脑卒中后肩关节半脱位的康复治疗与护理

[目的]探讨康复治疗与护理对脑卒中病人肩关节半脱位的影响.[方法]60例脑卒中后肩关节半脱位病人,通过心理干预、良肢位摆放、悬吊固定、纠正肩胛骨位置、促进肩周稳定肌肌力和维持肩关节活动等措施进行康复治疗及护理,在治疗后进行肩关节半脱位的测定.[结果]60例脑卒中病人治疗后肩关节半脱位情况明显改善.[结论]恰当的康复治疗及护理措施能促进脑卒中后肩关节半脱位病人上肢功能的恢复.     

超声引导下关节腔注射联合关节囊扩张治疗冻结肩

目的 观察超声引导下肩关节腔注射联合关节囊扩张治疗冻结肩的价值。方法 将100例临床诊断为冻结肩的患者随机分为试验组和对照组,每组各50例。对试验组进行连续3次超声引导下肩关节腔注射联合关节囊扩张治疗,对照组仅行连续3次单纯超声引导下关节腔注射治疗;分别于治疗前、治疗后6周和12周对肩关节疼痛（VAS）和主动活动范围（AROM）进行评分。结果 治疗后6周及12周,2组VAS及AROM均较治疗前明显改善（P均<0.05）。治疗后6周和12周,2组间VAS评分差异均无统计学意义（P均>0.05）;而试验组AROM评分均明显高于对照组（P<0.05）。结论 超声引导下肩关节腔注射联合关节囊扩张和单纯关节腔注射法均能有效改善冻结肩患者疼痛,而在改善肩关节功能方面,超声引导下肩关节腔注射联合关节囊扩张法的短、中期疗效明显优于单纯注射法。     

Dynamic inferior stabilizers of the shoulder joint

BACKGROUND: The glenohumeral joint is soft-tissue balanced. However, few studies have focused on its dynamic inferior stabilizers. OBJECTIVE: The objective of this study was to investigate the dynamic contributions of five shoulder muscles to inferior stability of the glenohumeral articulation in four joint positions. METHODS: The anterior, lateral and posterior deltoid, supraspinatus, short head of biceps, coracobrachialis and long head of triceps from ten cadaveric shoulders were tested in 0 degrees, 30 degrees, 60 degrees and 90 degrees of glenohumeral abduction. A constant inferior force of 15 N was applied to the humerus. The tendons were loaded sequentially in proportion to their respective muscle's cross-sectional area. Translations of the humeral head on the glenoid were recorded with a 3-Space tracking device. RESULTS: The lateral deltoid (8.2 mm, SD 4.8 mm) was potentially most effective in superior translation of the humeral head followed by the posterior deltoid (7.7 mm, SD 4.8 mm). The coracobrachialis and short head of biceps had considerable capability to translate the humeral head superiorly (2.8 mm, SD 1.3 mm) while the supraspinatus showed the weakest effects (1.3 mm, SD 0.5 mm). RELEVANCE: Strengthening exercises of the deltoid may be useful in the treatment of inferior glenohumeral instability, while the supraspinatus seems to be less important for inferior glenohumeral stability than previously assumed.     

肩部活动操在植入手臂输液港患者中的应用研究

目的评价肩部活动操在植入手臂输液港患者中的应用效果。方法采用便利抽样法,选取2019年10月—12月在郑州市某三级甲等医院肿瘤科住院、植入手臂输液港且肩关节活动受限的116例患者作为研究对象,采用随机数字表法,将其分为试验组59例和对照组57例。试验组进行肩部活动操锻炼,对照组进行握球运动锻炼,锻炼时长均为3个月。比较两组锻炼后肩关节功能评价量表得分,锻炼第1个月、第2个月、第3个月及锻炼期间血栓和导管阻塞发生率。结果锻炼后试验组肩关节功能评价量表中肩关节活动范围、日常生活活动能力、肌力评分高于对照组,差异具有统计学意义(P<0.05);锻炼第1个月,试验组血栓及导管阻塞发生率低于对照组,差异具有统计学意义(P<0.05);锻炼期间,试验组血栓及导管阻塞总发生率低于对照组,差异具有统计学意义(P<0.05)。结论肩部活动操锻炼有助于改善植入手臂输液港患者肩关节活动受限,降低其血栓和导管阻塞发生率。     

