关节镜下肩峰成形术治疗肩峰下撞击综合征

目的探讨关节镜下肩峰成形术治疗肩峰下撞击综合征的方法和效果。方法分析应用关节镜行肩峰成形术治疗68例经保守治疗无效的2期肩峰下撞击综合征的情况。随访12个月以上纳入分析。采用洛杉矶加洲大学（UCLA）肩关节功能标准评价疗效。结果平均随访16．4个月，术后3-24个月有持续的症状和功能的改善，UCLA评分从术前18．3分改善到31．7分，优良率为89．7％。结论关节镜能明确诊断，镜下肩峰成形术治疗肩峰下撞击综合征能达到减压要求，效果良好。早期、持久地术后锻炼是康复的保证。     

超声评估肩峰撞击综合征患者肩峰下滑囊的临床研究

目的:对比分析肩峰撞击综合征(SIS)患者与健康人群肩峰下滑囊(SAB)的超声图像特征,探讨一种简便而准确的SAB超声评估方法。方法:选取确诊为SIS的患者58例(病例组)共65个患肩,以及无任何肩关节不适的健康志愿者50例(正常对照组)共50个优势肩。均行肩关节超声检查,观察SAB是否增厚、有无积液等,并分别在肩胛下肌腱长轴及短轴切面、冈上肌腱长轴及短轴切面测量SAB厚度。结果:病例组滑囊增厚、积液发生率明显高于正常对照组,差异有统计学意义(χ2=71.265,P<0.001;χ2=15.345,P<0.001)。病例组和正常对照组冈上肌腱短轴切面测得的SAB平均厚度均大于肩胛下肌腱长轴、短轴及冈上肌腱长轴切面所测结果,差异有统计学意义(均P<0.05)。结论:超声能准确评估SIS患者SAB增厚、积液扩张等病理改变,冈上肌腱短轴切面测量SAB厚度简单可靠。     

Anatomical and biomechanical mechanisms of subacromial impingement syndrome

Subacromial impingement syndrome is the most common disorder of the shoulder, resulting in functional loss and disability in the patients that it affects. This musculoskeletal disorder affects the structures of the subacromial space, which are the tendons of the rotator cuff and the subacromial bursa. Subacromial impingement syndrome appears to result from a variety of factors. Evidence exists to support the presence of the anatomical factors of inflammation of the tendons and bursa, degeneration of the tendons, weak or dysfunctional rotator cuff musculature, weak or dysfunctional scapular musculature, posterior glenohumeral capsule tightness, postural dysfunctions of the spinal column and scapula and bony or soft tissue abnormalities of the borders of the subacromial outlet. These entities may lead to or cause dysfunctional glenohumeral and scapulothoracic movement patterns. These various mechanisms, singularly or in combination may cause subacromial impingement syndrome.     

肩袖损伤合并肩峰下撞击综合征的MRI表现

目的探讨肩袖损伤合并肩峰下撞击综合征的MRI影像表现。材料与方法对33例X线片无骨折但临床怀疑肩袖损伤或肩峰下撞击综合征的患者,用1.5 T MRI机检查,观察肩袖损伤及肩峰下撞击综合征在MR上的影像特征,分析两者的相关性,并与手术结果对比,计算准确率。结果 33例中肩袖损伤20例(合并肩峰下撞击综合征10例),肩峰下撞击综合征15例(合并肩袖损伤10例)。肩袖损伤和肩峰下撞击综合征术前MR诊断准确率分别约为95.0%、71.3%。结论肩关节MRI扫描对肩袖损伤及肩峰下撞击综合征的诊断有较高的临床应用价值,肩袖损伤者中至少半数合并肩峰下撞击综合征,临床和影像应予重视。     

