许攀攀,张艳美,赵晓萌,等.肩关节半脱位对脑卒中患者上肢神经传导和运动功能的影响[J].中华物理医学与康复杂志,2026,48(5):444-449
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| 肩关节半脱位对脑卒中患者上肢神经传导和运动功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20250514-00416 |
| 中文关键词: 脑卒中 肩关节半脱位 神经传导 上肢功能 |
| 英文关键词: Stroke Shoulder subluxation Nerve conduction Upper limb function |
| 基金项目:苏州市姑苏卫生人才研究项目（GSWS2022138）；苏州市重点实验室项目（SZS2025004） |
| 作者 | 单位 | | 许攀攀 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 张艳美 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 赵晓萌 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 魏天祺 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 罗家麒 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 王盛 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 | | 李向哲 | 南京大学医学院附属苏州医院（苏州科技城医院）康复医学科, 苏州市脑卒中防治及康复一体化重点实验室,苏州 215153 |
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| 中文摘要: |
| 目的 探讨肩关节半脱位对脑卒中患者上肢周围神经传导、运动功能和日常生活活动能力的影响。 方法 本研究共纳入22例脑卒中患者，依据脑卒中类型、偏瘫侧和性别进行配对，分为肩关节半脱位组和无肩关节半脱位组，每组各11例。采用Brunnstrom分期评估偏瘫侧上肢运动功能恢复阶段，并采用改良Barthel指数（MBI）评估患者的日常生活活动能力；采用神经传导检查技术，对双侧正中神经、尺神经和桡神经的运动和感觉传导，以及肩胛上神经、腋神经和肌皮神经的运动传导进行检测。 结果 肩关节半脱位组的偏瘫侧上肢Brunnstrom分期和MBI评分均差于无肩关节半脱位组（P<0.05）。与健侧相比，2组患者偏瘫侧肩胛上神经、腋神经、肌皮神经、桡神经、正中和尺神经的肌肉复合动作电位（CMAP）和桡神经的感觉神经动作电位（SNAP）波幅均降低，正中神经的运动传导速度减慢（P＜0.05）；与无肩关节半脱位组偏瘫侧相比，肩关节半脱位组偏瘫侧的腋神经、肌皮神经、正中神经和尺神经的CMAP波幅降低（P＜0.05）。偏瘫侧正中神经CMAP波幅与MBI评分之间呈正相关（P＜0.05）；偏瘫侧肩胛上神经、腋神经、肌皮神经、正中神经和尺神经的波幅与上肢Brunnstrom分期呈正相关（P＜0.05）。 结论 脑卒中后肩关节半脱位可能会加重上肢周围神经的异常，进而影响上肢功能的恢复和日常生活活动能力。 |
| 英文摘要: |
| Objective To document the impacts of shoulder subluxation (SS) on peripheral nerve conduction in the upper limb after a stroke, on motor functioning, and on ability in the activities of daily living (ADL). Methods In this matched-pair study, 11 stroke patients with SS and 11 without were matched based on stroke type, hemiplegic side, and gender. After baseline information was gathered, clinical functional evaluations were carried out, including Brunnstrom staging of the affected upper limb and assessments of ADL ability using the Modified Barthel Index (MBI). Motor and sensory conduction in the bilateral median, ulnar and radial nerves was quantified, as well as the motor conduction of the suprascapular, axillary and musculocutaneous nerves. Results The average Brunnstrom stage and MBI score of the SS group were significantly inferior to the no-SS group′s averages. Both groups exhibited significantly lower amplitudes of compound muscle action potential (CMAP) in their suprascapular, axillary, musculocutaneous, radial, median and ulnar nerves, a lower sensory nerve action potential (SNAP) amplitude of the radial nerve and a slower motor conduction velocity of the median nerve on the affected side. The CMAP amplitudes of the axillary, musculocutaneous, median, and ulnar nerves in the SS group showed a significant reduction compared to the no-SS group. CMAP amplitude of the median nerve on the affected side showed a significant positive correlation with the MBI scores, and the CMAP amplitudes of the suprascapular, axillary, musculocutaneous, median and ulnar nerves on the affected side were similarly correlated with the Brunnstrom stages. Conclusion Post-stroke SS can exacerbate peripheral nerve injuries within the upper limb, with negative impacts on the restoration of upper limb function and ADL ability. |
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