人工肩关节假体修复肩关节损伤

背景：肩关节置换成功的关键是尽可能重建肱骨近端的解剖结构,目前人工肩关节假体种类繁多,疗效差异较大。目的：总结人工肩关节假体在肩关节损伤修复中的应用进展。方法：由第一作者用计算机检索万方数据库、中国期刊全文数据库（CNKI）和PubMed数据库,检索时间为1999/2012,检索词分别为＂肩关节,人工假体＂和＂should erjoint,Artificial falsebody＂。从人工肩关节假体的类型,设计,应用及并发症方面进行总结,全面介绍人工肩关节假体在肩关节损伤修复中的应用进展。共检索到86篇文章,按纳入和排除标准对文献进行筛选,共纳入25篇文章。结果与结论：目前常用的人工肩关节假体中,UNIVERS3-D和Aequalis骨折型肩关节假体临床效果较好,置换后并发症及翻修率低,生物相容性较好。DeltaⅢ逆置式肩关节假体植入后因肩胛盂下凹槽形成及脱位等并发症,而致翻修率较高,生物相容性较差。因此,正确选择病例、熟悉肩关节的解剖学机制和肩关节特殊的重建技术,并在此基础上制定周密的置换方案可以降低人工肩关节假体置换并发症的发生,从而提高假体和宿主的生物相容性。     

脑卒中后肩关节半脱位的中西医结合治疗

目的：介绍脑卒中后肩关节半脱位的中西医治疗方法，为进一步探讨有效而简便的肩关节半脱位的治疗手段、预防并治疗脑卒中并发症提供借鉴。方法：将近年来康复治疗脑卒中后肩关节半脱位的研究文献进行综合述评，主要介绍脑卒中后肩关节半脱位的发病机制、康复治疗方法及作用机制，重点讨论康复治疗的优势。结果：脑卒中后肩关节半脱位的发生与病灶部位、肌肉瘫痪萎缩、稳固性降低和自身重力等因素有关，还可能与早期干预治疗及方式是否正确有关。常用的治疗和预防方法有正确的体位摆放，运动治疗、电刺激、针刺、手法治疗、外固定等。康复治疗可降低脑卒中瘫痪并发症和致残率，对提高患者的日常生活活动能力水平及改善生活质量有重要作用。结论：早期预防及康复治疗，能有效提高肩关节周围肌肉的张力，加强关节的稳定性，防止肩关节半脱位等并发症的发生。     

脑卒中后肩关节半脱位的中西医结合治疗

目的:介绍脑卒中后肩关节半脱位的中西医治疗方法,为进一步探讨有效而简便的肩关节半脱位的治疗手段、预防并治疗脑卒中并发症提供借鉴。方法:将近年来康复治疗脑卒中后肩关节半脱位的研究文献进行综合述评,主要介绍脑卒中后肩关节半脱位的发病机制、康复治疗方法及作用机制,重点讨论康复治疗的优势。结果:脑卒中后肩关节半脱位的发生与病灶部位、肌肉瘫痪萎缩、稳固性降低和自身重力等因素有关,还可能与早期干预治疗及方式是否正确有关。常用的治疗和预防方法有正确的体位摆放、运动治疗、电刺激、针刺、手法治疗、外固定等。康复治疗可降低脑卒中瘫痪并发症和致残率,对提高患者的日常生活活动能力水平及改善生活质量有重要作用。结论:早期预防及康复治疗,能有效提高肩关节周围肌肉的张力,加强关节的稳定性,防止肩关节半脱位等并发症的发生。     

药锘锤并功能锻炼治疗肩关节周围炎83例

MATERIALS AND METHODS Materials There were 83 cases of patients with 26 males and 57 females. Agedranging from 40 to 60 years, with 57 cses smaller than 60 and 26eases more than 60 years. Disease course was from 7 days to 4 yearrs.All the patients were coincident with the following diagnosis criteria,(1) Acute pain on one side or both sides shoulder, press pain oractivation pain and no other joint suffered. (2) Anterior lifting orabduction was smaller than 180° external rotation and. posterior ex-tension was smaller than 45° and lower than the healthy side. (3)Shoulder joint pained caused by other causes were excluded. Thecourse was classified to 3 degrees: Light: motion limitation ＜ 1/3,still pain and motion pain can beared. Intermedium: motion linita-tion ranging from 1/3 to 2/3, dressing combing and daily life isaffected. Obvious press pain and motion pain and suffered facial ex-pression. Severe: motion limitation ＞ 2/3, acute pain and especiallyduring night. Resting was affected and reluctant motion due topain. some daily activities can not self performed. There were 25cases with light, 32 cases with intermedium and 26 cases with se-vere     

Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.