脑卒中后肩痛的康复治疗研究进展

肩关节疼痛（简称肩痛）是脑卒中后偏瘫患者的重要并发症之一,通常在脑卒中后2～3个月内发生[1],其发病率16％～84％[2].肩痛不仅增加患者的痛苦,而且还会延缓和阻碍上肢运动功能的恢复,其原因主要与患者惧怕疼痛,从而减少患肢功能训练甚至进行患肢制动有关[3].临床上发生脑卒中后肩痛的原因很多,如肩肱节律的丧失、肌张力异常、关节囊挛缩、肩-手综合征、肩关节脱位、肩关节粘连性改变、患肢体位和处理不当、臂丛神经和周围神经损伤、粘连性关节囊炎等[4-6].康复早期干预措施有利于减少肩痛的发生,已成为脑卒中患者早期康复的重要治疗手段.     

早期康复护理干预在脑卒中肢体偏瘫患者中的应用

目的:探讨早期康复护理干预在脑卒中肢体偏瘫患者中的应用效果。方法:将90例脑卒中肢体偏瘫患者随机分为观察组和对照组各45例,对照组给予常规护理措施,观察组给予常规护理措施和早期康复护理干预。结果:观察组在出院时肩关节半脱位的程度及Barthel指数评分优于对照组(P0.05)。结论:早期康复护理干预对脑卒中肢体偏瘫患者肩关节半脱位起着重要作用。     

预防肩关节半脱位护肩带的研发及应用研究

肩关节半脱位是脑卒中常见的并发症,其发生率高达60%～70%[1],严重影响病人上肢功能的恢复及日常生活能力,也是导致肩痛和肩手综合征等并发症的主要原因之一[2]。因此肩关节半脱位的早期预防尤为重要。在临床护理工作中,护士一般采用卧位时瘫痪肢体良肢位的摆放,坐、立、行走时瘫侧上肢使用     

脑卒中后肩痛患者肩部红外热成像观察

摘要 目的：观察脑卒中患者及伴有肩手综合征、痉挛和肩关节半脱位的脑卒中患者的肩部皮肤温度变化特点并探讨红外热成像检查是否可作为脑卒中后肩痛的客观评价指标。 方法：选取86例脑卒中患者,使用数位式红外线热影像测温系统对脑卒中患者,伴有肩手综合征、痉挛和肩关节半脱位的脑卒中患者,以及脑卒中后肩痛患者进行肩部红外热成像观察。 结果：70例（81.4%）患者患侧肩部较健侧温度低,肩手综合征与非肩手综合征患者比较,差异有显著性意义（P＜0.05）;痉挛与非痉挛患者以及肩关节半脱位与非肩关节半脱位患者比较,差异均无显著性意义（P＞0.05）。脑卒中肩痛与非肩痛患者比较,差异无显著性意义（P＞0.05）。 结论：红外热成像检查能客观反映脑卒中患者肩部皮肤温度变化特点,大部分患者的患侧肩部皮肤温度较健侧低。合并肩手综合征的患者两侧皮肤温度不对称现象更明显,痉挛和肩关节半脱位不会明显影响皮肤温度。脑卒中后肩痛患者与非肩痛患者的红外热成像表现无明显差异。     

社区医院早期康复护理对脑卒中偏瘫病人日常生活活动能力影响的研究

[目的]探讨脑卒中偏瘫病人实施早期康复护理干预后日常生活活动能力的改善情况。[方法]将2015年1月—2016年8月入住中山市西区医院内科的64例脑卒中偏瘫病人作为研究对象,按照随机数字表法将其分为对照组和早期康复组,每组32例。对照组给予常规护理,早期康复组在对照组基础上实施早期康复护理干预,对比经两组病人的日常生活活动能力及并发症发生率。[结果]两组病人经护理干预后的BI评分均明显高于干预前,早期康复组经护理干预后的Barthel指数法(BI)评分与对照组相比明显要高,差异均具有统计学意义(P0.05);早期康复组并发症发生率明显低于对照组,差异有统计学意义(P0.05)。[结论]对脑卒中偏瘫病人实施早期康复护理干预后,病人肢体功能和日常生活能力得到有效的改善,有效减少了病人预后肩痛、肩关节脱位、肩手综合征等并发症的发生。     

