肩峰下夾擠症候群病患之肩胛運動學與機能損傷特性:預測接受物理治療之成效

Abstract

肩峰下夾擠症候群在活動量大的族群有很高的發生率，並且常伴隨疼痛與肩關節功能損失。患者對接受物理治療並不是都有好的療效，治療的策略可能因病患不同而有所差異。因此鑑別哪些肩峰下夾擠症候群病患適合作物理治療，以及了解哪些肩胛運動學與機能損傷特性的改變與降低疼痛和功能進步有相關是很重要的。本實驗目的有二 : (一) 找出哪些肩胛運動學與機能損傷的特性，與肩峰下夾擠症候群病患接受物理治療有成效有關係。本實驗將利用修改後的臨床預測規則來檢視，是否肩胛運動學與機能損傷的特性和肩峰下夾擠症候群病患接受物理治療成效有關係。(二) 看哪些肩胛運動學與機能損傷特性，在治療前後的改變與物理治療成功有相關，來解釋物理治療的機制。本實驗徵招33位肩峰下夾擠症候群病患，治療前接受三維肩胛運動學、機能損傷(包括關節活動度、肌力與自述式肩關節功能評估)。所有個案均接受六周每周兩次標準物理治療，完成治療後再作與治療前相同的評估。病患進步與否使用綜合評估改變量表(global rating of change scale)。肩胛運動學與機能損傷參數先使用獨立t 檢定找出預測影響進步因素，在合併於多變量預測模式。結果三個預測進步參數為:肩功能評估量表分數(FLEX-SF score)小於41分，前距肌肌力小於27.4%體重，和手臂未拿重物情況下，肩外展30度時肩胛內轉角度小於0.7度。而若前距肌肌力進步6.16%體重以及肩功能評估量表分數增加兩分，是決定病患進步的重要指標。總結來說，肩胛運動學和機能損傷特性可以預測肩峰下夾擠症候群接受物理治療的成效。此預測方法的驗證仍有待未來進一步研究。

Subacromial impingement syndrome (SAIS) associated with pain and a loss of function has a high occurrence in the physically active population. Not all patients responded positively to physical therapy. The purposes of the study were 2-folds: (1) to identify the shoulder kinematic and impairment of the patients who are more likely to response to physical therapy. Specifically, this study used a prediction method modified from a clinical prediction rule to establish the method of outcome prediction after physical therapy in patients with SAIS. (2) To determine which changes of impairments pre and post treatment among patients are related to the successful outcome for SAIS. Thirty-three subjects presenting SAIS were studied to determine altered shoulder kinematics and impairments. Three measurements were collected: (1) three-dimensional scapular kinematics during performing functional tasks; (2) impairment measurements of range of motion and muscle force; and (3) self-reported measurements of pain, satisfaction, and function. All patients received 6 weeks (2 times per week) physical therapy. After intervention, all the measurements will be collected again. Improvement with treatment was determined using the Global Rating of Change Scale. Scapular kinematics and impairment measurements were first identified by t-test in predicting improvement and then combined into a multivariate prediction method. A prediction method with three variables (FLEX-SF score < 41, muscle power of serratus anterior < 27.4% body weight, degree of scapular internal rotation at 30° shoulder flexion during lowing arm phase in unloading condition < 0.7°) were identified. For determinating improvement, serratus anterior increased 6.16% body weight, and FLEX-SF improved 2 points were more valuable. It appears that scapular kinematics and impairment features may predict improvement in subjects with SAIS. Prospective validation of the proposed prediction method is needed to further investigated.