便携式肌力测试仪在评估脊髓损伤患者肩袖肌力量中的信度研究①

冯亚男，张志杰，刘春龙

便携式肌力测试仪在评估脊髓损伤患者肩袖肌力量中的信度研究①

冯亚男1，张志杰1，刘春龙2

目的测试便携式肌力测试仪评估脊髓损伤患者肩袖肌群力量中的信度。方法测试者A和测试者B应用便携式肌力测试仪分别评估20例脊髓损伤患者肩袖肌群力量，其中测试者A在5 d后重复测试一次。结果应用便携式肌力测试仪评估脊髓损伤患者肩袖肌群力量(肩关节内、外旋力量)，同一测试者重复性测量信度为0.94和0.95，不同测试者间测量信度为0.91和0.93。结论便携式肌力测试仪可以客观、准确地测量脊髓损伤患者肩袖肌群力量。

便携式肌力测试仪；肩袖肌群；信度

[本文著录格式]冯亚男，张志杰，刘春龙.便携式肌力测试仪在评估脊髓损伤患者肩袖肌力量中的信度研究[J].中国康复理论与实践,2015,21(4):457-459.

CITED AS:Feng YN,Zhang ZJ,Liu CL.Reliability of a hand-held dynamometer on strength of shoulder rotator cuff among subjects with spinal cord injury[J].Zhongguo Kangfu Lilun Yu Shijian,2015,21(4):457-459.

肩关节疼痛是困扰脊髓损伤(spinal cord injury, SCI)患者最常见的病痛之一，其发病率高达73%[1-2]，尤其对于长期使用轮椅的脊髓损伤患者。由于他们长期用双上肢转移、驱动轮椅以及上举等动作，容易导致肩关节疼痛[3]，从而影响脊髓损伤患者生活质量[4]。但是脊髓损伤肩关节疼痛原因仍未完全清楚。研究表明，肩袖肌力量不足和不平衡是导致肩关节疼痛的原因之一[5-6]。因此，准确评估脊髓损伤肩袖肌力量有助于预防和治疗肩关节疼痛。

1 资料与方法

1.1 临床资料

从本院康复的脊髓损伤患者中筛选胸段脊髓损伤患者20例，经X线/CT确诊，均为椎管减压和内固定术后。其中男性10例，女性10例；年龄22～38岁，平均22.3岁；病程6～110个月，中位数37.5个月；损伤原因：高空坠落4例，车祸8例，重物砸伤6例，其他2例；完全型损伤12例(T32例，T46例，T63例，T71例)，不完全性损伤8例(T31例，T43例，T51例，T62

例，T71例)。

纳入标准：①肩、肘关节周围无疼痛；②肩、肘关节无任何骨折和手术；③以下实验均无疼痛：Neer测试阳性/Hawkins测试阳性/Jobe测试阳性/肩关节外展和内旋时疼痛/肩关节外展等长收缩时疼痛。

排除标准：①合并有脑损伤导致严重意识障碍；②肩关节周围疼痛；③肩关节有手术史；④肩关节骨折史；⑤肩关节脱位史；⑥其他严重并发症；⑦不愿意参与。

1.2 评定方法

应用便携式肌力测试仪器(Hand-held Dynamometer,Lafayette,美国)测量肩关节周围内、外旋肌肉力量，测量范围：0～199 kg。

测试步骤：①为患者解释研究的目的和过程；②患者坐于测试治疗床(有靠背)，躯干固定于靠背上，保持直立，双脚置于踏板上；③在测试过程中肩关节保持中立位，上臂紧贴侧胸壁(胸壁与上臂夹一条毛巾)，肘关节屈曲90°；④测试前首先将测试仪调“0”；⑤测试者将仪器置于受试者前臂远端掌面，让其尽最大力且保持5 s来测试肩关节内旋肌肉力量，测试3次，每组间休息30 s；⑥测试者将仪器置于受试者前臂远端背面，让其尽最大力且保持5 s来测试肩关节外旋肌肉力量，测试3次，每组间休息30 s。

