闭链运动训练对脑卒中偏瘫肩痛和肩关节稳定性的效果：基于超声的评定

doi:10.3969/j.issn.1006-9771.2025.03.003

Abstract

Abstract:

Objective To investigate the effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint stability in stroke patients, and to explore the relationship between hemiplegic shoulder pain and shoulder joint stability.

Methods A total of 52 stroke patients with hemiplegic shoulder pain in Jiangsu Province Hospital from October, 2020 to January, 2023 were selected, and were randomly divided into control group (n = 26) and experimental group (n = 26). Both groups received conventional rehabilitation therapy, while the experimental group additionally underwent closed-chain exercise training for shoulder joint. Pain severity and motor function were assessed using Visual Analog Scale (VAS) and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) before and after intervention. Musculoskeletal ultrasound was used to measure acromion-greater tuberosity distance (AGT), acromion-lesser tuberosity distance (ALT), acromiohumeral distance (AHD) and supraspinatus thickness (SST) to evaluate shoulder joint stability. Correlation analysis was conducted on the improvements in shoulder pain and shoulder joint stability in the experimental group.

Results Two cases in the control group and two in the experimental group dropped down. Both groups showed significant improvements in VAS and FMA-UE scores after intervention (|t| > 5.214, P < 0.001), and the scores improved more in the experimental group than in the control group (|t| > 2.087, P < 0.05). The experimental group also showed significant improvements in AGT, ALT, AHD and SST (|t| > 4.187, P < 0.001), with AGT, ALT and AHD being superior to those in the control group (|t| > 2.155, P < 0.05). The difference of VAS score in the experimental group was correlated with the difference of FMA-UE, AGT and ALT after intervention (r > 0.434, P < 0.05).

Conclusion Closed-chain shoulder exercise training can significantly improve shoulder joint stability while alleviating shoulder pain, and effectively enhancing upper limb function in stroke patients with hemiplegic shoulder pain. Hemiplegic shoulder pain is correlated with shoulder joint stability.

Key words: stroke, hemiplegic shoulder pain, closed-chain exercise, shoulder joint stability

CLC Number:

R743.3

LIN Changsheng, CAO Yu, WANG Tong, DAI Wenjun, HOU Hong, HU Cuiqin, BAO Shilei, PANG Sufang. Effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint stability in stroke patients: a study with ultrasound[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 264-273.

Figures/Tables 7

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References 53

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组别	n	性别(男/女)/n	年龄/岁	病程/周	卒中类型(梗死/出血)/n	偏瘫侧(左/右)/n
对照组	24	12/12	59.6±6.6	6.7±5.5	16/8	12/12
试验组	24	13/11	58.0±10.8	7.6±6.7	13/11	11/13
χ²/t值		0.083	0.647	-0.520	0.784	0.083
P值		0.773	0.522	0.606	0.376	0.773

变量	组别	n	测试	$\bar{x}±s$	t值	P值
VAS	对照组	24	前测	2.92±1.47	5.214	< 0.001
			后测	2.38±1.28
	试验组	24	前测	3.29±1.68	9.218	< 0.001
			后测	1.58±1.10
	治疗前两组均值差			-0.38±0.46	-0.822	0.415
	治疗后两组均值差			0.79±0.34	2.299	0.026
FMA-UE	对照组	24	前测	15.29±11.85	-5.599	< 0.001
			后测	19.88±12.50
	试验组	24	前测	16.00±12.13	-5.333	< 0.001
			后测	27.33±12.27
	治疗前两组均值差			-0.71±3.46	-0.205	0.839
	治疗后两组均值差			-7.46±3.57	-2.087	0.042

变量	组别	n	测试	$\bar{x}±s$	t值	P值
AGT	对照组	24	前测	3.00±0.52	5.662	< 0.001
			后测	2.89±0.50
	试验组	24	前测	2.83±0.39	5.521	< 0.001
			后测	2.58±0.36
	治疗前两组均值差			0.17±0.13	1.277	0.208
	治疗后两组均值差			0.32±0.13	2.533	0.015
ALT	对照组	24	前测	2.97±0.39	3.475	0.002
			后测	2.88±0.35
	试验组	24	前测	2.96±0.31	6.019	< 0.001
			后测	2.66±0.31
	治疗前两组均值差			0.12±0.10	0.120	0.905
	治疗后两组均值差			0.22±0.10	2.316	0.025
AHD	对照组	24	前测	3.22±0.58	2.850	0.009
			后测	3.12±0.58
	试验组	24	前测	3.18±0.45	4.187	< 0.001
			后测	2.82±0.37
	治疗前两组均值差			0.04±0.15	0.272	0.787
	治疗后两组均值差			0.30±0.14	2.155	0.037
SST	对照组	24	前测	1.95±0.15	-1.827	0.081
			后测	1.98±0.16
	试验组	24	前测	1.95±0.17	-5.432	< 0.001
			后测	2.04±0.17
	治疗前两组均值差			0.00±0.05	0.055	0.956
	治疗后两组均值差			-0.06±0.05	-1.266	0.212

Effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint stability in stroke patients: a study with ultrasound

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