肩胛上神经合并冈下窝阻滞治疗对冈下肌损伤功能恢复影响的临床观察

Clinical observation on therapeutic effect of suprascapular nerve block combined with infraspinous fossa block for recovering the function of injured infraspinatus muscle

目的观察应用肩胛上神经联合冈下窝阻滞治疗对冈下肌损伤功能恢复的临床疗效。方法选择冈下肌损伤伴疼痛患者27例,发病一周,未行局部特殊治疗(包括理疗、按摩、注射治疗、针灸)。将病人随机分为两组:冈下窝痛点注射组(A组,n=13),肩胛上神经联合冈下窝阻滞组(B组,n=14)。观察指标:(1)两组3个时间点(治疗前、治疗后1周、三周)的VAS疼痛评分值的比较;(2)两组3个时间点患侧肩关节抗阻力外旋时的VAS评分值的比较;(3)两组3个时间点肩关节外展活动范围评估比较。结果 (1)两组组内比较:A组治疗后第3周疼痛程度、及肩关节抗阻力外旋时的VAS疼痛评分均较治疗前显著性降低,肩关节外展活动范围明显改善(P<0.05);B组治疗后第1周和第3周的疼痛程度,及肩关节抗阻力外旋时的VAS疼痛评分均较治疗前显著性降低,肩关节外展活动范围明显改善(P<0.05);(2)两组组间比较:B组治疗后第1周和第3周的疼痛程度,及肩关节抗阻力外旋时的VAS疼痛评分均较A组评分值显著性降低(P<0.05),肩关节外展活动范围改善程度评分也明显高于A组(P<0.05)。结论应用肩胛上神经联合冈下窝阻滞治疗冈下肌损伤,可以有效控制冈下肌损伤患者的疼痛程度,并可明显改善肩关节功能活动范围。

Objective To observe the therapeutic effect of suprascapular nerve block combined with infraspinous fossa block for recovery of the function of impaired infraspinatus muscle. Methods Twenty-seven patients with impaired infraspinatus muscle and pain lasting for one week without any remission by local special treatment including physical therapy,massage,injection or acupuncture moxibustion were randomly assigned into group A（ n = 13） in which the trigger point in infraspinous fossa was blocked and in group B（ n = 14） both suprascapular nerve and trigger point in infraspinous fossa were blocked. Items in these two groups were observed as follows： firstly,visual analogue scale（ VAS） at rest（ VAS-R） before the treatment,one week and 3 weeks after the treatmentt. Secondly,VAS while affected side of shoulder in external rotation against resistance（ VAS-ERAR） before the treatment,one week and 3 weeks after the treatment. Thirdly,the range of motion in affected side of shoulder in abduction（ MRA） before the treatment,one week and 3 weeks after the treatment had been compared. Results Patients in group A had lower VAS-R,lower VAS-ERAR,and improved MRA at the time of three weeks after the treatment than those before treatment（ P〈0. 05）,while patients in group B had lower VAS-R,lower VAS-ERAR,and more improved MRA at one week and three weeks after the treatment than those before the treatment（ P〈0. 05）. VAS-R and VAS-ERAR in group at the time of one week and three weeks after the treatment were lower than those of group A（ P〈0. 05） and MRA in group B at the time of one week and three weeks after the treatment was improved than that of group A（ P〈0. 05）. Conclusion Suprascapular nerve block combined with infraspinous fossa block can effectively decrease the intensity of pain and significantly improve the range of functional motion of shoulder.