测试两侧肩关节内、外旋力量，并取3次测量结果的平均值。

测试者A按以上方法测量肩关节力量，让患者休息10 min后，测试者B应用同样的方法评估患者肩关节力量，5 d后测试者A再应用同样的方法测量患者肩关节内、外旋力量。

1.3 统计学分析

应用SPSS 13.0统计软件对所得数据进行统计分析，应用等级相关系数(interclass correlation coefficient,ICC)作为重测信度指标，分别对肩关节内、外旋肌肉力量接进行分析。重复性测试信度等级划分：ICC＜0.55为差；0.55＜ICC＜0.75为中等；0.75＜ICC＜0.90为好；ICC＞0.90为优秀。

2 结果

应用便携式肌力测试仪测量脊髓损伤患者肩关节内、外旋肌群力量，同一测试者重复性测量信度分别为0.94和0.95，不同测试者重复性测试信度分别为0.91和0.93。见表1～表2。

表1 同一测试者重复性信度测试结果(kg)

表2 不测试者重复性信度测试结果(kg)

3 讨论

肩袖肌群主要包括：肩胛下肌、岗上肌、岗下肌和小圆肌。肩袖肌肌群力量不足和不平衡是导致肩关节疼痛的原因之一[3,5]。由于脊髓损伤患者长期依靠双上肢完成日常生活活动例如推轮椅、转移、臀部减压等肩关节负重动作，同时坐在轮椅上生活工作常需要做上肢高举过肩的动作，易导致肩关节周围软组织过度劳损产生疼痛。

有文献报道应用等速肌力测试仪器评估肩关节内、外旋肌群[7-8]，但是等速测试仪器有些不足之处，如价格昂贵、操作不方便等。

前期研究应用便携式肌肉力量测试仪评估运动员髋关节力量[9-11]、慢性阻塞性肺气肿肌肉力量[12-13]和脑瘫儿童膝关节力量[14-16]等。此外，有学者应用便携式肌力测试仪评估肩袖肌群力量，但是仍未见报道应用便携式肌力测试仪评估脊髓损伤患者肩袖肌群力量的研究。

Hayes等应用便携式肌力测试仪对8名健康者评估肩袖肌群力量，结果显示，同一测试者肩关节内、外旋肌肉力量重复性信度系数分别为0.85与0.92；不同测试者肩关节内、外旋肌肉力量重复性信度系数分别为0.85和0.82[17]。Cadogan等应用便携式肌力测试仪对40例肩关节疼痛患者肩袖肌肌群力量进行评估，结果表明，同一测试者肩关节内、外旋力量重复性测试系数分别为0.98和0.99，不同测试者重复性测试系数未报道[18]。Kolber等应用便携式肌力测试仪评估30名健康自愿者肩袖肌肌群力量，结果显示，同一测试者评估肩关节内、外旋肌肉力量重复性测试系数为0.97和0.97[19]。Cools等应用便携式力量测试仪评估30名健康自愿者肩关节内、外旋肌群力量，结果显示，其信度系数为0.85和0.99[20]。

本研究应用便携式肌力测试仪评估脊髓损伤患者肩关节内、外旋肌群力量，重测信度为0.94和0.95，测试者间信度为0.91和0.93。此结果与其他研究者结

果相近。

此外，众多学者应用等速力量测试仪评估肩关节内、外旋力量。丛卉等应用等速肌力测试仪评估不同体位肩关节旋转肌群等速肌力评定的重测信度研究，结果显示，坐位与仰卧位进行肩关节旋转肌群等速肌力评定均具有良好的重测信度，其中仰卧位测试的信度比坐位更佳[21]。

