目的 观察脑卒中患者偏瘫侧肩关节病变情况,明确不同被动运动对脑卒中患者偏瘫侧肩关节喙肩韧带形变的影响,减少康复训练中肩部撞击综合征的发生。方法 选择武警浙江总队医院2019年1－11月收治的31例脑卒中偏瘫患者,对患者肩关节进行规范化超声检查,测量患侧喙肩韧带在肩关节前屈,水平后伸,0°外展时内旋、外旋,90°外展时内旋和背部内旋运动时垂直位移变化,并与健侧测量结果相比较。结果 31例脑卒中偏瘫患者中发生肩关节超声异常28例(90.32%),主要病变包括:长头腱炎症并腱鞘积液 22 例,长头腱脱位 1例;滑囊炎并滑囊积液 13 例;肩袖损伤 15例,肩关节半脱位 18 例。其中23例为多种病变并存,对侧肩关节超声异常8例(25.81%),主要病变包括长头腱鞘积液3例,肩袖损伤3例,滑囊炎并滑囊积液2例。脑卒中患者偏瘫侧肩关节喙肩韧带平均垂直位移明显大于对侧组;同一运动偏瘫侧肩关节喙肩韧带垂直位移大于对侧组;不同运动对喙肩韧带垂直位移影响不同,由大到小依次为90°外展时内旋、水平后伸、前屈、背部内旋、0°外展时内旋及外旋动作,差别有统计学意义(P<0.01)。结论 超声能显示脑卒中患者偏瘫侧肩关节病变;可观察肩关节不同运动对喙肩韧带形变的影响,进行90°外展时内旋、水平后伸等对喙肩韧带形变影响较大的运动时应谨慎。

Objective To explore the ultrasonographic characteristics of hemiplegic shoulders and evaluate coracoacromial ligament displacement during passive motions with dynamic ultrasound. Methods A total of 31 patients who suffered from post-stroke hemiplegic shoulders for the first time underwent dynamic ultrasound examinations. The vertical displacement of the coracoacromial ligament was analyzed by the motion tracing program during the following passive assisted motions: forward flexion in the scapular plane, horizontal abduction in the axial plane,external rotation with the arm at 0° abduction , internal rotation with the arm at 0° abduction, internal rotation with the arm at 90° abduction, and internal rotation at the back. Results ①Twenty-eight cases(90.32%) of abnormal ultrasound results were found among these patients. The findings of ultrasound disclosed 22 cases of lesions of the long head of the biceps tendon and tendon sheath,1 case of dislocation of the long head tendon,13 cases of bursitis and bursa effusion,15 cases of rotator cuff injury, and 18 cases of shoulder subluxasion. Multiple lesions existed simultaneously in 23 cases. There was significant difference in the incidence of the disease compared to the contralateral shoulders (P<0.01).②The mean vertical displacement of the coracoacromial ligament during passive assisted motions was significantly different between hemiplegic shoulders and contralateral shoulders(P<0.01).At the same time,the mean vertical displacement of the coracoacromial ligament during forward flexion, horizontal abduction, internal rotation with the arm at 90° abduction, and internal rotation at the back was significantly different compared to external rotation with the arm at 0° abduction and internal rotation with the arm at 0° abduction(P<0.01). Conclusions Dynamic ultrasound can disclose lesions of the post-stroke hemiplegic shoulder and help observe the variations of vertical displacement of the coracoacromial ligament during passive assisted motions. It is recommended that patients avoid shoulder motions which are likely to cause subacromial impingement.