早期康复护理干预对脑卒中患者肩手综合征发生率的效果影响

目的 探讨早期康复护理干预对脑卒中患者肩手综合征发生率的影响.方法 120例脑卒中患者随机分两组,观察组60例在神经内科常规治疗及早期介入康复护理干预,对照组60例给予神经内科常规治疗及护理.结果 两组治疗后,采用Fugl-Meyer评定法(FMA)对运动功能进行评分,采用改良Barthel指数(MBI)对ADL能力进行评分,观察组评分明显优于对照组(P＜0.05),并比较两组患者脑卒中后肩手综合征的发生率.观察组肩手综合征发生率12%,对照组肩手综合征发生率30%,观察组患者肩手综合征发生率明显低于对照组(P＜0.01).结论 早期实施康复护理干预,干预手段包括正确预防方法的体位摆放、主动和被动运动、手法按摩、心理干预等,有助于预防和减少脑卒中肩手综合征的发生,并能明显改善脑卒中患者的运动功能及日常生活活动能力,降低偏瘫的致残率,提高患者生活质量.     

脑卒中患者的肩部问题

肩部问题是脑卒中患者常见的并发症 ,主要表现有肩痛、肩关节半脱位和肩 -手综合征。肩部问题的存在有碍于脑卒中患者上肢功能的恢复 ,早期预防和治疗肩痛有助于改善上肢的功能活动能力。     

脑卒中后肩部问题

脑卒中后常见的肩部问题包括:肩关节半脱位、肩手综合征和肩痛。(1)肩关节半脱位治疗包括:矫正肩胛骨的位置,恢复肩原有的锁定机制;刺激肩关节周围固定肌的活动及张力;在不损伤关节及其周围结构的前提下,保持肩关节无痛性的全范围被动活动。(2)肩-手综合征治疗主要是减轻水肿和疼痛,改善手、腕关节的活动度。(3)肩痛的治疗包括改善肩胛骨活动度、体位摆放、增加被动活动度及指导患者采用正确的肩关节运动来逐步改善患者的症状。     

充气式与普通型肩吊带对脑卒中后肩关节半脱位的疗效比较

<正>肩关节半脱位是脑卒中最常见的并发症之一,严重影响功能恢复~([1])及日常生活活动能力。肩关节半脱位往往在脑卒中早期即可出现。由于冈上肌、三角肌等肩部肌肉张力降低、关节囊松弛,无法抵抗坐或站立时上肢重力而引发肱骨头下滑而脱离关节盂,造成肩关节半脱位~([2—3])。研究报道,脑卒中患者肩关节半脱位发生率在17%—81%且超过20%的患者伴有肩痛、肩手综合征以及废用肩等并发症,甚至继发腋神经损害~([4—5])。因此,脑卒中早期肩关节半脱位预防及康     

脑卒中偏瘫的继发障碍

脑卒中偏瘫患者常有肩关节半脱位、肩 -手综合征、肩痛、体位性低血压、关节挛缩等继发障碍。因此 ,应在发病早期即采取康复措施 ,预防继发障碍的发生 ,对已发生的继发障碍应积极治疗。1肩关节半脱位脑卒中患者易发生肩关节半脱位。从解剖学上看 ,肱骨头的 2 / 3处于关节囊外 ,肩关节自身的稳定性差 ,需要韧带和部分肌肉来加强固定肩关节。固定肩关节的肌肉其纤维呈水平走向 ,可加强关节囊水平方向的紧张性 ,防止向下方脱位。另外 ,关节囊上部的喙肱韧带 ,也可起到加强关节囊的作用。脑卒中后 ,这些固定作用减弱或丧失 ,加上患肢本身的重力…     

脑卒中后肩-手综合征的综合康复

目的探讨康复综合干预对脑卒中后肩-手综合征的治疗效果。方法对181例脑卒中后并发肩-手综合征患者分为综合康复治疗组(观察组)96例和对照组85例,两组均行常规康复训练,观察组还另外采用良肢位摆放、空气波压力治疗、冷水热水交并浸泡、运动想像等综合康复措施。治疗4周后评定疗效。结果观察组偏瘫侧肩痛、关节活动度、水肿等与治疗前比较有明显改善,与对照组比较有显著性差异(P<0.05)。结论综合治疗能提高脑卒中后肩-手综合征的康复治疗效果,有助于肩关节功能的恢复。     

