肩关节后脱位并发反Hill-Sacks损伤术后居家康复训练个案分析

doi:10.3969/j.issn.1006-9771.2021.02.018

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (2): 230-236.doi: 10.3969/j.issn.1006-9771.2021.02.018

肩关节后脱位并发反Hill-Sacks损伤术后居家康复训练个案分析

周罗治非(),夏晓胜,王梓力

中南大学湘雅三医院，湖南长沙市 410000

收稿日期:2020-06-24 修回日期:2020-10-26 出版日期:2021-02-25 发布日期:2021-02-26
通讯作者: 周罗治非 E-mail:zhouluozhifei@126.com
作者简介:周罗治非(1988-)，女，汉族，湖南常德市人，硕士，主治医师，主要研究方向：运动损伤及骨关节疾病康复。

Effect of Home-based Rehabilitation Training on Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion: A Case Report

Luo-zhi-fei ZHOU(),Xiao-sheng XIA,Zi-li WANG

The Third Xiangya Hospital of Central South University, Changsha, Hunan 410000, China

Received:2020-06-24 Revised:2020-10-26 Published:2021-02-25 Online:2021-02-26
Contact: Luo-zhi-fei ZHOU E-mail:zhouluozhifei@126.com

摘要/Abstract

摘要： 目的

探讨1例肩关节后脱位并发反Hill-Sacks损伤患者术后居家康复训练疗效。

方法

根据患者术前、术后评估及手术方式，为其制定居家康复训练的方案，分4个阶段，包括关节活动度训练、肌力训练和本体感觉训练等。患者于术后定期来康复科门诊随诊，测量肩关节活动度，并采用徒手肌力检查、视觉模拟评分(VAS)和改良Rowe评分进行评价。

结果

术后6个月，患者肩关节主动前屈、后伸、内收、外展、外旋活动度达到正常，主动内旋至L₃水平，肌力正常，VAS由术前6分到术后0分，改良Rowe评分由术前16分提高至91分。术后10个月，患者主动内旋至L₁水平，改良Rowe评分达93分。

结论

肩关节后脱位并发反Hill-Sachs损伤可通过个体化的远程指导及合理的居家康复训练获得理想的临床效果。

关键词: 肩关节后脱位, 反Hill-Sacks损伤, 居家康复

Abstract: Objective

To explore the effect of home-based rehabilitation training on a patient with posterior shoulder dislocation with reverse Hill-Sacks lesion.

Methods

According to the preoperative and postoperative evaluation and the operation way, a four-phase home-based rehabilitation training plan was developed for the patient, which included the training of muscle strength and range of motion, and proprioceptive sensation training and so on. The patient was followed up in rehabilitation department regularly. The range of motion was measured, and were also evaluated with Manual Muscle Test, Visual Analogue Score (VAS) and modified Rowe Score.

Results

Six months after operation, the active range of motion of flexion, extension, adduction, abduction and external rotation of his shoulder reached to the normal range, the active internal rotation reached to level L₃, the muscle strength recovered to the normal level, the VAS decreased from six preoperative to 0 postoperative, and the modified Rowe Score improved from 16 preoperative to 91. Ten months after operation, his active internal rotation reached to level L₁, and the modified Rowe Score was 93.

Conclusion

Individualized remote guidance and reasonable home-based rehabilitation training might be effective on posterior shoulder dislocation with reverse Hill-Sacks lesion.

Key words: posterior shoulder dislocation, reverse Hill-Sacks lesion, home-based rehabilitation

中图分类号:

R684

周罗治非,夏晓胜,王梓力. 肩关节后脱位并发反Hill-Sacks损伤术后居家康复训练个案分析[J]. 《中国康复理论与实践》, 2021, 27(2): 230-236.

Luo-zhi-fei ZHOU,Xiao-sheng XIA,Zi-li WANG. Effect of Home-based Rehabilitation Training on Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion: A Case Report[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 230-236.

图/表 4

图1

表1

居家康复方案"

项目	第一阶段(第0~4周)	第二阶段(第5~8周)	第三阶段(第9~14周)	第四阶段(> 14周)
康复问题	制动保护期：患肩疼痛及肿胀明显，肩关节长时间制动易产生关节僵硬	保护过渡期：肩关节各向被动活动度及肩胛骨的稳定性稍差	功能恢复期：肩关节被动外旋、内收、内旋受限，肩袖肌群的主动肌力弱	巩固强化期：肩关节的整体灵活性及协调性欠佳
康复目标	控制疼痛和肿胀，促进损伤软组织修复，防止肩关节僵硬及软组织粘连	扩大肩关节被动活动度，强化肩关节肌力，为肩关节主动运动做准备	肩关节被动活动度接近正常，开始肩关节主动肌力训练	增加肩关节主动活动及肩部肌群整体力量、本体感觉和协调性
关节活动度	仰卧位肩胛骨平面上肩关节被动前屈及外展< 45°，木棒辅助下外旋< 30°	肩关节被动前屈及外展< 90°，被动外旋< 45°。肩关节轻微钟摆运动(15°为宜)	肩关节被动前屈、外展、外旋10周时至正常。开始仰卧位被动至助动内收、内旋。增加向内钟摆及划圈运动	肩关节主动前屈，外展，外旋训练，如手指爬墙，擦桌子等。主动内旋至最大范围
肌力训练	支具保护下站立位肩关节前屈、后伸、外展肌群等长收缩训练	仰卧位主动耸肩，肩胛骨主动内收、外展等肌力训练	肩袖肌群主动前屈、外展。站立位/坐位主动耸肩，肩胛骨内收、外展等肌力训练	肩胛带肌群和肩袖肌群的各向抗阻耐力训练，如举哑铃
其他康复内容	支具外展外旋位佩戴8周(图7~图8)。患侧手、腕各向主动运动，肘关节被动运动。健侧肢体及躯干主动运动	第一、二阶段每次训练完患肩冰敷15 min，每4~6小时1次。疼痛剧烈时口服小剂量非甾体类消炎药	此阶段开始至训练结束，训练前患肩热敷10~15 min，手法按摩放松肩部各肌群，训练完患肩冰敷15 min，每天1~2次	进行患肩本体感觉和协调性训练。站立位各个方向抛接球，弹力带斜拉稳定性训练

表1

表2

图10

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时间	前屈(°)	后伸(°)	内收(°)	外展(°)	外旋(°)	内旋	肌力(级)	VAS	改良Rowe评分
术前(AROM)	0~60	0~15	0~20	0~30	-10~0	腰骶部	NS	6	16
术后2个月(PROM)	0~90	0~10	-	0~80	0~15	股骨粗隆下	2	4	51
术后4个月(AROM)	0~110	0~30	0~20	0~100	0~40	骶尾部	4	0	71
术后6个月(AROM)	0~180	0~50	0~45	0~180	0~90	L₃水平	5	0	91
术后10个月(AROM)	0~180	0~50	0~45	0~180	0~90	L₁水平	5	0	93

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肩关节后脱位并发反Hill-Sacks损伤术后居家康复训练个案分析

Effect of Home-based Rehabilitation Training on Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion: A Case Report

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