肩痛伴肩关节内旋障碍的康复疗效观察

关键词：盂肱关节内旋  肩胛骨动力障碍  康复治疗

Keywords:glenohumeral joint internal rotation  scapula dynamic disorder  rehabilitation treatment

摘要：

      摘要 目的：针对盂肱关节内旋时出现肩胛骨前倾上移这类肩痛的患者，寻求一套有效便捷的康复治疗方案，并观察按此治疗方案患者居家康复与医院结合家庭康复两种治疗模式的近期及远期治疗效果。 方法：选自2021年6月—2023年6月来我科就诊的单侧盂肱关节内旋出现肩胛骨上移代偿的肩痛患者72例，按照数字随机表法分为治疗组和对照组，研究过程中每组均脱落1例，最终完成病例数治疗组（n=35）和对照组（n=35）。治疗组采用医院+家庭康复模式，对照组采用居家康复模式。治疗组的患者先来我科接受一对一康复治疗，待盂肱关节被动内旋时的角度及阻力接近健侧且疼痛显著改善后改为居家康复继续维持训练。对照组患者按同样的运动处方由家属辅助居家康复，每月复查1次。两组均坚持治疗3个月，于治疗前、治疗1个月后及治疗3个月后采用肩关节疼痛与功能障碍指数（SPADI）进行评定，并追踪治疗1年后的复发率，其次监测治疗3个月内双肩主动内旋的角度差及双肩内旋至T7时肩胛骨下角高度差的改善情况。 结果：治疗1个月后治疗组SPADI显著优于对照组（P<0.05），而继续治疗3个月后两组差异不显著（P>0.05）。治疗组治疗1年后的复发率显著低于对照组（P<0.05）。 结论：肩痛伴肩关节内旋障碍的患者，采取医院结合家庭康复的治疗模式相比居家康复能更快地改善症状且1年后的复发率更低。

Abstract:

      Abstract Objective： To seek a set of effective and convenient rehabilitation protocol for patients with shoulder pain caused by scapular anterior tilt and elevation during glenohumeral internal rotation， and to observe the short- and long-term therapeutic effects of home rehabilitation and hospital combined with home rehabilitation. Method： From June 2021 to June 2023， 72 patients with shoulder pain with unilateral glenohumeral joint internal rotation and scapular upward displacement compensation were selected from our department. They were randomly assigned to either the treatment group or control group using a numerical random table. During the study， 1 case dropped out from each group， resulting in a final sample size of 35 in both the treatment and the control groups. The treatment group received a combined hospital-home rehabilitation mode， and the control group received home rehabilitation. Patients in the treatment group initially came to our department to receive one-on-one rehabilitation treatment. After achieving passive glenohumeral internal rotation angles and resistance comparable to the unaffected side with significant pain reduction， they were transitioned to home rehabilitation and continued to maintain training. The control group received family-assisted home rehabilitation following the same exercise prescription， with monthly clinical re-assessments. Both groups were treated for three months. The shoulder pain and dysfunction index （SPADI） was measured before treatment， one month， and three months after treatment， and the recurrence rate was tracked one year after treatment. Additionally， the improvement in bilateral active internal rotation angle discrepancy and the height difference of subscapular angle when the shoulder rotation reached T7 within three months of treatment was monitored. Result： The treatment group demonstrated significantly better SPADI scores than the control group after one month of treatment （P<0.05）， and there was no significant difference between the two groups after three months of continued treatment（P>0.05）. The recurrence rate after one year of treatment was significantly lower in the treatment group than in the control group（P<0.05）. Conclusion： For patients with shoulder pain combined with internal rotation dysfunction， hospital plus home rehabilitation treatment mode can provide faster symptomatic relief and reduce 1-year recurrence rate compared with home rehabilitation.