脑卒中后肩痛的综合康复治疗

肩痛是脑卒中患者常见的并发症之一 ,不仅延缓了上肢运动功能的康复 ,而且还阻碍了患者整体康复的进展 ,故对脑卒中后肩痛的治疗显得尤为重要。我科采用针灸结合理疗、康复训练等治疗脑卒中后肩痛患者 2 0例 ,取得了满意疗效。现报道如下。一、资料与方法选取 1999年 8月～ 2 0 0 2年 5月间我院收治的脑卒中后肩痛患者 2 0例 ,男 11例 ,女 9例 ;年龄 43～ 78岁 ,平均 5 8岁 ;病程在 1月内的 7例 ,1～ 3月的 10例 ,3月以上的 3例 ;脑出血 12例 ,脑梗死 7例 ,脑动脉瘤破裂、蛛网膜下腔出血 1例。 2 0例患者就诊前均未进行系统的康复治疗 ,我们…     

关节松动术治疗脑卒中后肩痛的临床研究

目的 探讨脑卒中后肩痛的治疗方法.方法 采用关节松动术对脑卒中后肩痛患者的肩部进行治疗,用简式McGill疼痛问卷和Fugl-Meyer上肢功能评分在治疗前和治疗后30 d进行评定.结果 治疗组疼痛评分明显低于对照组(P<0.01),治疗组上肢功能评分明显高于对照组(P<0.01).结论 对脑卒中偏瘫患者肩痛进行关节松动治疗可明显减轻了肩痛并有效提高了上肢的运动功能.     

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.     

持续被动运动的临床应用

持续被动运动作为一种全新的治疗方式,已得到广泛的临床应用,就其使用方法、临床应用范围及其效果评价作一阐述。     

持续被动运动的临床应用

持续被动运动作为一种全新的治疗方式，已得到广泛的临床应用，就其使用方法、临床应用范围及其效果评价作一阐述。     

脑卒中后肩痛的家庭康复训练

脑卒中后肩痛是影响患者全面康复的主要障碍 ,对康复训练有很大影响。所以在整体康复中 ,应优先考虑肩的正确治疗 [1] ,尤其是脑卒中患者出院后出现肩痛将丧失获得的康复成果。作者从 1 997年起指导家庭训练员运用关节松动术对 2 8例脑卒中后肩痛患者进行家庭康复训练 ,效果满意。1　资料与方法1 .1　一般资料　脑卒中后肩痛患者 2 8例 ,男 1 5例 ,女 1 3例 ;年龄 49- 77岁 ;病程 1 - 38个月 ;脑出血 1 3例 ,脑梗死 1 5例 ,其中合并肩关节半脱位1 4例 ;住院期间即出现肩痛 1 9例 ,出院后出现肩痛9例。1 .2　方法　 1松动肩胛骨 :患者仰卧 ,…     

手法治疗脑卒中后肩痛疗效观察

资料和方法　　脑卒中后肩痛患者 2 9例 ,分为治疗组和对照组。治疗组 15例 ,男 9例 ,女 6例 ;年龄 4 4～ 79岁 ,平均 6 2 .3岁 ;其中脑出血 10例 ,脑梗死 5例 ;病程15ｄ～ 2个月。对照组 14例 ,男 8例 ,女 6例 ;年龄5 3～ 72岁 ,平均 6 3.6岁 ;其中脑出血 7例 ,脑梗死7例 ;病程 2 0ｄ～ 2个月。两组患者均除外患脑血管意外前有肩痛病史 ,发病年龄、病程等差异无显著性 ,具有可比性。　　对照组采用 :①矿泉浴 ,全身浸浴 37～ 39℃ ,8～10ｍｉｎ/次 ;②中频电疗法 (北京产Ｋ8832 -Ｔ电脑中频治疗仪 )低频频率 1～ 15 0Ｈｚ ,中频频率 2ｋＨ…     