肩峰下撞击综合征患者肩峰下空间的超声和姿势分析初步研究

目的:对肩峰肱骨距离、冈上肌肌腱厚度以及肩、颈姿势进行评估,对肩峰下撞击综合征(SIS)患者肩峰下空间变化的机制进行探讨。方法:纳入试验组SIS患者20例,同期招募的年龄、性别、体重均匹配健康人对照组20例(试验组及对照组均为右利手)。使用超声测量肩峰肱骨距离(AHD)以及冈上肌肌腱厚度。使用GPS姿势分析系统分析头前伸姿势(FHP)和肩前伸姿势(FSP)。分别测量颅椎角(CA)和肩前伸角度(FSA)联合上述两种方式对肩峰下空间变化的机制进行探讨。结果:试验组冈上肌肌腱厚度明显大于对照组,两者差异具有显著性意义(P0.01)。两组之间AHD无显著性差异(P0.05)。试验组冈上肌厚度与AHD比值大于对照组,差异具有显著性意义(P0.01)。试验组FSA小于对照组,具有显著性差异(P0.01)。两组CA相比,差异无显著性意义(P0.05)。试验组FSA与AHD两者间存在中度相关(P0.05,R=0.62)。CA与AHD之间不存在相关关系(P0.05)。结论:SIS与试验组患者相比,冈上肌肌腱更厚且肩前伸更为明显。     

Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome

Subacromial impingement syndrome (SAIS), which is associated with pain and a loss of function, has a high occurrence in the physically active population. Not all patients respond positively to treatment. Classifying patients can improve decision-making. The scapular kinematic and clinical impairments can aid in classifying the patients who are more likely to respond to physical therapy treatment. Thirty-three subjects (males, 20–33 years) presenting SAIS were studied to determine altered scapular kinematics and clinical impairments. Three measurements were collected: (1) three-dimensional scapular kinematics during performing functional tasks; (2) impairment outcomes of range of motion and muscle force; and (3) self-reported measurements of pain, satisfaction, and function. All patients received 6-week (2 times per week) physical therapy treatment. Improvement with treatment was determined using the Global Rating of Change Scale. Scapular kinematics and clinical impairments were first identified by t-test in predicting improvement and then combined into a multivariate prediction method. A prediction method with three variables (Flexilevel Scale of Shoulder Function score < 41, muscle power of serratus anterior < 27.4% body weight, degree of scapular internal rotation at 30° shoulder elevation during descending arm phase in unloaded condition < 0.7°) were identified. It appears that scapular kinematics and impairment features can be used to classify subjects with SAIS in addition to self-report. Prospective validation of the proposed prediction method requires further investigation.     

肩峰下撞击综合征发病机制、诊断及治疗的研究进展

肩峰下撞击综合征(subacromial impingement syndrome,SAIS)是肩关节病变中较为常见的疾患,对其整体了解仍有所不足.多年来,多种假设提出来描述肩峰下撞击征的发病机制,但尚未找到明确的解释.近年来,否认撞击存在的内源性机制越来越受到大众的认可;多个不同的肩峰下撞击综合征的体格检查特异性较低...     

Occipital neuralgia evoked by facial herpes zoster infection

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. We report a patient with occipital neuralgia followed by facial herpes lesion. A 74-year-old male experienced sudden-onset severe headache in the occipital area. The pain was localized to the distribution of the right side of the greater occipital nerve, and palpation of the right greater occipital nerve reproduces the pain. He was diagnosed with occipital neuralgia according to ICHD-II criteria. A few days later, the occipital pain was followed by reddening of the skin and the appearance, of varying size, of vesicles on the right side of his face (the maxillary nerve and the mandibular nerve region). This was diagnosed as herpes zoster. This case represents a combination of facial herpes lesions and pain in the C2 and C3 regions. The pain syndromes can be confusing, and the classic herpes zoster infection should be considered even when no skin lesions are established.     