Forthomme等研究不同体位对测量肩关节周围力量的影响，结果显示，仰卧位伴肩关节外展90°进行等速肌力评定肩关节内、外旋力量信度系数最佳[22]。Leong等应用等速肌力测试仪评估排球运动员肩关节肌肉力量，此外应用超声测量肩峰-大结节距离，结果显示，肩关节周围力量与肩峰-大结节距离成正比[23]。Alta等应用等速测量肩关节成形术后患者的肌肉力量，结果显示，等速可以准确评估肩关节成形术后的肌肉力量[24]。Andrade等应用等速肌力测试仪评估女子手球运动员肩关节内、外旋肌群离心和向心收缩，结果表明，功能性训练可以增加肩袖肌离心力量，并且可以预防肩关节损伤[25]。

等速肌力测试仪仍有不足之处，如价格昂贵、操作复杂和不宜携带等。研究表明，应用等速测量肌力结果与便携式肌力测试仪测量结果相关性高，且有可比性[26]。

本研究应用便携式肌力测试仪测量脊髓损伤患者肩袖肌力量时，同一测试者和不同测试者重复性测试信度良好至优秀，可以客观、准确地测量脊髓损伤患者肩袖肌群力量，有助于制定康复治疗方案，评估康复进展情况。

[1]Pentland WE,Twomey LT.The weight-bearing upper extremity in women with long term paraplegia[J].Paraplegia,1991,29(8):521-530.

[2]Eriks-Hoogland IE,Hoekstra T,de Groot S,et al.Trajectories of musculoskeletal shoulder pain after spinal cord injury:Identification and predictors[J].J Spinal Cord Med,2014,37(3):288-298.

[3]Samuelsson K,Tropp H,Gerdle B.Shoulder pain and its consequences in paraplegic spinal cord injured wheelchair users[J].Spinal Cord, 2004,42(2):41-46.

[4]Kemp BJ,Bateham AL,Mulroy SJ,et al.Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia:a randomized control trial[J].J Spinal Cord Med,2011,34(3):278-284.

[5]Burnham RS,May L,Nelson E,et al.Shoulder pain in wheelchair athletes.The role of muscle imbalance[J].Am J Sports Med,1993,21(2): 238-242.

[6]Dehail P,Gagnon D,Noreau L,et al.Assessment of agonist-antagonist shoulder torque ratios in individuals with paraplegia:a new interpretative approach[J].Spinal Cord,2008,46(8):552-558.

[7]Edouard P,Codine P,Samozino P,et al.Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer[J].J Sci Med Sport,2013,16(2):162-165.

[8]Forthomme B,Dvir Z,Crielaard JM,et al.Isokinetic assessment of the shoulder rotators:a study of optimal test position[J].ClinPhysiolFunct Imaging,2011,31(3):227-232.

[9]Bolgla LA,Malone TR,Umberger BR,et al.Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome[J].Int J Sports PhysTher,2011,6(4): 285-296.

[10]Ieiri A,Tushima E,Ishida K,et al.Reliability of measurements of hip abduction strength obtained with a hand-held dynamometer[J].Physiother Theory Pract,2015,31(2):146-152.

[11]Bloom N,Cornbleet SL.Hip rotator strength in healthy young adults measured in hip flexion and extension by using a hand-held dynamometer[J].PM R,2014,6(12):1137-1142.

[12]O'Shea SD,Taylor NF,Paratz JD.Measuring muscle strength for people with chronic obstructive pulmonary disease:retest reliability of hand-held dynamometry[J].Arch Phys Med Rehabil,2007,88(1): 32-36.

[13]Robles PG,Mathur S,Janaudis-Fereira T,et al.Measurement of peripheral muscle strength in individuals with chronic obstructive pulmonary disease:a systematic review[J].J Sports Sci,2010,28(7):743-749.

[14]Williams SA,Reid S,Elliott C,et al.Muscle volume alterations in spastic muscles immediately following Botulinum toxin type-A treatment in children with cerebral palsy[J].Dev Med Child Neurol,2013, 55(9):813-820.

[15]Dallmeijer AJ,Baker R,Dodd KJ,et al.Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy[J].Gait Posture,2011,33(3):326-332.

[16]Stockton KA,Wrigley TV,Mengersen KA.Test-retest reliability of hand-held dynamometry and functional tests in systemic lupus erythematosus[J].Lupus,2011,20(2):144-150.

