本文選題：半脫位　切入點(diǎn)：超聲　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分：超聲評(píng)估腦卒中后肩關(guān)節(jié)半脫位的信度和效度研究 目的研究超聲測量肩峰-大結(jié)節(jié)間距評(píng)估腦卒中后肩關(guān)節(jié)半脫位的信度和效度。 方法選擇腦卒中后肩關(guān)節(jié)半脫位患者48例。兩位檢查者先后對(duì)受試者兩側(cè)肩關(guān)節(jié)進(jìn)行超聲測量檢查。測量部位為肩峰外側(cè)緣至肱骨大結(jié)節(jié)上緣的最短距離，記為肩峰-大結(jié)節(jié)間距（acromion-greater tuberosity distance，AGT）。每側(cè)肩部測量進(jìn)行兩次，每次測量重復(fù)3次，兩次測量間隔時(shí)間為10分鐘。采用組內(nèi)相關(guān)系數(shù)（intraclasscorrelation coefficient，ICC)評(píng)估超聲測量的重測信度和評(píng)測者間信度，采用測量標(biāo)準(zhǔn)誤及其百分比（standard error of measurement，SEM和SEM%)評(píng)估超聲的重復(fù)測量誤差，采用重復(fù)測量方差分析評(píng)價(jià)超聲的判別效度，采用Pearson相關(guān)分析法評(píng)價(jià)超聲與X線測量結(jié)果的一致性。 結(jié)果超聲測量的重測信度和評(píng)測者間信度均為極佳，重測信度在患、健側(cè)肩部分別為0.99和0.98，評(píng)測者間信度在患、健側(cè)肩部分別為0.96和0.95；患、健側(cè)肩部重復(fù)測量標(biāo)準(zhǔn)誤及其百分比（SEM、SEM%）分別為1.19mmmm、3.54%和1.0mmmm、6.53%；重復(fù)測量方差分析顯示患、健側(cè)肩部超聲測量結(jié)果差異有顯著性（F=106.50，P0.05）；Pearson相關(guān)分析顯示，超聲與X線測量結(jié)果具有高度相關(guān)性(r=0.85，P0.05)。 結(jié)論超聲測量AGT評(píng)估腦卒中后肩關(guān)節(jié)半脫位具有極佳的信度和良好的判別效度，可有效評(píng)估肩關(guān)節(jié)半脫位的程度。 第二部分：超聲在腦卒中后肩關(guān)節(jié)半脫位治療效果評(píng)估中的臨床應(yīng)用研究 目的探討超聲在腦卒中后肩關(guān)節(jié)半脫位治療效果評(píng)估中的臨床實(shí)用性。 方法選擇腦卒中后肩關(guān)節(jié)半脫位患者48例。選用功能性電刺激（functionalelectrical stimulation，F(xiàn)ES）聯(lián)合康復(fù)手法對(duì)其進(jìn)行治療，連續(xù)治療6周。分別于治療前后，使用FugI-Meyer運(yùn)動(dòng)功能評(píng)定量表評(píng)定受試者患肢運(yùn)動(dòng)功能，并對(duì)受試者雙側(cè)肩關(guān)節(jié)行超聲和X線測量檢查，X線測量部位為肩鎖關(guān)節(jié)下外側(cè)緣至肱骨頭中點(diǎn)的垂直距離（記為D），超聲測量部位為肩峰外側(cè)緣至肱骨大結(jié)節(jié)上緣的最短距離，即肩峰-大結(jié)節(jié)間距（acromion-greater tuberosity distance，AGT）。采用Pearson相關(guān)分析法分別評(píng)價(jià)超聲測量結(jié)果與X線測量結(jié)果的相關(guān)性以及超聲測量結(jié)果與FugI-Meyer評(píng)分的相關(guān)性。 結(jié)果治療前、治療6周后，患側(cè)D值分別為39.76±5.21mm和32.32±5.46mm，健側(cè)D值分別為25.52±4.25mm和24.24±4.51mm，，治療前后比較患、健側(cè)D值差值差異有顯著性（P0.05）；治療前、治療6周后，患側(cè)AGT值分別為28.24±5.26mm和21.34±4.92mm，健側(cè)AGT值分別為15.14±4.28mm和14.84±4.34mm，治療前后比較患、健側(cè)AGT值差值差異有顯著性（P0.05）；治療前、治療6周后，F(xiàn)ugI-Meyer評(píng)分分別為9.46±2.35分和21.25±2.52分，治療前后比較差異有顯著性（P0.05）；Pearson相關(guān)分析顯示，超聲測量結(jié)果與X線測量結(jié)果呈高度相關(guān)性（r=0.81，P0.05）；超聲測量結(jié)果與FugI-Meyer評(píng)分呈負(fù)相關(guān)性（r=-0.76，P0.05）。 結(jié)論超聲測量AGT可對(duì)腦卒中后肩關(guān)節(jié)半脫位的治療效果進(jìn)行客觀定量評(píng)估，并且超聲還具有無創(chuàng)、高效、操作簡便等優(yōu)點(diǎn)，值得臨床推廣應(yīng)用。
[Abstract]:The first part: the study of reliability and validity of ultrasonic assessment of shoulder subluxation after stroke
Objective to evaluate the reliability and validity of the shoulder peak space interval between the shoulder and the shoulder joint subluxation after stroke.
Methods after stroke patients with shoulder subluxation in 48 cases. Two examiners conducted ultrasound measurement check on the subjects on both sides of the shoulder. The measured position is the shortest distance between the greater tuberosity humerus lateral acromial margin to margin, denoted as large nodules spacing (acromion-greater acromion - tuberosity distance, AGT). The measurement on each side the shoulder two times, each time the measurements were repeated 3 times, two times the measurement interval is 10 minutes. The intraclass correlation coefficient (intraclasscorrelation, coefficient, ICC) to assess the test-retest reliability and inter rater reliability evaluation of ultrasonic measurement, standard error of measurement and the percentage (standard error of measurement, SEM and SEM%) of repeated measurement error evaluation ultrasound analysis, discriminant validity evaluation of ultrasound by repeated measurement of variance consistency using Pearson correlation analysis method to evaluate the ultrasound and X-ray measurements.
