脑卒中患者康复训练时冈上肌保护探讨.pdfVIP

第 9 届北京国际康复论坛 The 9th Beijing International Forum on Rehabilitation 脑卒中患者康复训练时冈上肌保护探讨 胡世红，凌晴，许佳，陈丽丹，乔峰雷，陈庆珍，周亚飞 复旦大学附属上海市第五人民医院康复医学科 [摘要] 目的：通过对脑卒中患者冈上肌损伤的研究，探讨康复治疗时对其保护的问题。方法：回顾性研究 182 例脑卒中患者，研究其中出现肩痛的患者、发生肩痛的原因以及肩关节 MR 表现。结果：182 例病例中， 56 例在脑卒中发生后 2 周到 6 个月先后出现肩痛，发生率 30.1%，肩关节 MR 检查发现其中 27 例有不同程度 的冈上肌肌腱损伤，占48.2% 。27 例患者中 4 例为护理不当引起，3 例原因不明，20 例在康复治疗过程中发生。 结论：康复治疗时应注意肩关节保护。 [关键词] 脑卒中；肩痛；冈上肌腱 Protection of supraspinatus tendon in stroke rehabilitation practice: a retrospective study Hu shihong, Ling qing, Xu jia, et al. Department of Rehabilitation Medicine ， the Shanghai fifth people’s Hospital ，Fudan University，Shanghai, 200240,China. Abstract: Objective: how to prevent the shoulder from injury after stroke. Methods: a retrospective study of 182 cases of patients with stroke was performed. The MR performances of the shoulder joint were studied. The possible causes of shoulder pain were studied. Results: Among the 182 cases, 56 cases got shoulder pain in 2 weeks to 6 months after the onset of stroke. The incidence of shoulder pain was 30.1%. Among those 56 cases, 27 had different degrees of supraspinatus tendon injury on MR findings, which accounted for 48.2%. In 27 patients, 4 cases were caused by improper care, 3 cases of unknown reasons, 20 cases in treatment process during rehabilitation. Conclusion: the rehabilitation therapy should pay attention to the protection of shoulder joint. Key words: stroke; shoulder pain; supraspinatus tendon 肩痛是脑卒中患者常见的并发症，常发生于脑卒中后 1-3 个月，据不完全统计肩痛的发生 率为 5%-84%‖(1)(2)。肩痛不仅会导致肩关节活动受限，还会影响患者休息和睡眠，导致患者情 绪低落，而且肩痛一旦发生，临床很难治愈，病情可能迁延数月，严重影响患者的日常生活和 康复治疗。目前对脑卒中后肩痛的发生机制尚未十分明确，近期研究发现肩部损伤与之有一定 关系，特别是软瘫期不恰当的护理、被动活动等都在一定程度上对肩袖造成损伤，而最常见的 是冈上肌的损伤。因此探讨脑卒中患者冈上肌损伤原因、检查方法及保护措施，有利于临床康 复工作开展，有利于提高康复疗效