超声定位在体外冲击波疗法治疗肩部疾患的价值

Extracorporeal shock wave therapy for soft tissue disorders of the shoulder with ultrasonic orientation

目的探讨彩色超声定位在体外冲击波疗法(extracorporealshockwave therapy,ESWT)治疗肩部疾患的应用价值,比较超声定位及痛点定位ESWT的疗效差异。方法151例肩部疾患患者,病程均在3个月以上,且症状及体征较重。其中肩峰下滑囊炎65例,肱二头肌长头腱鞘炎86例,均行ESWT治疗。超声定位法采用彩色多普勒诊断仪探测确定冲击点,痛点定位法以触痛点结合解剖结构体表定位确定冲击点。65例肩峰下滑囊炎患者,采用超声定位25例,痛点定位40例;86例肱二头肌长头腱鞘炎患者,采用超声定位31例,痛点定位55例。采用0.12～0.16mJ/mm治疗能量,以超声及痛点定2位点为冲击点,每次治疗选1～2个冲击点,每个冲击点冲击800～1000次,一般做2～5次治疗,每次治疗间隔5d。对应用超声定位ESWT与痛点定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的疗效进行比较。结果随访6个月,超声定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的优良率分别为89.6%、92.3%;痛点定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的优良率分别为67.6%、73.6%。超声定位ESWT的优良率均高于痛点定位ESWT,两者比较差异有统计学意义。结论超声定位可通过观察肩部疾患的声像图特征,准确定位,提高ESWT治疗肩部疾患的疗效。

Objective In order to reveal the effect of extracorporeal shock wave therapy (ESWT) with ultrasonic orientation for soft tissue disorders of the shoulder. Methods 151 cases of severe disorders of the shoulder were treated with ESWT. The course of disorders was longer than 3 months. Among them, 65 cases were of subacromial bursitis (SB) and 86 of tenosynovitis of long-tendon of biceps muscle (ILBM). The treatment point of ESWT was oriented with color Doppler ultrasonography, while the pain-point was determined with tenderness combining with local anatomic markers. The energy density of ESWT was 0.12-0.16 mJ/mm2, and 1-2 shock-points were selected for each treatment, the number of shock waves were 800-1000 times, each course consisted of 2-5 times, with an interval of 5 days. 25 of 65 cases of SB were refered for ESWT by ultrasonic orientation, other 40 by pain-point orientation; 31 of 86 cases of ILBM were refered for ESWT of ultrasonic orientation, other 55 by pain-point orientation. The satisfactory rate of SB and ILBM with ESWT were compared between 2 different orientation cases. Results Through 6 months follow up, the satisfactory rates of SB and ILBM with ESWT were 89.6% and 92.3% respectively in cases of ultrasonic orientation, while in cases of pain-point orientation, the satisfactory rates of SB and ILBM with ESWT were 67.6% and 73.6% respectively, the difference of satisfactory rates was significant between 2 groups. Conclusion The effect of the ESWT with ultrasonic orientation is better than the ESWT with pain-point orientation both for SB and ILBM. The ultrasonic orientation plays an important role in promoting the satisfactory rates of ESWT.