Results the test-retest reliability and inter rater reliability evaluation of ultrasound measurement are excellent, the test-retest reliability in patients with contralateral shoulders were 0.99 and 0.98, assessment of interrater reliability in the affected and contralateral shoulders were 0.96 and 0.95; with repeated measurement standard error of the contralateral shoulder and the percentage of (SEM, SEM%) respectively. For 1.19mmmm, 3.54% and 1.0mmmm, 6.53%; repeated measure analysis of variance showed that patients had significant contralateral shoulder ultrasound measurement results difference (F=106.50, P0.05); Pearson correlation analysis showed that ultrasound and X-ray measurements are highly correlated (r=0.85, P0.05).
Conclusion ultrasonic measurement of the shoulder joint subluxation after stroke with AGT has excellent reliability and good discriminative validity, and it can effectively evaluate the degree of shoulder subluxation.
The second part: the clinical application of ultrasound in the evaluation of the treatment effect of shoulder joint subluxation after stroke
Objective to investigate the clinical usefulness of ultrasound in the evaluation of the effect of the treatment of shoulder subluxation after stroke.
Methods after stroke patients with shoulder subluxation, 48 cases with functional electrical stimulation (functionalelectrical, stimulation, FES) for the treatment and rehabilitation techniques, continuous treatment for 6 weeks. Before and after treatment, using the FugI-Meyer locomotor rating scale of subjects of limb motor function, and the subjects of bilateral shoulder ultrasound and X-ray measurement of joint inspection, the vertical distance from the X-ray measurement site for acromioclavicular joint lateral edge to the midpoint of the humeral head (D), ultrasonic measurement site is the shortest distance between the greater tuberosity lateral acromial margin to the upper edge of the humerus, namely the acromion - large nodules (acromion-greater tuberosity distance, AGT spacing). Correlation using Pearson correlation analysis method were evaluated for ultrasonic measurement results and X-ray measurement results and the correlation between ultrasonic measurement results and FugI-Meyer scores.
Results before treatment, after 6 weeks of treatment, the ipsilateral D = 39.76 + 5.21mm and 32.32 + 5.46mm, contralateral D = 25.52 + 4.25mm and 24.24 + 4.51mm, compared with before and after treatment, the contralateral D value had significant difference (P0.05); before treatment, after 6 weeks of treatment, patients the AGT values were 28.24 + 5.26mm and 21.34 + 4.92mm, contralateral AGT = 15.14 + 4.28mm and 14.84 + 4.34mm, compared with before and after treatment, the contralateral AGT value had significant difference (P0.05); before treatment, after 6 weeks of treatment, FugI-Meyer scores were 9.46 + 2.35 and 21.25 + 2.52, there was significant difference before and after treatment (P0.05); Pearson correlation analysis showed that the ultrasonic measurement results and the results of the X-ray measurement was highly correlated (r=0.81, P0.05); there was a negative correlation between ultrasonic measurement results and FugI-Meyer scores (r=-0.76, P0.05).
Conclusion ultrasonic measurement of AGT can objectively and quantitatively evaluate the therapeutic effect of shoulder subluxation after stroke, and ultrasound has the advantages of non-invasive, high efficiency and simple operation. It is worthy of clinical application.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3;R49

