脑卒中后偏瘫肩痛患者肩关节挛缩病变及发生挛缩的因素分析

张立宁; 谢惠敏; 樊文萍; 王瑞; 李圣节; 解涛; 左秀芹; 贾子善

doi:10.3969/j.issn.2095-5227.2021.05.005

脑卒中后偏瘫肩痛患者肩关节挛缩病变及发生挛缩的因素分析

Shoulder joint contracture in patients with hemiplegic shoulder pain after stroke and associated factors analysis

摘要

摘要:
背景肩痛是脑卒中偏瘫患者最常见的症状之一，影响日常活动能力，降低生活质量。
目的分析脑卒中偏瘫肩痛患者肩关节损伤情况及发生肩关节挛缩的相关因素。
方法选取2013年10月- 2019年12月解放军总医院第一医学中心康复科收治的偏瘫肩痛(hemiplegic shoulder pain，HSP)患者66例，男46例，女20例，平均年龄(57.28 ± 12.08)岁。对患者患侧肩行MRI扫描，记录患侧肩关节磁共振结果和各项临床指标。根据是否存在关节挛缩，将患者分为关节挛缩组(35例)和非关节挛缩组(31例)，比较两组各项指标差异。
结果 66例中肩胛下滑囊炎/关节腔积液59例(89.39%)，冈上肌肌腱损伤54例(81.82%)，肱二头肌肌腱炎54例(81.82%)，肩峰下-三角肌下滑囊炎50例(75.76%)，喙突下滑囊炎57例(86.36%)。关节挛缩组肩峰下-三角肌下滑囊炎、盂唇损伤率较非关节挛缩组高(85.71% vs 64.51%，P=0.050；62.86% vs 35.48%，P=0.026)，两组其他指标差异无统计学意义。
结论肩胛下滑囊炎/关节腔积液、冈上肌肌腱损伤、肱二头肌肌腱炎是HSP患者最常见的MRI改变；肩关节挛缩患者更容易发生肩峰下-三角肌下滑囊炎及盂唇损伤。

Abstract:
Background Shoulder pain is one of the most common complaints of hemiplegic patients after stroke, affecting their daily activity and quality of life.
Objective To analyze the factors related to shoulder contracture in stroke patients with hemiplegic shoulder pain.
Methods From October 2013 to December 2019, 66 patients with hemiplegic shoulder pain (HSP) were recruited in the department of rehabilitation in the First Medical Center of Chinese PLA General Hospital. Of the 66 cases, there were 46 males and 20 females with average age of (57.28 ± 12.08) years. MRI scanning was performed on the affected shoulder, and clinical characteristics were recorded. The patients were divided into contracture group (n=35) and non-contracture group (n=31), and indexes were compared between the two groups.
Results MRI results showed that 59 cases (89.39%) had subscapular bursitis/joint cavity effusion, 54 cases (81.82%) had supraspinatus tendon injury, 54 cases (81.82%) had biceps tendinitis, 50 cases (75.76%) had subacromial deltoid bursitis, and 57 cases (86.36%) had subcococoid bursitis. The incidences of subacromial deltoid bursitis and labrum injury in the joint contracture group were higher than those in the non-joint contracture group (85.71% vs 64.51%, P=0.050; 62.86% vs 35.48%, P=0.026). No significant difference was found in other indexes between the two groups.
Conclusion Subscapular bursitis/joint cavity effusion, supraspinatus tendon injury and biceps tendinitis are the most common MRI changes in patients with HSP. HSP patients with shoulder contracture are more prone to have subacromial deltoid bursitis and glenoid lip injury.

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