【摘要】 目的:评估综合性卒中单元模式中脑卒中后肩痛(SPAS)的危险因素及相关病因,为基于不同病因的SPAS患者个体化预防和治疗提供依据。方法:连续性纳入脑卒中患者2 585例,登记人口学基线资料,进行肩痛的专科评价,包括患侧肩痛、肩关节活动度、肩关节半脱位、肌张力及NIHSS上肢肌力评分等;对患侧肩关节行MRI扫描,对肩痛的病因进行多学科的一致性评估,统计SPAS的危险因素与相关病因。结果:综合性卒中单元模式中SPAS的发病率为12.50%,SPAS的危险因素包括糖尿病、复发性脑卒中、肩关节活动受限、BrunnstromⅠ～Ⅲ期、Ashworth 3～4级、NIHSS上肢肌力评分3～4分及感觉障碍;SPAS的病因复杂多样,其中肩袖肌腱病发病率58.64%,冻结肩48.14%,肩袖损伤40.34%,肩关节半脱位36.27%,肩手综合征26.44%,肩关节痉挛23.73%及脑卒中后中枢性疼痛10.85%,多种病因常混合存在。结论:SPAS的危险因素包括糖尿病、复发性脑卒中、肩关节活动受限、BrunnstromⅠ～Ⅲ期、Ashworth 3～4级、NIHSS上肢肌力评分3～4分及感觉障碍;肩痛的病因复杂,多种病因常混合并存,并互相影响;建议对SPAS患者行肩关节MRI检查,并对肩痛的病因进行多学科的一致性评估,明确肩痛的病因对于肩痛的个体化防治具有重要的指导意义。更多还原

【Abstract】 Objective: To evaluate risk factors and etiologies of shoulder pain after stroke(SPAS) in comprehensive stroke unit, to further provide the basis for individualized prevention and treatment of SPAS. Methods: A total of 2 585 patients with stroke were prospectively enrolled, baseline demographic data were registered and physical examinations were evaluated, including shoulder pain,range of shoulder motion, shoulder subluxation, muscular tension, and NIHSS upper extremity muscle strength. MRI of affected shoulder was scanned and etiologies of shoulder pain were evaluated by multidisciplinary physicians. Related etiologies and risk factors were analyzed. Results: The incidence of SPAS in comprehensive stroke unit was 12.50%. Risk factors of SPAS included diabetes mellitus, recurrent stroke, limited range of shoulder motion, Brunnstrom stageⅠ-Ⅲ grade, Ashworth 3-4 grade, NIHSS upper extremity muscle strength score 3-4 points and sensory deficit. The etiologies of SPAS were complicated and the incidence rate of cuff tendinopathy was 58.64%, frozen shoulder 48.14%, rotator cuff injury 40.34%, shoulder subluxation 36.27%, shoulder-hand syndrome26.44%, shoulder spasm 23.73% and central pain after stroke 10.85% respectively. Multiple causes of SPAS often coexisted. Conclusion: Risk factors comprise diabetes mellitus, recurrent stroke, limited range of shoulder motion, Brunnstrom stage Ⅰ-Ⅲ grade, Ashworth 3-4 grade, NIHSS upper extremity muscle strength score 3-4 points and sensory deficit. The etiologies of SPAS are complicated.Complicated causes of shoulder pain often interact with each other. MRI of shoulder should be scanned and multi-professional evaluation should be performed to detect the diversity and complexity of shoulder pain, which play important roles in individualized prevention and treatment.更多还原