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉景;王威;;針刺、康復(fù)手法結(jié)合生物反饋治療中風(fēng)后肩關(guān)節(jié)半脫位36例療效觀察[J];河北中醫(yī);2011年09期

2 楊年煜;;肌力訓(xùn)練對(duì)卒中后肩關(guān)節(jié)半脫位的療效觀察[J];中國實(shí)用神經(jīng)疾病雜志;2009年23期

3 白蓉;李麗;;低頻調(diào)制中頻聯(lián)合PNF技術(shù)治療腦卒中后肩關(guān)節(jié)半脫位療效觀察[J];中國實(shí)用神經(jīng)疾病雜志;2010年21期

4 楊年煜;王勇麗;;針刺對(duì)中風(fēng)早期肩關(guān)節(jié)半脫位的療效觀察[J];河南中醫(yī);2011年08期

5 盧志娟;李建鋒;;二維超聲心動(dòng)圖對(duì)正常人肺動(dòng)脈直徑的測量與分析[J];中外醫(yī)療;2010年21期

6 楊惠青;劉大川;趙立蘋;趙麗艷;;球后視神經(jīng)直徑的超聲波測量[J];臨床眼科雜志;2011年01期

7 趙景宏;喬彥;唐紅;趙超美;;實(shí)時(shí)三維超聲測量右心室容積及收縮功能的可行性研究[J];嶺南心血管病雜志;2012年02期

8 項(xiàng)飛翔,陳漢榮,黃幼珍,謝明星,黃三菊,魯成發(fā),冷松,吳限,林鋌,王新房;實(shí)時(shí)三維超聲測量膀胱容積的初步探討[J];中國臨床醫(yī)學(xué)影像雜志;2004年05期

9 馮躍琴;王學(xué)梅;許東陽;張?jiān)骑w;;經(jīng)腹超聲對(duì)957例體檢者前列腺大小的測量及其相關(guān)影響因素分析[J];中國男科學(xué)雜志;2009年07期

10 李敬民;李彩英;李慶嘯;趙爽;劉曉偉;王偉;羅文飛;柳青;;256iCT和心動(dòng)超聲對(duì)左心房容積定量測量的準(zhǔn)確性研究[J];臨床放射學(xué)雜志;2012年11期

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