肩峰-肱骨头间距与肩胛骨长度比评估脑卒中偏瘫患者肩关节半脱位的临床研究

目的:探讨肩峰-肱骨头间距与肩胛骨上下角长度比临床应用的效度及信度,评价该比值评定脑卒中偏瘫患者肩关节半脱位的临床应用价值。方法:纳入30例健康成年人,计算受试者离平板探测器不同距离下(0cm、50cm)肩关节摄片的肩峰-肱骨头间距与肩胛骨上下角间距比;使用组内系数评估该方法的信度;利用该比值与肩峰-肱骨头间距进行相关分析,探讨该法的效度。计算54例脑卒中偏瘫肩关节半脱位患者患侧肩峰-肱骨头间距与肩胛骨长度比,利用该比值与肩峰-肱骨头间距进行相关分析,探讨该法的临床应用价值。结果:不同距离下测量的健康成年人肩峰-肱骨头间距与肩胛骨长度比组内相关系数左侧为0.808、右侧为0.820;受试者距离平板探测器0cm下,左、右侧肩峰-肱骨头间距和各自肩峰-肱骨头间距与肩胛骨长度比具有相关性,结果具有显著性意义(左侧:r=0.955,P<0.05,右侧:r=0.944,P<0.05);受试者距离平板探测器50cm下,左、右侧肩峰-肱骨头间距和各自肩峰-肱骨头间距与肩胛骨长度比具有相关性,结果具有显著性意义(左侧:r=0.828,P<0.05,右侧:r=0.804,P<0.05)。脑卒中偏瘫肩关节半脱位患者半脱位程度和肩峰-肱骨头间距与肩胛骨长度比具有相关性,结果具有显著性意义(r=0.886,P<0.05)。结论:肩峰-肱骨头间距与肩胛骨上下角长度比具有较好的信度及效度,可用于临床评估脑卒中偏瘫患者肩关节半脱位。

TREATMENT OF 36 CASES OF SCAPULOHUMERAL PERIARTHRITIS MAINLY BY CONTRALATERAL NEEDLING

Objective: To analyze the therapeutic effect of contralateral needling in the treatment of scapulohumeral periarthritis. Methods: A total of 68 cases of scapulohumeral periarthritis were outpatients and were randomized into treatment group (n=36) and control group (n=32). In treatment group, Zhiyin (BL 67), Jinmen (BL 63) and Yanglao (SI 6) on the contralateral side of the affected shoulder and local tenderpoints (Ashi-points) were punctured once every other day, with 7 days being a therapeutic course; while in control group, local Ashi-points were used for injection of Procaine and Prednisolone Acetate, once every 7 days and with 3～4 sessions being a therapeutic course. Results: Following 2 courses of treatment, of the 32 cases in control group, 8 (25.0%) were cured, 17 (53.1%) experienced improvement and 7 failed in the treatment, with a total of effective rate of 78.1%; of the 36 cases in treatment group, 18 (50.0%) were cured, 16 (44.4%) experienced improvement and 2 (5.6%) failed in the treatment, with a total effective rate of 94.4%. The therapeutic effect of contralateral needling is significantly higher than that of Ashi-point blocking method (P<0.05). Conclusion: Contralateral needling is superior to Ashi-point in the treatment of scapulohumeral periarthritis.

肱骨头与肩胛骨关节盂一体固定复位法在老年肱骨近端骨折微创钢板内固定术中的应用

目的 观察肱骨头与肩胛骨关节盂一体固定复位法在老年NeerⅡ、Ⅲ型肱骨近端骨折微创钢板内固定术中的应用效果。方法 回顾性分析自2016-01—2019-10诊治的36例老年NeerⅡ、Ⅲ型肱骨近端骨折,采用肱骨头与肩胛骨关节盂一体固定复位骨折,C型臂X线机透视肱骨头颈长轴位,透视下从肩袖足印区肱骨头处沿肱骨距长轴方向置入2枚直径2 mm平行或交叉克氏针直至肩胛骨关节盂上,将肱骨头和肩胛骨连成一体,在肱骨距长轴平面外展上肢,直至嵌插或套叠的肱骨内侧柱张开,矫正内翻移位。骨折复位后采用微创钢板内固定技术置入肱骨近端锁定钢板内固定。结果 36例均获得至少12个月随访。术后X线片显示骨折复位固定良好,无切口感染、肩关节感染、脂肪液化及深静脉血栓形成等早期并发症发生。随访期间骨折全部愈合,无钢板断裂、内固定失效、再次内翻移位发生。末次随访时采用肩关节功能Constant-Murley评分标准对患者术后肩关节功能恢复情况及主观满意度进行评估:优10例,良18例,可7例,差1例。结论 肱骨头与肩胛骨关节盂一体固定复位骨折后采用微创钢板内固定治疗老年肱骨近端骨折能较好地保留肱骨近端的血供,创伤较小,有利于骨折愈合和患者早期功能锻炼。肱骨头与肩胛骨关节盂一体固定复位是微创手术中矫正肱骨近端骨折内翻移位的一项可行性技术,值得临床推广应用。

Clinical Observation on Scapulohumeral Periarthritis Treated by Tuina and SSP Meridian Therapeutic Apparatus

目的：观察推拿结合经脉治疗仪治疗肩周炎的疗效。方法：观察组采用推拿结合日本产SSP经脉治疗仪治疗肩周炎患者35例。对照组单纯用经脉治疗仪治疗肩周炎患者30例。结果：观察组与对照组对肩周炎的治疗都有一定效果。但观察组的治愈率与对照组相比有明显差距(P<0．01)，观察组对肩周炎的治愈率明显高于对照组。结论：经脉治疗仪结合推拿是治疗肩周炎的一种有效方法。