肩痛合并肩胛骨动力障碍患者相关肌肉的超声评估研究

关键词：肩痛  肩胛骨动力障碍  前锯肌  斜方肌  超声

Keywords:shoulder pain  scapular dyskinesis  serratus anterior  trapezius muscle  ultrasound

摘要：

      摘要 目的：探讨肩痛合并肩胛骨动力障碍(scapular dyskinesis， SD)患者的肩胛骨相关肌肉在不同SD分型、疼痛病程及严重程度时静息和收缩状态下肌肉厚度的超声改变，为临床制定个体化康复计划提供理论依据。 方法：使用肌骨超声技术对48例肩痛合并SD患者及20例正常人的双侧斜方肌上部(upper trapezius， UT)、斜方肌中部(middle trapezius， MT)，以及斜方肌下部(lower trapezius， LT)、前锯肌(serratus anterior， SA)的静息和收缩时厚度进行测量。将所有SD依据Kibler分型分为2型SD组、3型SD组及混合型组。依据0—10数字疼痛程度评分量表(numerical rating scale， NRS)将患者分为轻度疼痛组、中度疼痛组。依据疼痛病程将患者分为急性疼痛组和慢性疼痛组。各组内比较双侧肩胛骨相关肌肉的静息厚度及收缩幅度百分比改变。 结果：2型SD及中度疼痛组的患侧SA静息厚度均明显低于健侧，差异有显著性意义(P<0.05)；而患侧UT、MT、LT的静息厚度与健侧相比均无显著性差异(P>0.05)；3型SD组、轻度疼痛组及急性疼痛组的患侧UT、MT、LT及SA静息厚度和健侧相比，差异无显著性意义(P>0.05)。各组内患侧UT、MT、LT、SA收缩幅度百分比与健侧相比，差异均无显著性意义(P>0.05)。20例正常人双侧肩胛骨相关肌肉厚度均无显著性差异。 结论：2型SD和中度疼痛者的患侧SA以及慢性疼痛者的患侧LT和SA静息厚度均有改变。提示肌骨超声是一个有效的影像学定量评估方法，并可为制定相关康复训练方案提供依据。

Abstract:

      Abstract Objective： To investigate the ultrasonic changes of muscle thickness in scapular-related muscles under resting and contractile states in patients with shoulder pain with different scapular dyskinesis (SD) types， pain course and severity， so as to provide theoretical basis for development of clinical individualized rehabilitation plan. Method： Thickness of the serratus anterior (SA) 、upper trapezius(UT)、middle trapezius(MT) and lower trapezius(LT) of 48 patients with shoulder pain and SD as well as 20 healthy subjects were captured with ultrasound under rest and contractionagainst gravity， All patients with SD were divided into type 2 group， type 3 group and atypical group according to the Kibler typing method. And all patients were divided into mild pain group (NRS score 1—3, 23 subjects)， moderate pain group(NRS score 4—6, subjects). All patients were also divided into acute pain group and chronic pain group according to the course of shoulder pain. The resting thickness and the percentage of contracted extent of bilateral scapular stabilizing muscle of patients were compared in each group. Result： The resting thickness of SA on the affected side was significantly lower than that on the healthy side in type 2 group and moderate pain group (P<0.05)， while the resting thickness of UT， MT and LT on the affected side showed no significant difference between the two sides (P>0.05). The resting thickness of LT and SA on the affected side was statistically significant lower than that on the healthy side in the chronic pain group(P<0.05)， while those the resting thickness of UT and MT on the affected side was not significantly different from that on the healthy side (P>0.05). There were no significant differences in the resting thickness of UT， MT， LT and SA between the affected side and the healthy side in type 3 group， mild pain group and acute pain group (P>0.05). There were no significant difference in the percentage of contracted extent of UT， MT， LT and SA between the affected side and the healthy side in all groups (P>0.05).There were no significant differences in the resting thickness of bilateral scapular-related muscles in 20 healthy subjects. Conclusion： Resting thickness of LT in patients with type 2 SD and resting thickness of LT and SA in moderate pain had changes in affected side. The results of this study indicate that musculoskeletal ultrasound is an effective imaging quantitative evaluation method， and can provide a basis for the formulation of rehabilitation trainning programs.