脊髓損傷截癱使用輪椅者的肩關節超音波檢查

脊髓損傷截癱輪椅族的肩部因長期使用，易受傷害而出現疼痛現象，過去研究多使用關節攝影或磁振造影等進行影像檢查，本研究使用超音波影像檢查長期使用輪椅的脊髓損傷病人之肩關節旋轉肌腱，比較出現異常影像表現之比例，並探討肩關節超音波結果異常表現與患者肩痛症狀、年齡、每日使用輪椅時間、和截癱期間的相關性。 30位脊髓損傷長期使用輪椅者接受兩側肩關節超音波檢查，在60個肩關節中，發生旋轉肌腱斷裂或肌腱病變變化共計20個肩關節(33.3%)。其平均年齡、平均截癱期間及肩痛症狀比例在肩關節超音波檢查正常組分別爲39.3±11.1歲、13.1±7.5年及27%，異常組則爲46.3±9.4歲、19.2±7.1年及65%，此三方面在二組間統計上均有明顯差別（P值分別爲0.02，0.004，0.005），而性別及每日使用輪椅時間在兩組間並無差別。以多變項邏輯迴歸模式來分析年紀、肩痛症狀和截癱期間和肩關節超音波異常間之關係，顯示肩痛症狀和截癱期間爲肩關節超音波異常的獨立預測因子，有肩痛症狀爲無肩痛症狀的肩關節的勝算比爲4.1倍（95%信賴區間爲1.20-13.67），截癱期間每增加1年其勝算比爲1.1倍（95%信賴區間爲1.02-1.19）。本研究以超音波檢查脊髓損傷長期使用輪椅者之肩關節，發現肩部疼痛症狀與超音波檢查發生異常變化間有顯著相關性，並且隨著截癱期間增加，超音波檢查結果出現異常變化機會增加。臨床上使用超音波檢測肩關節，並注意肩痛症狀的發生，對肩部疾患可早期發現及早治療。

關鍵字

肩關節；截癱；輪椅；超音波

並列摘要

Due to the prolonged use of upper extremities for weight-bearing, the shoulder joints of paraplegic wheelchair-users are prone to injury. Once shoulder pain occurs, performance of activities required for daily living would thus be disturbed. In past studies, the shoulders of the spinal cord injured patients were evaluated with arthrography or magnetic resonance images and the rotator cuff injuries were found. In the current study, we used ultrasonography to detect rotator cuff injuries of paraplegic wheelchair-users. The factors associated with ultrasonographic findings were also investigated. Thirty paraplegic wheelchair-users, 26 males and 4 females, were recruited for this study. Both shoulder joints of each subject were investigated with ultrasonography. Twenty shoulders (33.3%) had abnormal ultrasonographic findings (i.e., rotator cuff tears or tendinosis). Between the two groups of patients with normal and abnormal ultrasonographic findings, there was a significant difference in the age, duration of wheelchair-dependence, and shoulder pain history. No significant difference existed between the two groups with respect to gender and the time of daily wheelchair-use. On multivariate logistic regression analysis, a history of shoulder pain and the duration of wheelchair-dependence remained independent predictors of abnormal ultrasonographic findings (odds ratio, 4.1 and 1.1, respectively). We conclude that there is a significant relationship between a history of shoulder pain and abnormal ultrasonographic findings of shoulder joints in paraplegic wheelchair-users. The longer the duration of wheelchair dependence, the more abnormal are the findings of ultrasonography. Ultrasonography is a non-invasive, easy-to-use and accurate method to evaluate soft tissues. We easily used ultrasonography to evaluate shoulder tendinopathy for paraplegic wheelchair-users.

並列關鍵字

shoulder joint ； paraplegia ； wheelchair ； ultrasonography

國際替代計量

脊髓損傷截癱使用輪椅者的肩關節超音波檢查

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