[17]Hayes K,Walton JR,Szomor ZL,et al.Reliability of 3 methods for assessing shoulder strength[J].J Shoulder Elbow Surg,2002,11(1):33-39.

[18]Cadogan A,Laslett M,Hing W,et al.Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength[J]. Man Ther,2011,16(1):97-101.

[19]Kolber MJ,Beekhuizen K,Cheng MS,et al.The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device[J].Physiother Theory Pract,2007,23(2):119-124.

[20]Cools AM,De Wilde L,Van Tongel A,et al.Measuring shoulder external and internal rotation strength and range of motion:comprehensive intra-rater and inter-rater reliability study of several testing protocols[J].J Shoulder Elbow Surg,2014,23(10):1454-1461.

[21]丛卉,周谋望,杨延砚,等.不同体位肩关节旋转肌群等速肌力评定的重测信度研究[J].中国康复医学杂志,2014,29(1):36-41.

[22]Forthomme B,Dvir Z,Crielaard JM,et al.Isokinetic assessment of the shoulder rotators:a study of optimal testposition[J].ClinPhysiol-Funct Imaging,2011,31(3):227-232.

[23]Leong HT,Tsui S,Ying M,et al.Ultrasound measurements on acromio-humeral distance and supraspinatus tendon thickness:test-retest reliability and correlations with shoulder rotational strengths[J].J Sci Med Sport,2012,15(4):284-291.

[24]Alta TD,Veeger DH,de Toledo JM,et al.Isokinetic strength differences between patients with primary reverse and total shoulder prostheses: muscle strength quantified with a dynamometer[J].ClinBiomech(Bristol,Avon),2014,29(9):965-970.

[25]Andrade Mdos S,Fleury AM,de Lira CA,et al.Profile of isokinetic eccentric-to-concentric strength ratios of shoulder rotator muscles in elite female team handball players[J].J Sports Sci,2010,28(7): 743-749.

[26]Stark T,Walker B,Phillips JK,et al.Strength field tests performance are correlated with hand-held dynamometry correlation with the gold standard isokinetic dynamometry:a systematic review[J].PM R,2011, 3(5):472-479.

Reliability of a Hand-Held Dynamometer on Strength of Shoulder Rotator Cuff among Subjects with Spinal Cord Injury

FENG Ya-nan,ZHANG Zhi-jie,LIU Chun-long
1.Guangdong Provincial Work Injury Rehabilitation Center,Guangzhou,Guangdong 510440,China;2.Clinical Medical College of Acupuncture,Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China

Objective To assess the reliability of strength of shoulder rotator cuff using a hand-held dynamometer among subjects with spinal cord injury.Methods 20 spinal cord injury subjects without shoulder pain participated in this study.A hand-held dynamometer was used to assess the strength of shoulder rotator cuff.Two therapists(A/B)obtained the strength of shoulder rotator cuff.One of the therapists assessed again 5days later.The intra-and inter-reliability(ICC)of strength of shoulder rotator was calculated.Results The strength of rotator cuff was assessed by the hand-held dynamometer.The intra-reliability of external and internal muscle strength was 0.94 and 0.95,respectively.The inter-reliability was 0.91 and 0.93,respectively.Conclusion A hand-held dynamometer is a feasible and reliable tool to assess the strength of rotator cuff among subjects with spinal cord injury.

hand-held dynamometer;shoulder rotator cuff strength;reliability

10.3969/j.issn.1006-9771.2015.04.020

R651.2

A

1006-9771(2015)04-0457-03

2014-09-18

2014-10-14)

1.广东省工伤康复中心作业疗法科，广东广州市510440；2.广州中医药大学针灸康复临床医学院，广东广州市510405。作者简介：冯亚男(1982-)，女，汉族，广东广州市人，本科，主管治疗师，主要研究方向：骨关节运动损伤的康复治疗。通讯作者：刘春龙(1980-)，男，副教授，硕士生导师，主要研究方向：运动损伤康复研究。E-mail:polonmpt@163.com。