Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany.
J Bone Joint Surg Am. 2010 Jan;92(1):23-30. doi: 10.2106/JBJS.H.01373.
Musculoskeletal injuries of the shoulder in paraplegic patients with long-term survival can result from overuse and/or inappropriate use of wheelchairs. The purpose of the present study was to evaluate the prevalence and risk of pathological changes in the weight-bearing shoulder girdle of paraplegic patients who have been wheelchair-dependent for more than thirty years in comparison with able-bodied volunteers.
One hundred paraplegic patients were matched for sex and age with a group of 100 able-bodied volunteers. Two hundred shoulders from each group were evaluated with use of magnetic resonance imaging. Collected outcome measures included a standardized clinical examination protocol, the Constant score, and a visual analog score for pain intensity.
Shoulder function according to the Constant score was significantly worse in the paraplegic patients than in the able-bodied volunteers. Similarly, the visual analog scale pain scores were significantly worse for the paraplegic patients. Magnetic resonance imaging showed that the prevalence of rotator cuff tears in either shoulder was significantly higher in the paraplegic patients than in the able-bodied volunteers (63% compared with 15%), resulting in a tenfold higher risk of rotator cuff rupture among paraplegic patients.
The present study demonstrates that the structural and functional changes of the shoulder joint are more severe and the risk of development of shoulder girdle damage is significantly higher in individuals with long-term paraplegia than in age-matched controls.
长期生存的截瘫患者由于过度使用和/或使用轮椅不当，可能导致肩部肌肉骨骼损伤。本研究的目的是评估长期依赖轮椅的截瘫患者与身体健全的志愿者相比，其承重肩带出现病理性变化的发生率和风险。
将 100 名截瘫患者按性别和年龄与 100 名身体健全的志愿者相匹配。对每组 200 个肩膀进行磁共振成像评估。收集的结果测量包括标准化临床检查方案、Constant 评分和疼痛强度的视觉模拟评分。
根据 Constant 评分，截瘫患者的肩部功能明显差于身体健全的志愿者。同样，截瘫患者的视觉模拟评分疼痛得分也明显更高。磁共振成像显示，截瘫患者中任何一侧肩袖撕裂的发生率明显高于身体健全的志愿者（63%比 15%），导致截瘫患者肩袖破裂的风险增加十倍。
本研究表明，长期截瘫患者的肩关节结构和功能变化更严重，肩带损伤的发展风险明显高于年龄匹配的对照组。