半关节重建术后持续被动运动的护理

１９９０～１９９４年共有６８例骨肿瘤肿瘤大块切除，并以异体骨或灭活的自体瘤骨行半关节重建术，根据术后处理情况将这些病人分成二组，３７例术后关节外固定４～６周，而另３１例术后即接受关节持被动运动（ＣＰＭ），持续应用７～１０天经过４个月至４年的随访，发现ＣＰＭ组膝关节（２０例）平均屈曲度比对照组（２１例）大５０°（Ｐ＜０．０１）。根据本研究结果，认为半关节重建术后立即进行ＣＰＭ具有（１）预防或克服重建关节的强直，（２）不妨碍创口，韧带和肌腱愈合，（３）病人相对无痛苦。文中同时对ＣＰＭ的详细方法、护理及心理咨询等进行了讨论。     

膝关节镜下治疗骨关节炎术后下肢持续被动运动的应用

目的探讨膝关节镜下治疗肩关节炎术后下肢持续被动运动(CPM)的应用。方法Ⅱ～Ⅲ期老年性膝关节性膝关节炎(OA)40例,随机分为术后使用下肢CPM(20例)和术后关节腔内注入布比卡因(20例)两组,采用Ventafridda的整合评分法(IS)观察术后第1、3、5、7天止痛效果。结果术后第1天,两组无显著差异(P＞0.05),术后第3、5、7天有显著差异(P＜0.01)。结论术后使用下肢CPM的止痛效果明显优于布比卡因。     

持续被动运动治疗膝关节功能障碍的疗效观察

目的　观察膝部骨折术后膝关节功能障碍患者运用持续被动运动的疗效。方法　将 3 6例膝部骨折术后膝关节功能障碍患者随机分为治疗组和对照组。治疗组以膝关节持续被动运动为主 ,辅以综合康复治疗 ;对照组只接受辅助的综合康复治疗。结果　所有病例治疗后膝关节活动范围、疼痛均较治疗前明显好转 ,差异有统计学意义 (P <0 .0 1)。治疗组膝关节活动范围大于对照组 ,差异有统计学意义 (P <0 .0 1)。结论　采用持续被动运动并辅以综合康复治疗是治疗膝部骨折术后膝关节功能障碍的有效方法。     

兔膝关节持续被动运动仪的研究及应用

目的：通过对兔全层关节软骨缺损修复的研究，验证持续被动运动（CPM）实验仪器的实用性和稳定性。方法：将20个兔膝关节建立全层关节软骨缺损动物模型，随机分为A、B两组，A组术后给予CPM干预，B组仅笼内自由活动。CPM干预4周后，处死兔并取其全层关节软骨行HE染色和大体形态学评分。结果：A组全层关节软骨缺损修复的效果优于B组，差异有统计学意义（P〈0．05）。结论：CPM实验仪器设计合理、结构简单实用、稳定性好，适用于兔膝关节进行CPM的动物实验。     

持续被动运动的不同初始角度对全膝关节置换术后康复的影响

目的探讨持续被动运动(CPM)不同初始角度使用方法对全膝关节置换术后膝关节被动屈曲、伸展角度及肿胀的影响。方法 72例单侧全膝关节置换术患者随机分为CPM1组和cPM2组,每组36 例。所有患者均于术后第2天进行CPM,每日2次,每次1 h。CPM1组初始角度0-40°,每日增加10-20°; CPM2组初始角度90-50°,每日增加伸展角度10-15°,4 d内达到90-0°。结果 CPM2组在术后第7天、第 3个月时的膝关节屈曲、伸展角度均优于CPM1组,关节肿胀程度也较CPM1组轻。结论全膝关节置换术后 CPM早期屈曲角度越大越有利于康复。     

Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain

Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.

Objective

To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).

Design

Pilot study with assessments before and after BTX-A intra-articular injection.

Setting

Hospital rehabilitation department.

Participants

Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm.

Intervention

Intra-articular BTX-A injection.

Main Outcome Measure

Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection.

Results

Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection.

Conclusions

We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.     

