超声评估脑卒中后肩关节半脱位的临床研究

发布时间：2018-03-14 12:48

本文选题：半脱位　切入点：超声　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分：超声评估脑卒中后肩关节半脱位的信度和效度研究目的研究超声测量肩峰-大结节间距评估脑卒中后肩关节半脱位的信度和效度。方法选择脑卒中后肩关节半脱位患者48例。两位检查者先后对受试者两侧肩关节进行超声测量检查。测量部位为肩峰外侧缘至肱骨大结节上缘的最短距离，记为肩峰-大结节间距（acromion-greater tuberosity distance，AGT）。每侧肩部测量进行两次，每次测量重复3次，两次测量间隔时间为10分钟。采用组内相关系数（intraclasscorrelation coefficient，ICC)评估超声测量的重测信度和评测者间信度，采用测量标准误及其百分比（standard error of measurement，SEM和SEM%)评估超声的重复测量误差，采用重复测量方差分析评价超声的判别效度，采用Pearson相关分析法评价超声与X线测量结果的一致性。结果超声测量的重测信度和评测者间信度均为极佳，重测信度在患、健侧肩部分别为0.99和0.98，评测者间信度在患、健侧肩部分别为0.96和0.95；患、健侧肩部重复测量标准误及其百分比（SEM、SEM%）分别为1.19mmmm、3.54%和1.0mmmm、6.53%；重复测量方差分析显示患、健侧肩部超声测量结果差异有显著性（F=106.50，P0.05）；Pearson相关分析显示，超声与X线测量结果具有高度相关性(r=0.85，P0.05)。结论超声测量AGT评估脑卒中后肩关节半脱位具有极佳的信度和良好的判别效度，可有效评估肩关节半脱位的程度。第二部分：超声在脑卒中后肩关节半脱位治疗效果评估中的临床应用研究目的探讨超声在脑卒中后肩关节半脱位治疗效果评估中的临床实用性。方法选择脑卒中后肩关节半脱位患者48例。选用功能性电刺激（functionalelectrical stimulation，FES）联合康复手法对其进行治疗，连续治疗6周。分别于治疗前后，使用FugI-Meyer运动功能评定量表评定受试者患肢运动功能，并对受试者双侧肩关节行超声和X线测量检查，X线测量部位为肩锁关节下外侧缘至肱骨头中点的垂直距离（记为D），超声测量部位为肩峰外侧缘至肱骨大结节上缘的最短距离，即肩峰-大结节间距（acromion-greater tuberosity distance，AGT）。采用Pearson相关分析法分别评价超声测量结果与X线测量结果的相关性以及超声测量结果与FugI-Meyer评分的相关性。结果治疗前、治疗6周后，患侧D值分别为39.76±5.21mm和32.32±5.46mm，健侧D值分别为25.52±4.25mm和24.24±4.51mm，，治疗前后比较患、健侧D值差值差异有显著性（P0.05）；治疗前、治疗6周后，患侧AGT值分别为28.24±5.26mm和21.34±4.92mm，健侧AGT值分别为15.14±4.28mm和14.84±4.34mm，治疗前后比较患、健侧AGT值差值差异有显著性（P0.05）；治疗前、治疗6周后，FugI-Meyer评分分别为9.46±2.35分和21.25±2.52分，治疗前后比较差异有显著性（P0.05）；Pearson相关分析显示，超声测量结果与X线测量结果呈高度相关性（r=0.81，P0.05）；超声测量结果与FugI-Meyer评分呈负相关性（r=-0.76，P0.05）。结论超声测量AGT可对脑卒中后肩关节半脱位的治疗效果进行客观定量评估，并且超声还具有无创、高效、操作简便等优点，值得临床推广应用。
[Abstract]:The first part: the study of reliability and validity of ultrasonic assessment of shoulder subluxation after stroke
Objective to evaluate the reliability and validity of the shoulder peak space interval between the shoulder and the shoulder joint subluxation after stroke.
Methods after stroke patients with shoulder subluxation in 48 cases. Two examiners conducted ultrasound measurement check on the subjects on both sides of the shoulder. The measured position is the shortest distance between the greater tuberosity humerus lateral acromial margin to margin, denoted as large nodules spacing (acromion-greater acromion - tuberosity distance, AGT). The measurement on each side the shoulder two times, each time the measurements were repeated 3 times, two times the measurement interval is 10 minutes. The intraclass correlation coefficient (intraclasscorrelation, coefficient, ICC) to assess the test-retest reliability and inter rater reliability evaluation of ultrasonic measurement, standard error of measurement and the percentage (standard error of measurement, SEM and SEM%) of repeated measurement error evaluation ultrasound analysis, discriminant validity evaluation of ultrasound by repeated measurement of variance consistency using Pearson correlation analysis method to evaluate the ultrasound and X-ray measurements.
