Braus D F, Krauss J K, Strobel J
Department of Neuropathology, Albert-Ludwigs University, Freiburg, Germany.
Ann Neurol. 1994 Nov;36(5):728-33. doi: 10.1002/ana.410360507.
Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.
在一项前瞻性研究中，132例偏瘫患者中有36例（27%）发生了肩手综合征。半脱位、肩胛带肌无力、中度痉挛以及对侧视野测试缺陷是主要危险因素。在一项安慰剂对照、非盲试验中，36例患者中有31例在接受低剂量口服皮质类固醇治疗10天内几乎症状消失。对7例患者尸检时获取的肩关节囊显示患侧肩部有既往创伤迹象。在本研究的第二部分，对另外86例患者而言，对肩关节结构潜在损伤的早期认知使肩手综合征的发生率从27%降至8%。这些临床发现提示偏瘫患者的肩手综合征由周围性病变引发。可能会形成一个自我持续的恶性循环，随后出现“反射性交感神经营养不良”的临床表现。在大多数卒中患者中，这种临床现象似乎可通过避免肩部创伤来预防。
