神經肌肉電刺激於旋轉肌全層破裂患者之肱骨內收肌對肩峰下空間與肩胛骨運動學之效果

The Effects of Neuromuscular Electrical Stimulation on Humeral Adductors for Acromiohumeral Distance and Scapular Kinematics in Patients with Full-Thickness Rotator Cuff Tear

張哲源(Che-Yuan Chang)

指導教授 ： 林居正

國立臺灣大學/醫學院/物理治療學研究所/碩士(2022年)

https://doi.org/10.6342/NTU202200695

摘要

研究背景：無症狀個案相對肩峰下疼痛患者，於大圓肌表現出較高共同收縮性（即較低活性比），於胸大肌則表現出較低共同收縮性（即較高活性比）模式。神經肌肉電刺激於不同內收肌對旋轉肌全層破裂(Full-thickness rotator cuff tear, FT-RCT)患者肩胛運動學與肩峰下空間的效益，目前尚不清楚。實驗目的：本次實驗目的包含（1）探討電刺激於旋轉肌全層破裂患者之大圓肌及胸大肌，相對無電刺激下在休息角度下、60度、90度肩主動外展之肩峰下空間與在肩胛平面下手臂上抬時肩胛動作的差異。（2）量測電刺激對相關內收肌共同收縮活性比的立即效應。實驗設計：本實驗招募30位診斷為旋轉肌全層破裂的患者，個別於無電刺激、大圓肌與胸大肌電刺激下記錄主要量測項目。實驗使用超音波影像測量主動肩外展之肩峰下空間以及使用三維電磁動作分析儀紀錄在肩胛平面下手臂上抬時之肩胛動作，並於60%最大等長內收與外展力量下量測大圓肌與胸大肌於電刺激前後之共同收縮比。實驗結果: 在三個肩膀位置下，神經肌肉電刺激於大圓肌相對無電刺激對肩峰下空間顯著增加(休息姿勢下改變值＝0.43 mm, p<0.001; 60度外展姿勢下改變值＝0.88 mm, p<0.001; 90度外展姿勢下改變值＝0.87 mm, p<0.001)。在肩休息位置下，電刺激於胸大肌相對無電刺激對肩峰下空間顯著降低(改變值＝0.78 mm, p<0.001)。此外，電刺激於大圓肌相對電刺激於胸大肌（60度、90度上抬p < 0.001；90度下降p <0.001；60度下降p = 0.001)與無電刺激狀態（60度上抬p = 0.007；90度上抬p = 0.001；90度下降p < 0.001；60度下降p = 0.012）在手臂抬高60度、90度位置對肩胛骨上轉顯著增加。電刺激於胸大肌相對電刺激於大圓肌在手臂上抬期間顯著降低肩胛骨外轉(p = 0.003)。電刺激前後大圓肌的共同收縮活性均顯著低於胸大肌的共同收縮活性比(p <0.05)。實驗結論：在手臂抬高期間，電刺激於大圓肌相對於無電刺激狀態顯著增加肩胛骨上轉與相關之肩峰下空間，尤其是手臂上抬60度及90度的位置。有無電刺激在胸大肌上對肩峰下空間並無明顯改變，且電刺激於胸大肌將相對降低肩胛上轉與外轉，此機轉與肩夾擠有關。旋轉肌全層破裂患者偏向於使用大圓肌進行共同收縮，儘管活性比並沒有在神經肌肉電刺激後被改變。

關鍵字

肩旋轉肌全層破裂 ； 肱骨內收肌 ； 肩峰下空間 ； 神經肌肉電刺激 ； 肩胛動作

並列摘要

Background: Asymptomatic subjects present higher and lower co-contraction in teres major (TM) and pectoralis major (PM) compared to patients with subacromial pain syndrome, respectively. The effects of neuromuscular electrical stimulation (NMES) on adductors for the acromiohumeral distance (AHD) and scapular kinematics in patients with symptomatic full-thickness rotator cuff tear (FT-RCT) are unclear. Objective: The objectives in this study were to (1) determine the effects of NMES on TM or PM for AHD at shoulder resting position, 60°, 90° abduction, and scapular kinematics during arm elevation in patients with FT-RCT; (2) evaluate the immediate effect of NMES on the AR of the associated adductors. Design: Thirty subjects diagnosed with FT-RCT were recruited and recorded the primary outcomes before stimulation, during NMES on TM and PM. We measured the AHD at active shoulder abduction under ultrasonography and scapular kinematics during arm elevation by three-dimensional electromagnetic motion analyses. The TM and PM activation ratio were calculated on pre- and post- NMES immediately at the 60% maximum isometric abducted and adducted force. Results: In three shoulder positions, the AHD were significant increased during NMES on TM compared to control (resting position = 0.43 mm, p < 0.001; 60°abduction = 0.88 mm, p < 0.001; 90°abduction = 0.87 mm, p < 0.001). In resting position, the AHD was significantly decreased during NMES on PM compared to control (difference = 0.78 mm, p < 0.001). Besides, the scapular UR were greater during NMES on TM compared with NMES on PM (elevation 60° and 90°, p < 0.001; lowering 90° and 60°, p < 0.01) and control (elevation 60° and 90°, p < 0.05; lowering 90° and 60°, p < 0.01). Scapular ER significantly decreased during NMES on PM than that with NMES on TM during humeral elevation (p = 0.003). Despite NMES or not, ARs of TM were significantly higher than those of PM (p < 0.05). Conclusions: NMES on TM relatively increased the scapular UR and related to AHD compared with control, especially at 60° and 90° of humeral elevation. However, there was no detectable changes in AHD during NMES on PM compared to control at 60° and 90° of arm elevation. Additionally, the decreased scapular UR and ER during arm elevation with NMES on PM is associated with possible subacromial impingement. Co-contraction of TM plays an important role for patients with FT-RCT, even though activation ratio remains similar after NMES.

並列關鍵字

full-thickness rotator cuff tear ； humerus adductors ； acromiohumeral distance ； neuromuscular electrical stimulation ； scapular kinematics

參考文獻

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