运动训练在肩峰下撞击综合征患者功能恢复中的应用

目的:探讨运动训练对肩峰下撞击综合征患者功能恢复的影响。方法:将86例肩袖损伤为1度或2度的肩峰下撞击综合征患者随机分为包含运动训练的物理治疗组(试验组)和不包含运动训练的物理治疗组(对照组)。两组患者均采用常规的脉冲超短波、温热疗、冷疗等物理治疗,试验组同时按肩峰下撞击综合征患者运动训练计划进行康复治疗,两组患者均进行12周治疗,并于开始治疗前以及3个月、6个月、12个月随访时进行评估。采用Constant评分表和美国加州大学(UCLA)肩评分表评估其疗效。结果:从入组到第3个月,从入组到第6个月,从入组到第12个月的三个阶段随访时,每个阶段的Constant总分和各分项的分数增加值,试验组与对照组比较,有显著性差异(P<0.05);经过治疗,第3个月,第6个月,第12个月随访时,Constant总分分数,试验组与对照组比较,有显著性差异(P<0.05),UCLA肩关节功能各项评分,试验组与对照组比较,有显著性差异(P<0.05);经过治疗,第3个月,第6个月,第12个月随访时,Constant总分分数,两组与各自治疗前后比较,有显著性差异(P<0.05),UCLA肩关节功能评分中,除对照组第3个月,第6个月随访时力量得分与治疗前无显著性差异(P>0.05),其余各项评分两组与各自治疗前后比较有显著性差异(P<0.05)。结论:系统的、以运动生物力学及运动生理学为理论指导的运动训练同时结合其他物理治疗手段能更有效地治疗肩峰下撞击综合征,对肩关节功能恢复有明显的促进作用。     

The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome

Purpose. To investigate the effectiveness of low-level laser therapy (LLLT) in addition to exercise programme on shoulder function in subacromial impingement syndrome (SAIS).

Method. Sixty-seven patients with SAIS were randomly assigned to either a group that received laser (n = 34) or a group that received placebo Laser (n = 26). Pain, functional assessment, disability and muscle strength of shoulder were assessed before and after a 3-week rehabilitation programme. Besides Laser or placebo Laser, superficial cold and progressive exercise programme were administered to both groups, 5 days a week, for 3 weeks. A progressive exercise programme that was done daily twice under supervision in clinic and at home was given to the patients.

Results. After the treatment, all outcome measurements had shown significant improvement except muscle strength in both the groups. When the parameters of the improvement were compared, there were no significant differences between the two groups after treatment.

Conclusion. We concluded that there is no fundamental difference between LLLT and placebo LLLT when they are supplementing an exercise programme for rehabilitation of patients with shoulder impingement syndrome.     

肩峰下撞击综合征肩峰下滑囊骨形态发生蛋白-2及7表达及意义

目的探讨骨形态发生蛋白-2及7在肩峰下撞击综合征患者肩峰下滑囊中表达及临床意义。方法肩峰下撞击综合征患者12例为观察组,非肩峰下撞击综合征肱骨外科颈骨折10例为对照组,观察组采用肩关节镜微创手术方式取肩峰下滑囊标本,对照组采取开放手术方式取标本,采用ELISA法检测肩峰下滑囊骨形态发生蛋白-2及7含量。结果观察组骨形态发生蛋白-2及7表达水平（760．36士98．61）pg／mL及（620．34±101．43）pg／mL明显高于对照组（230．35±97．30）pg／mL及（320．42±98．51）pg／mL（P％0．05）。结论肩峰下撞击综合征肩峰下滑囊骨形态发生蛋白-2及-7表达水平明显增加,可能与肩峰下骨赘、肩袖退变等肩峰下间隙内病理变化有关。     

Natural history of sensory function after herpes zoster

The natural history of sensory function in the first 6 months after herpes zoster (HZ) was determined in a cohort of 94 subjects at elevated risk for developing post-herpetic neuralgia (PHN). All four visits included ratings of pain and sensory symptoms, mapping areas of altered sensation and allodynia, and quantitative thermal and mechanical sensory testing. The last three visits included the capsaicin response test. Sensory thresholds in distant control skin were stable. Mirror-image skin was persistently hyperesthetic to warming and mechanical stimuli and hyperalgesic to heat compared to distant control skin. HZ skin showed deficits in all thermal modalities. Sensory recovery was limited and selective. Allodynia area and severity, hyperalgesia to von Frey hair, and cold detection threshold improved, but deficits to warmth and heat pain did not. Capsaicin on HZ skin significantly aggravated pain and allodynia in the majority of subjects at 6–8 weeks after HZ onset. At study entry, eventual PHN subjects had significantly more impairment in detecting warmth and cold, a larger area of altered sensation, a larger area of allodynia, and more severe allodynia. The results support the study hypothesis that severity of initial injury predicts PHN, especially impaired cold sensation in HZ skin. The hypothesis that PHN develops because of a failure to recover normal neural function was not supported. Sensory recovery proceeded at the same rate in eventual pain-free and eventual PHN subjects and is not a requirement for pain resolution. Early interventions that reduce neural injury or enhance recovery should be of benefit.     

