【摘要】：目的:1.研究介入性超聲注射治療聯(lián)合康復(fù)訓(xùn)練對(duì)腦卒中后肩手綜合征Ⅰ期患者的臨床療效,同時(shí)與微波治療聯(lián)合康復(fù)訓(xùn)練組的臨床療效對(duì)比。2.對(duì)肩手綜合征發(fā)病原因及發(fā)病機(jī)制進(jìn)行初步探討。方法:選取2014年1月至2016年7月我科收治的腦卒中肩手綜合征Ⅰ期患者42例,分為微波聯(lián)合常規(guī)康復(fù)訓(xùn)練組(19例)和介入性超聲聯(lián)合常規(guī)康復(fù)訓(xùn)練組(23例)。治療組在常規(guī)康復(fù)治療基礎(chǔ)上予以偏癱側(cè)肩關(guān)節(jié)周圍軟組織肌骨超聲引導(dǎo)下介入注射復(fù)方倍他米松注射液治療,對(duì)照組在常規(guī)康復(fù)治療基礎(chǔ)上予以偏癱側(cè)肩關(guān)節(jié)微波治療。采用治療前后對(duì)比,分別于治療前、治療后3和10天采用視覺(jué)模擬評(píng)分(VAS)評(píng)價(jià)肩關(guān)節(jié)疼痛程度、測(cè)量手背和掌指小關(guān)節(jié)水腫程度,分別于治療前和治療后10天采用簡(jiǎn)化的Fugl-Meyer上肢運(yùn)動(dòng)功能評(píng)價(jià)量表(FMA)和Barthel指數(shù)(BI)評(píng)價(jià)上肢運(yùn)動(dòng)功能和日常生活活動(dòng)能力。結(jié)果:冶療前治療組與對(duì)照組兩組患者在VAS、FMA、BI、手背及掌指小關(guān)節(jié)水腫情況各項(xiàng)評(píng)分比較,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(p0.05)。兩組患者VAS評(píng)分、水腫評(píng)分在治療后隨著時(shí)間均呈下降改變,治療組下降幅度大且速度快,尤其是治療后3天治療組的水腫評(píng)分已有明顯下降;而對(duì)照組未見(jiàn)明顯改變。兩組患者組在治療后3天及10天在VAS、手背及掌指小關(guān)節(jié)水腫情況評(píng)分比較治療組較對(duì)照組各時(shí)點(diǎn)相比均有明顯下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者FMA、BI評(píng)分在治療后隨著時(shí)間均呈上升改變,但治療組治療后10天在FMA、BI評(píng)分同對(duì)照組相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.超聲介入注射治療在改善腦卒中后肩手綜合征Ⅰ期患者肩關(guān)節(jié)疼痛、手背及掌指小關(guān)節(jié)水腫方面有明顯效果,且超聲介入組效果優(yōu)于微波組。2.超聲介入注射能在短時(shí)間內(nèi)改善腦卒中后肩手綜合征患者肩痛、手背及掌指小關(guān)節(jié)水腫,進(jìn)一步促進(jìn)患側(cè)上肢運(yùn)動(dòng)功能恢復(fù),提高日常生活能力,改善患者生活質(zhì)量。3.肩手綜合征發(fā)病與肩袖損傷、肩關(guān)節(jié)腔積液、肱二頭肌長(zhǎng)頭肌腱鞘積液(尤其是肩峰下-三角肌下滑囊積液)有相關(guān)性。
[Abstract]:Purpose 1. To study the clinical effect of interventional ultrasound injection combined with rehabilitation training in patients with shoulder hand syndrome after stroke, and compared with microwave therapy combined with rehabilitation training group. 2. The etiology and pathogenesis of shoulder-hand syndrome were discussed. Methods: from January 2014 to July 2016, 42 patients with shoulder hand syndrome were divided into two groups: microwave combined with conventional rehabilitation group (19 cases) and interventional ultrasound combined group (23 cases). The treatment group was treated by interventional injection of compound betamethasone injection under the guidance of ultrasound in the soft tissue around the shoulder joint of hemiplegic side on the basis of routine rehabilitation treatment, while the control group was treated with microwave therapy on the basis of routine rehabilitation treatment for the shoulder joint of hemiplegic side. Visual analogue score (VAS) was used to evaluate the degree of shoulder pain and edema of the dorsal and metacarpophalangeal joints before and after treatment. The upper limb motor function and ADL were evaluated by simplified Fugl-Meyer motor function evaluation scale (FMA) and Barthel index (BI) before and 10 days after treatment. Results: there was no significant difference in the scores of VASFMA BI, hand dorsal and metacarpophalangeal facet joint edema between the treatment group and the control group before treatment (p0.05). The VAS score and edema score of the two groups decreased with time after treatment, and the decrease was large and rapid in the treatment group, especially in the treatment group 3 days after treatment, but the edema score in the control group did not change significantly. The scores of edema in VAS, dorsal hand and metacarpophalangeal facet joints in the treatment group were significantly lower than those in the control group at 3 and 10 days after treatment (P0.05). The FMABI scores of the two groups increased with time after treatment, but the FMABI scores in the treatment group were not significantly different from those in the control group 10 days after treatment (P0.05). Conclusion 1. Ultrasound interventional injection was effective in ameliorating pain of shoulder joint, edema of palmar and phalangeal facet joints in patients with shoulder and hand syndrome after stroke, and the effect of ultrasound intervention group was better than that of microwave group. Ultrasound interventional injection can improve shoulder pain, edema of palmar and phalangeal facet joints in patients with shoulder and hand syndrome after stroke in a short period of time, further promote the recovery of motor function of the affected upper limbs, improve the ability of daily life, and improve the quality of life of patients. The incidence of shoulder and hand syndrome was correlated with rotator cuff injury, fluid accumulation of shoulder joint cavity, and accumulated fluid of tendon sheath of long head muscle of biceps brachii (especially subacromian-deltoid muscle glide sac).
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R493

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