神经肌肉本体易化技术联合神经肌肉电刺激治疗脑卒中患者肩关节半脱位疗效观察

目的：观察神经肌肉本体易化技术（ proprioceptive neuromuscular facilitation ,PNF）技术联合神经肌肉电刺激对脑卒中后肩关节半脱位的治疗效果。方法将90例脑卒中后肩关节半脱位患者按随机数字表示分为治疗组和对照组各45例。2组患者均接受早期药物治疗、良肢位摆放及常规康复治疗,治疗组加用PNF技术联合神经肌肉电刺激。2组患者治疗前及治疗后均拍摄双肩关节X射线片并进行指诊,测定两侧肩峰至肱骨头的间距（ AHI）评价肩关节脱位恢复情况,采用Fugl-Meyer评定量表（ FMA）评价患者患侧上肢运动功能。结果2组患者在治疗1月后AHI评分及FMA评分均较治疗前改善,且治疗组较对照组改善更显著（ P＜0.05）。结论 PNF技术联合神经肌肉电刺激对脑卒中后肩关节半脱位及上肢运动功能改善效果显著,其疗效优于常规康复治疗。     

早期标准营养制剂肠内营养支持对急性脑卒中患者营养状况的影响

目的探讨早期标准营养制剂肠内营养（enteral nutrition,EN）支持对急性脑卒中患者营养状况的影响。方法将我院神经内科收住的70例首发脑卒中患者按入院先后分为实验组和对照组,每组均35例患者。实验组为康复体位联合阶段化、个性化肠内营养干预组;对照组为康复体位联合肠内营养护理组。两组患者在入院Ft、7、14、28d分别测定血清白蛋白（albumin,ALB）、血清前白蛋白（pre-albumin,PAB）含量,测量非瘫痪侧上臂肌围（armmuscle circumference,AMC）、三头肌皮褶厚度（triceps skin fold,TSF）。此外两组患者在入院第1天及第28天时,进行简式Fugl-Meyer量化评分。结果入院第7天,对照组患者AMC明显低于实验组,差异有统计学意义（P〈0．05）;入院后28d,实验组患者TSF、AMC、PAB和ALB优于对照组,差异有统计学意义（P〈0．05）。入院后第28d两组患者均进行Fugl Meyer评分,差异无统计学意义。结论对急性脑卒中患者实施早期标准营养制剂肠内营养干预,更能够有效地改善其营养状况,促进患者康复。     

Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey

OBJECTIVE: Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. DESIGN: A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. RESULTS: Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. CONCLUSION: These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.     

早期肠内营养支持对脑卒中后重症吞咽障碍患者预后的影响

目的 探讨早期肠内营养支持对急性脑卒中后重症吞咽障碍患者预后的影响.方法 将符合才藤氏吞咽障碍7级评价法1级标准的139例急性脑卒中后吞咽障碍患者随机分成早期肠内营养组(EEN,n=69)和早期肠外营养组(EPN,n=70),在给予综合治疗的基础上,采用不同方法的营养支持,观察两组治疗前及治疗4w后血清白蛋白,非瘫痪侧上臂三头角肌肌围(MAMC)、三头肌皮褶厚度(TSF)等体重相关营养指标的变化及腹胀、应激性溃疡、肺部感染、病死率等临床并发症发生情况.结果 治疗4w后后,EEN组在营养学指标:血清白蛋白、TSF、MAMC、体重优于EPN组,差异有统计学意义(P<0.05),EEN组并发症发生数小于EPN组,其中并发应激性溃疡、肺部感染者差异有统计学意义(P<0.05),其余差异无统计学意义.结论 重症吞咽障碍是影响脑卒中神经功能康复的因素之一,也是加剧营养状况恶化、并发症发生的主要诱因,脑卒中合并重症吞咽困难患者早期应用肠内营养支持,可改善机体的营养状况,减少并发症发生,有利于患者的康复.     

