩轴病变、肩峰-三角肌下滑囊病变和肱二头肌肌腱病变率分别为10.0%、22.0%、14.0%,显著低于对照组的26.0%、42.0%、32.0%(P<0.05);两组肩锁关节病变率比较,差异无统计学意义(P>0.05)。观察组患者治疗后的临床总有效率(98.0%)明显高于对照组(86.0%),差异具有统计学意义(P<0.05)。治疗前,对照组VAS评分为(7.29±1.98)分,FMA评分为(31.36±10.72)分,观察组VAS评分为(7.37±2.01)分,FMA评分为(30.31±10.68)分;治疗后,对照组VAS评分为(3.59±1.27)分,FMA评分为(38.59±11.38)分,观察组VAS评分为(1.48±0.19)分,FMA评分为(46.94±12.42)分。与治疗前比较,两组患者治疗后的VAS、FMA评分均有所改善;与对照组比较,观察组患者治疗后的VAS评分更低,FMA评分更高,差异具有统计学意义(P<0.05)。观察组治疗前后的MBI评分分别为(42.37±10.15)、(76.48±15.19)分;对照组治疗前后的MBI评分分别为(42.29±10.12)、(64.59±12.27)分。与治疗前比较,两组患者治疗后的MBI评分均有所升高;且与对照组比较,观察组患者治疗后的MBI评分升高幅度更明显,差异具有统计学意义(P<0.05)。结论脑卒中偏瘫肩痛患者经肌骨超声引导下精准康复治疗后,患者的临床症状明显得到改善,临床疗效显著,能够有效降低患者的痛疼程度,增强患者的上肢运动功能,提高患者的生活质量,值得临床推广。

Objective To explore the clinical effect of musculoskeletal ultrasound guided precision rehabilitation on patients with post-stroke hemiplegic shoulder pain.Methods 100 patients with post-stroke hemiplegic shoulder pain were divided into a control group and an observation group by simple random method,with 50 cases in each group.The control group received routine rehabilitation training,and the observation group received precise rehabilitation guided by musculoskeletal ultrasound on the basis of the control group.Comparison was made on results of musculoskeletal ultrasound(shoulder axis lesions,acromion-subtrochanteric bursa lesions,biceps tendon lesions,and acromioclavicular joint lesions),clinical efficacy,visual analogue scale(VAS)score,Fugl-Meyer assessment(FMA)score,and modified Barthel index(MBI)score between the two groups.Results The rates of shoulder axis lesions,acromion-subtrochanteric bursa lesions and biceps tendon lesions in the observation group were 10.0%,22.0%and 14.0%,which were significantly lower than 26.0%,42.0%and 32.0%in the control group(P<0.05).There was no significant difference in the incidence of acromioclavicular joint lesion between the two groups(P>0.05).The total clinical effective rate of the observation group(98.0%)after treatment was significantly higher than 86.0%of the control group,and the difference was statistically significant(P<0.05).Before treatment,VAS score and FMA score of the control group were(7.29±1.98)and(31.36±10.72)points,and those of the observation group were(7.37±2.01)and(30.31±10.68)points.After treatment,VAS score and FMA score of the control group were(3.59±1.27)and(38.59±11.38)points,and those of the observation group were(1.48±0.19)and(46.94±12.42)points.Compared with before treatment,VAS and FMA scores of both groups were improved after treatment.Compared with control group,VAS score of the observation group was lower and FMA score was higher after treatment,and the difference was statistically significant(P<0.05).MBI scores of the observation group were(42.37±10.15)and(76.48±15.19)points before and after treatment;MBI scores of the control group were(42.29±10.12)and(64.59±12.27)points before and after treatment.Compared with before treatment,MBI scores in both groups increased after treatment.Compared with the control group,MBI scores in the observation group increased more significantly after treatment,and the difference was statistically significant(P<0.05).Conclusion For patients with post-stroke hemiplegic shoulder pain,precision rehabilitation guided by musculoskeletal ultrasound can significantly improve the clinical symptoms of patients,and the clinical efficacy is remarkable,which can effectively reduce the intensity of pain of the patients,enhance the motor function of the upper limbs of the patients,and improve the quality of life of the patients.It is worthy of clinical promotion.