摘要
目的探讨脑卒中后偏瘫侧肩周软组织病变临床特点,分析病变临床特点与超声表现的关系。方法选取2018-03-01-2020-12-31天津市北辰医院住院治疗的69例脑卒中后偏瘫患者,对所有患者均行肩关节超声检查,根据脑卒中后病程长短分为为<3个月、3~6个月、>6个月3组,将3组超声检查结果进行分析;根据是否伴有偏瘫性肩痛分为肩痛组和非肩痛组,对2组肩周软组织病变超声检查结果进行对比分析,对2组分别在不同病程中(<3个月、3~6个月、>6个月)肩周软组织病变差异进行分析。结果偏瘫患者肱二头肌长头肌腱病变<3个月占11.8%,3~6个月占27.3%,>6个月占52.6%,差异有统计学意义,χ^(2)=7.376,P=0.025;肩峰下-三角肌下滑囊(SA-SD)病变<3个月占17.6%,3~6个月占48.5%,>6个月占10.5%,差异有统计学意义,χ^(2)=9.948,P=0.007。肩痛组与非肩痛组比较,肩袖病变分别为51.5%和27.8%,χ^(2)=4.073,P=0.044;SA-SD病变分别为54.6%和8.3%,χ^(2)=17.367,P<0.001;盂肱关节积液分别为18.2%和2.8%,χ^(2)=4.482,P=0.034。肩痛患者不同病程中肩周软组织病变比较,盂肱关节积液<3个月为60.0%,3~6个月为15.8%,>6个月为0,χ^(2)=7.951,P=0.019;SA-SD病变<3个月为20.0%,3~6个月为78.9%,>6个月为22.2%,χ^(2)=10.762,P=0.005。非肩痛组在不同病程中肩周软组织病变差异无统计意义,均P>0.05。结论脑卒中后偏瘫患者盂肱关节积液更易发生于<3个月,SA-SD病变更易发生于3~6个月,肩痛组更为明显;肩痛组肩袖病变、SA-SD病变的发病率高于非肩痛组。脑卒中后偏瘫患者在不同病程中肩周软组织病变存在一定差异,偏瘫后肩痛患者与非肩痛患者肩周软组织病变存在一定差异。
Objective To explore the clinical characteristics of perishoulder soft tissue lesions of hemiplegia after stroke,and to analyze the relationship between the clinical characteristics of lesions and ultrasound manifestations.Methods A total of 69 patients with hemiplegia after stroke who were hospitalized in Tianjin Beichen Hospital from March 1,2018 to December 31,2020 were selected and all patients were examined by shoulder joint ultrasound.According to the length of the course of disease after stroke,they were divided into three groups:<3 Months,3-6 months and>6 months.The ultrasonic examination results of these three groups were analyzed.According to whether there was hemiplegic shoulder pain,they were divided into shoulder pain group and non-shoulder pain group,and the ultrasonic examination results of soft tissue lesions around shoulder of the two groups were compared and analyzed,and the differences of soft tissue lesions around shoulder between the two groups in different course of disease(<3 months,3-6 months,>6 months)were analyzed.Results Among hemiplegic patients,the long head tendon disease of biceps brachii accounted for 11.8%in<3 months,27.3%in 3-6 months,and 52.6%in>6 months,the difference was statistically significant,χ^(2)=7.376,P=0.025.subacromial-subdeltoid bursa(SA-SD)lesions<3 months accounted for 17.6%,3-6 months accounted for 48.5%,and>6 months accounted for 10.5%,the difference was statistically significant,χ^(2)=9.948,P=0.007.The shoulder pain group was compared with the non shoulder pain group,rotator cuff lesions were 51.5%and 27.8%,respectively,χ^(2)=4.073,P=0.044.SA-SD lesions were 54.6%and 8.3%,respectively,χ^(2)=17.367,P<0.001.the effusion of glenohumeral joint was 18.2%and 2.8%,respectively,χ^(2)=4.482,P=0.034.Comparison of soft tissue lesions around shoulder in patients with shoulder pain in different courses,hydrops in glenohumeral joint<3months was 60.0%,3-6months was 15.8%,and>6months was 0,χ^(2)=7.951,P=0.019.SA-SD lesions were20.0%in<3 months,78.9%in 3-6 months,and 22.2%in>6months,χ^(2)=10.762,P=0.005.In the non shoulder pain group,there was no statistical difference in the pathological changes of soft tissue around the shoulder in different courses,all P>0.05.Conclusions Post-stroke hemiplegic patients are more likely to occur<3 months,SA-SD disease changes are more likely to occur with 3-6months,shoulder pain group is more significant.The incidence of rotator cuff lesions and SA-SD lesions in shoulder pain group is significantly higher than that in non-shoulder pain group.There are certain differences in perishoulder soft tissue lesions among hemiplegic patients after stroke in different course of disease,and there are certain differences in perishoulder soft tissue lesions between hemiplegic patients with shoulder pain and non-shoulder pain patients.
作者
何明英
郑爱平
赵静
HE Ming-ying;ZHENG Ai-ping;ZHAO Jing(Department of Ultrasound,Tianjin Beichen Hospital,Tianjin 300400,China)
出处
《社区医学杂志》
CAS
2022年第13期742-746,共5页
Journal Of Community Medicine
关键词
脑卒中
偏瘫
肩痛
肩关节超声
肩周软组织
stroke
hemiplegia
shoulder pain
shoulder ultrasound
perishoulder soft tissue
作者简介
通信作者:何明英,女,河北唐山人,硕士,主治医师,主要从事肌骨超声诊断的研究工作。E-mail:hemingying19@126.com