The use of electrical stimulation and taping to address shoulder subluxation for a patient with central cord syndrome

BACKGROUND AND PURPOSE: This case report describes the examination, intervention, and outcome of a patient with central cord syndrome (CCS) who participated in acute rehabilitation that included the use of electrical stimulation (ES) and strapping to address shoulder subluxation. The only literature found describing these interventions for shoulder subluxation was for patients with stroke. CASE DESCRIPTION: The patient was a 29-year-old man with CCS and bilateral shoulder subluxation. He received ES over 8 weeks to the anterior and middle deltoid and supraspinatus muscles of the right shoulder. Taping was repeated every 3 to 4 days on both shoulders following over the anterior and middle deltoid muscles up to the acromion. OUTCOMES: The initial shoulder subluxation measurements were 1.5 cm on the right and 1.0 cm on the left. The final measurements were 0.3 cm on the right and 0.2 cm on the left. The patient's American Spinal Injury Association upper-extremity motor scores were 26/50 initially and 48/50 at discharge. CONCLUSION: The use of ES and shoulder taping in conjunction with other rehabilitation may have played a role in reducing the patient's shoulder subluxation.     

脑血管意外患者早期良肢位的护理

目的观察良肢位对脑血管意外偏瘫患者早期康复护理效果的影响。方法将240例脑血管意外患者随机分为良肢位组和对照组,各120例,良肢位组采用早期床上良肢位摆放,对照组采用偏瘫常规护理。结果经4周的康复护理,良肢位组患者并发症发生率显著低于对照组(p<0.01)。结论良肢位在脑血管意外患者早期康复护理中能明显减少并发症的发生。     

急性脑卒中患者过早下肢负重与患肢伸肌痉挛及膝过伸的关系研究

目的:研究下肢过早负重对脑卒中偏瘫患者下肢功能的影响。方法:急性脑卒中患者80例,对全部患者的临床资料进行回顾性分析。结果:根据患者康复过程中的依从性,分为规范康复组和过早负重组,各40例,2组均接受康复治疗2个月,但过早负重组患者康复治疗期间过早下肢负重;治疗2个月后,过早负重组患者下肢出现伸肌痉挛及膝过伸的例数均高于规范康复组(P<0.05)。结论:过早下肢负重容易使脑卒中偏瘫患者下肢出现伸肌痉挛及膝过伸。     

康复护理干预对脑卒中后肩手综合征肌痉挛的效果观察

目的:观察康复护理干预对脑卒中后肩手综合征肌痉挛的效果。方法:将49例脑卒中所致肩手综合征肌痉挛患者采用数字表法分为康复组和对照组。康复组25例,采用综合康复护理方法,对照组24例采用常规护理措施。采用改良的Ashworth方法,对两组患者干预前、后肢体痉挛状态进行评定。结果:康复组治疗后患肢痉挛评分较治疗前有明显改善,与对照组比较有统计学意义。结论:康复护理干预对脑卒中所致肩手综合征肌痉挛有显著的改善作用,可提高患者的生活自理能力。     

Percutaneous, intramuscular neuromuscular electrical stimulation for the treatment of shoulder subluxation and pain in chronic hemiplegia: a case report

This case report describes the first survivor with chronic stroke who was treated with percutaneous, intramuscular neuromuscular electrical stimulation (NMES) for shoulder subluxation and pain. The patient developed shoulder subluxation and pain within 2 mo of his stroke. After discharge from acute inpatient rehabilitation, he developed shoulder and hand pain, which was treated with subacromial bursa steroid injection and ibuprofen with eventual resolution. The patient remained clinically stable until approximately 15 mo after his stroke-when he developed severe shoulder pain associated with shoulder abduction, external rotation, and downward traction. The patient could not tolerate transcutaneous NMES because of the pain of stimulation. At approximately 17 mo post-stroke, the patient's posterior deltoid, middle deltoid, and supraspinatus muscles were percutaneously implanted with intramuscular electrodes. After 6 wk of percutaneous, intramuscular NMES treatment, marked improvements in shoulder subluxation and pain, and modest improvements in activities of daily living and motor function were noted. One year after the onset of treatment, the patient remained pain free, but subluxation had recurred. However, the patient was able to volitionally reduce the subluxation by abducting his shoulder. The patient remained pain free for up to 40 mo after the initiation of percutaneous, intramuscular NMES treatment. This case report demonstrates the feasibility of using percutaneous, intramuscular NMES for treating shoulder subluxation and pain in hemiplegia.