臂丛神经阻滞麻醉下麦肯基手法松解与痛点阻滞治疗肩周炎的疗效

Clinical outcome of Mackenzie arthrolysis under brachial plexus block versus pain point blocking for the treatment of frozen shoulder

目的评价臂丛神经阻滞麻醉下采用麦肯基手法松解与痛点阻滞治疗肩周炎的疗效和安全性。方法选取在江西省九江市第一人民医院疼痛科门诊和住院治疗的肩周炎患者120例,随机分入观察组和对照组,每组60例,分别采用臂丛神经阻滞麻醉下麦肯基手法松解和肩关节周围痛点阻滞的方法治疗肩周炎。比较两组患者治疗后的疼痛视觉模拟评分(VAS评分)、肩关节活动度和治疗总有效率。结果两组间治疗前的疼痛VAS评分和肩关节外展、前屈、后伸活动度的差异均无统计学意义(P值均>0.05)。两组治疗后的疼痛VAS评分均显著低于同组治疗前(P值均<0.01),肩关节外展、前屈、后伸活动度均显著大于同组治疗前(P值均<0.01)。观察组治疗后的疼痛VAS评分显著低于对照组治疗后(P<0.05),肩关节外展、前屈、后伸活动度均显著大于对照组治疗后(P值均<0.05)。观察组治疗总有效率为93.33%(56/60),显著高于对照组的71.67%(43/60,P<0.01)。结论臂丛神经阻滞麻醉下采用麦肯基手法松解治疗肩周炎的疗效显著,无严重不良事件发生。

Objective To observe the therapeutic effects and safety of Mackenzie arthrolysis under brachial plexus block versus pain point blocking for frozen shoulder. Methods A total of 120 patients with frozen shoulder were randomized into two groups （n = 60）. The patients in observation group were treated by Mackenzie arthrolysis under brachial plexus block and those in control group were treated with pain point blocking around the shoulder joint. Visual analogue scale （VAS） score and range of motion （ROM） of shoulder were compared between two groups. Results There were no significant differences in VAS score or shoulder ROM （posterior extension, uplift, outreach） between groups before treatment （all P 〉0.05）. Compared with those before treatment, VAS score was significantly decreased and shoulder ROM was significantly increased after treatment in both groups （all P〈0. 01）. After_treatment, VAS score in observation group was significantly lower than that in control group （P〈 0.05）, and shoulder ROM （posterior extension, uplift, outreach） in observation group were significantly greater than those in control group （all P〈0.05）. The total effective rate Of observation group was significantly higher than that of control group （93. 33% [56/60]vs. 71.67% [43/60], P〈0.01）. Conclusion Mackenzie arthrolysis under brachial plexus block is more effective than pain point block in treatment of frozen shoulder, with no severe adverse reaction. （Shanghai Med J, 2016, 39： 350-352）