Results the test-retest reliability and inter rater reliability evaluation of ultrasound measurement are excellent, the test-retest reliability in patients with contralateral shoulders were 0.99 and 0.98, assessment of interrater reliability in the affected and contralateral shoulders were 0.96 and 0.95; with repeated measurement standard error of the contralateral shoulder and the percentage of (SEM, SEM%) respectively. For 1.19mmmm, 3.54% and 1.0mmmm, 6.53%; repeated measure analysis of variance showed that patients had significant contralateral shoulder ultrasound measurement results difference (F=106.50, P0.05); Pearson correlation analysis showed that ultrasound and X-ray measurements are highly correlated (r=0.85, P0.05).
Conclusion ultrasonic measurement of the shoulder joint subluxation after stroke with AGT has excellent reliability and good discriminative validity, and it can effectively evaluate the degree of shoulder subluxation.
The second part: the clinical application of ultrasound in the evaluation of the treatment effect of shoulder joint subluxation after stroke
Objective to investigate the clinical usefulness of ultrasound in the evaluation of the effect of the treatment of shoulder subluxation after stroke.
Methods after stroke patients with shoulder subluxation, 48 cases with functional electrical stimulation (functionalelectrical, stimulation, FES) for the treatment and rehabilitation techniques, continuous treatment for 6 weeks. Before and after treatment, using the FugI-Meyer locomotor rating scale of subjects of limb motor function, and the subjects of bilateral shoulder ultrasound and X-ray measurement of joint inspection, the vertical distance from the X-ray measurement site for acromioclavicular joint lateral edge to the midpoint of the humeral head (D), ultrasonic measurement site is the shortest distance between the greater tuberosity lateral acromial margin to the upper edge of the humerus, namely the acromion - large nodules (acromion-greater tuberosity distance, AGT spacing). Correlation using Pearson correlation analysis method were evaluated for ultrasonic measurement results and X-ray measurement results and the correlation between ultrasonic measurement results and FugI-Meyer scores.
Results before treatment, after 6 weeks of treatment, the ipsilateral D = 39.76 + 5.21mm and 32.32 + 5.46mm, contralateral D = 25.52 + 4.25mm and 24.24 + 4.51mm, compared with before and after treatment, the contralateral D value had significant difference (P0.05); before treatment, after 6 weeks of treatment, patients the AGT values were 28.24 + 5.26mm and 21.34 + 4.92mm, contralateral AGT = 15.14 + 4.28mm and 14.84 + 4.34mm, compared with before and after treatment, the contralateral AGT value had significant difference (P0.05); before treatment, after 6 weeks of treatment, FugI-Meyer scores were 9.46 + 2.35 and 21.25 + 2.52, there was significant difference before and after treatment (P0.05); Pearson correlation analysis showed that the ultrasonic measurement results and the results of the X-ray measurement was highly correlated (r=0.81, P0.05); there was a negative correlation between ultrasonic measurement results and FugI-Meyer scores (r=-0.76, P0.05).
Conclusion ultrasonic measurement of AGT can objectively and quantitatively evaluate the therapeutic effect of shoulder subluxation after stroke, and ultrasound has the advantages of non-invasive, high efficiency and simple operation. It is worthy of clinical application.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R49

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