关节镜下肩峰下减压治疗肩峰撞击征的康复护理

总结了30例关节镜下肩峰下减压微创治疗肩峰撞击征患者的康复护理.对患者实施分阶段康复训炼,注意循序渐进,避免关节粘连.本组按计划完成康复训练,患肩主动前屈、外展、中立位外旋、体侧内旋均较术前均明显增加,美国肩肘外科医师评分(ASES)由术前66.53分提高到93.62分,26例患者无疼痛残留,4例残留轻度的疼痛,所有患者均表示对治疗和康复效果满意.     

Role of physiotherapy in the treatment of subacromial impingement syndrome: a prospective study

Objective

To investigate the effectiveness of a physiotherapy programme in patients with subacromial impingement syndrome.

Design

Prospective randomised study.

Setting

Orthopaedic department in a district general hospital.

Participants

Eighty-five patients who had been listed for surgery for subacromial impingement syndrome.

Interventions

Patients were allocated at random into one of two groups. One group containing 45 patients received physiotherapy while the other group containing 40 patients acted as controls.

Outcome measures

All patients entering the study underwent Constant score evaluation prior to being allocated to a group. This was repeated at 6 months, prior to surgical intervention.

Results

Seventy-three patients were able to complete the study. In the physiotherapy group, 11 patients no longer required surgery (26%). In this group, all patients improved their Constant score by a mean of 20 (range 4-45). In the control group, all patients required surgery. The mean improvement in the Constant score for the 31 control patients available for review was 0.65 (range −16 to 14).

Conclusion

All patients in this study improved with physiotherapy. Physiotherapy should be thought of as a first-line management for patients with subacromial impingement syndrome.     

CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的疗效观察

目的 观察CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的临床疗效。 方法 采用随机数字表法将88例颈段带状疱疹后神经痛患者分为对照组、电针组、脉冲射频组及联合组。4组患者均常规给予加巴喷丁、曲马多治疗,电针组在药物干预基础上给予电针围刺治疗;脉冲射频组在药物干预基础上给予CT引导下颈段背根神经节脉冲射频治疗;联合组则同时给予CT引导下颈段背根神经节脉冲射频及电针围刺治疗。于治疗前（即入组时）、治疗后15 d、治疗后30 d时分别观察各组患者疼痛程度及面积、心理情绪、生活质量改善情况。 结果 入组时4组患者疼痛视觉模拟评分（VAS）、汉密顿焦虑量表（HAMA）评分、汉密顿抑郁量表（HAMD）评分、皮肤疼痛面积及生活质量评估量表（QOL-SF36）评分组间差异均无统计学意义（P>0.05）。与入组时比较,电针组、脉冲射频组及联合组在治疗后15 d及1个月时,其疼痛VAS、HAMA、HAMD评分、皮肤疼痛面积、QOL-SF36评分均有明显改善（P<0.05）。治疗后15 d、1个月时,联合组患者疼痛VAS评分［分别为（2.59±1.01）分、（1.77±1.10）分］、HAMA评分［分别为（12.45±4.11）分、（11.31±3.82）分］、HAMD评分［分别为（20.22±6.50）分、（16.54±6.58）分］、皮肤疼痛面积［分别为（66.36±31.25）cm2、（53.68±29.89）cm2］及QOL-SF36评分［分别为（90.54±15.02）分、（101.95±19.84）分］与电针组、脉冲射频组及对照组比较,发现组间差异均具有统计学意义（P<0.05）。治疗后3个月时联合组患者加巴喷丁与曲马多使用量［分别为（1309.1±603.8）mg/d、（104.5±57.5）mg/d］均较电针组、脉冲射频组及对照组显著下降,组间差异均具有统计学意义（P<0.05）。 结论 CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛疗效确切,且安全性高、并发症少、风险低,该联合疗法值得临床推广、应用。     

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome

Purpose

In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction.

Materials and methods

Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro–Wilk test was used in the assessment of normal distribution of parameters.

Results

The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively.

Conclusion

Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.