本文選題：半脫位　切入點：超聲　出處：《蘇州大學》2014年碩士論文　論文類型：學位論文

【摘要】：第一部分：超聲評估腦卒中后肩關節(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)間距評估腦卒中后肩關節(jié)半脫位的信度和效度。 方法選擇腦卒中后肩關節(jié)半脫位患者48例。兩位檢查者先后對受試者兩側(cè)肩關節(jié)進行超聲測量檢查。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)肩部測量進行兩次，每次測量重復3次，兩次測量間隔時間為10分鐘。采用組內(nèi)相關系數(shù)（intraclasscorrelation coefficient，ICC)評估超聲測量的重測信度和評測者間信度，采用測量標準誤及其百分比（standard error of measurement，SEM和SEM%)評估超聲的重復測量誤差，采用重復測量方差分析評價超聲的判別效度，采用Pearson相關分析法評價超聲與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)肩部重復測量標準誤及其百分比（SEM、SEM%）分別為1.19mmmm、3.54%和1.0mmmm、6.53%；重復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相關分析顯示，超聲與X線測量結(jié)果具有高度相關性(r=0.85，P0.05)。 結(jié)論超聲測量AGT評估腦卒中后肩關節(jié)半脫位具有極佳的信度和良好的判別效度，可有效評估肩關節(jié)半脫位的程度。 第二部分：超聲在腦卒中后肩關節(jié)半脫位治療效果評估中的臨床應用研究 目的探討超聲在腦卒中后肩關節(jié)半脫位治療效果評估中的臨床實用性。 方法選擇腦卒中后肩關節(jié)半脫位患者48例。選用功能性電刺激（functionalelectrical stimulation，F(xiàn)ES）聯(lián)合康復手法對其進行治療，連續(xù)治療6周。分別于治療前后，使用FugI-Meyer運動功能評定量表評定受試者患肢運動功能，并對受試者雙側(cè)肩關節(jié)行超聲和X線測量檢查，X線測量部位為肩鎖關節(jié)下外側(cè)緣至肱骨頭中點的垂直距離（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相關分析法分別評價超聲測量結(jié)果與X線測量結(jié)果的相關性以及超聲測量結(jié)果與FugI-Meyer評分的相關性。 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相關分析顯示，超聲測量結(jié)果與X線測量結(jié)果呈高度相關性（r=0.81，P0.05）；超聲測量結(jié)果與FugI-Meyer評分呈負相關性（r=-0.76，P0.05）。 結(jié)論超聲測量AGT可對腦卒中后肩關節(jié)半脫位的治療效果進行客觀定量評估，并且超聲還具有無創(chuàng)、高效、操作簡便等優(yōu)點，值得臨床推廣應用。
[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.

【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3;R49

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