人工膝关节置换术后连续被动活动对关节功能的影响

目的观察连续被动活动(CPM)对人工膝关节置换术后膝关节功能的恢复情况,进行临床对照研究评估连续被动活动在全膝置换术后康复中的作用。方法将本院行首次全膝置换的44例患者以单纯随机抽签方法分成两组,23例术后除行物理康复治疗外辅助应用CPM康复治疗,21例患者仅行物理康复治疗。对所有患者进行术后随访,记录术后第7,10,14天,6周,6个月及1年时的关节活动范围(ROM)。结果与未应用CPM组相比,应用CPM组患者平均膝关节活动度在术后7,10,14d,6周,3,6个月及1年时分别多19°,15°,10°,8°,8°,2°和5°(t=4.763,3.621,3.529,2.614,2.507,2.178,2.117,P<0.05)。结论CPM有助于全膝置换患者术后较早恢复膝关节活动度。     

Arthrographic and clinical findings in patients with hemiplegic shoulder pain

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.     

持续被动运动在改善截瘫患者踝关节屈伸功能和减轻骨质疏松的效果观察

目的观察持续被动运动(continuous passive motion,CPM)在改善截瘫患者踝关节屈伸功能和减轻骨质疏松的效果。方法将60例截瘫患者随机分为CPM组32例和对照组28例,CPM组应用CPM,对照组应用人工手法被动运动。比较治疗前后两组患者踝关节被动屈伸活动范围和骨密度的差异。结果治疗后CPM组患者踝关节活动度和骨密度优于对照组(均P<0.01)。结论 CPM可改善截瘫患者踝关节屈伸功能,减轻骨质疏松的发生。     

不同的持续被动运动时间对软骨损伤后发生骨性关节炎的影响

目的 研究关节软骨损伤后早期给予持续被动运动（CPM）治疗是否具有预防损伤后发生骨性关节炎（OA）的作用，以及不同的CPM治疗时间对结果的影响。方法 将15只雄性新西兰大白兔的30个膝关节均通过手术造成关节软骨全层缺损模型，术后按不同的处理随机分为对照组（A组）、2h CPM组（B组）和8h CPM组（C组）。术后12周处死所有兔子，肉眼观察膝关节软骨状况，并取软骨及滑膜标本进行HE染色和免疫组织化学染色，分别进行病理学评分和MMP-3阳性细胞数比较。结果 C组软骨病理评分和MMP-3阳性细胞分数都显著低于A、B组（P〈0．05）；B组关节软骨除浅层病理评分和软骨细胞缺失方面的病理学评分低于A组外，其它与A组无明显差异。结论 软骨缺损后早期给予CPM治疗可有效减缓OA的发生，且每天8h CPM的效果优于每天2h CPM。     

Hemiplegic shoulder pain: Evidence of a neuropathic origin

Hemiplegic shoulder pain (HSP) is common after stroke. Whereas most studies have concentrated on the possible musculoskeletal factors underlying HSP, neuropathic aspects have hardly been studied. Our aim was to explore the possible neuropathic components in HSP, and if identified, whether they are specific to the shoulder or characteristic of the entire affected side. Participants included 30 poststroke patients, 16 with and 14 without HSP, and 15 healthy controls. The thresholds of warmth, cold, heat-pain, touch, and graphesthesia were measured in the intact and affected shoulder and in the affected lower leg. They were also assessed for the presence of allodynia and hyperpathia, and computed tomography/magnetic resonance imaging scans of the brain were reviewed. In addition, chronic pain was characterized. Participants with HSP exhibited higher rates of parietal lobe damage (P < 0.05) compared to those without HSP. Both poststroke groups exhibited higher sensory thresholds than healthy controls. Those with HSP had higher heat-pain thresholds in both the affected shoulder (P < 0.001) and leg (P < 0.01), exhibited higher rates of hyperpathia in both these regions (each P < 0.001), and more often reported chronic pain throughout the affected side (P < 0.001) than those without HSP. The more prominent sensory alterations in the shoulder region suggest that neuropathic factors play a role in HSP. The clinical evidence of damage to the spinothalamic-thalamocortical system in the affected shoulder and leg, the presence of chronic pain throughout the affected side, and the more frequent involvement of the parietal cortex all suggest that the neuropathic component is of central origin.