介入性超声与微波治疗脑卒中后肩手综合征疗效比较研究

Comparison study of the curative effect between interventional ultrasound and microwave in the treatment of post-stroke shoulder-hand syndrome

目的探讨介入性超声和微波治疗脑卒中后肩手综合征的有效性和安全性。方法共42例脑卒中后肩手综合征Ⅰ期患者随机接受微波联合常规康复训练(19例)和介入性超声联合常规康复训练(23例),于治疗前、治疗后3和10 d采用视觉模拟评分(VAS)评价肩关节疼痛程度、测量手背和掌指小关节水肿程度,于治疗前和治疗后10 d采用Fugl-Meyer上肢评价量表(FMA-UE)评价上肢运动功能、Barthel指数(BI)评价日常生活活动能力。结果两组患者不同时间点VAS评分(P=0.000)以及手背和掌指小关节水肿程度(P=0.000)差异有统计学意义,其中,治疗后3和10 d VAS评分(对照组:P=0.000,0.000;治疗组:P=0.000,0.000)以及手背和掌指小关节水肿程度(对照组:P=0.042,0.000;治疗组组:P=0.000,0.000)低于治疗前,治疗后10 d VAS评分(P=0.000,0.000)以及手背和掌指小关节水肿程度(P=0.000,0.000)亦低于治疗后3 d。治疗后两组患者VAS评分(P=0.031)以及手背和掌指小关节水肿程度(P=0.000)低于治疗前,FMA-UE(P=0.000)和BI(P=0.000)评分高于治疗前。结论介入性超声和微波联合常规康复训练均可以改善脑卒中后肩手综合征患者肩关节疼痛程度、手背和掌指小关节水肿程度、上肢运动功能和日常生活活动能力,且介入性超声联合常规康复训练较微波联合常规康复训练在改善肩关节疼痛程度以及手背和掌指小关节水肿程度方面疗效更佳。

Objective To investigate the efficacy and safety of interventional ultrasound and microwave in the treatment of post-stroke shoulder-hand syndrome （SHS）. Methods A total of 42 cases of post-stroke SHS （stage I ） were randomized to receive microwave combined with routine rehabilitation training （control group, N = 19） and interventional ultrasound combined with routine rehabilitation training （treatment group, N = 23）, respectively. Before and 3 d, 10 d after treatment, Visual Analogue Scale （VAS） was used to evaluate shoulder joint pain, and measure the swelling degree of dorsum of hand and metacarpophalangeal joints. Before and 10 d after treatment, Fugl-Meyer Assessment Scale for Upper Extremity （FMA-UE） and Barthel Index （BI） were used to assess upper limb motor function and activities of daily living （ADL）. Results There was statistically significant difference between 2 groups at different time points on VAS score （P = 0.000） and swelling degree of dorsum of hand and metacarpophalangeal joints （P = 0.000）. VAS score （control group： P = 0.000, 0.000; treatment group： P=0.000, 0.000） and swelling degree of dorsum of hand and metacarpophalangeal joints （control group： P = 0.042, 0.000; treatment group： P = 0.000, 0.000） at 3 and 10 d after treatment were significantly lower than before treatment. VAS score（P = 0.000, 0.000） and swelling degree of dorsum of hand and metacarpophalangeal joints （P = 0.000, 0.000） 10 d after treatment were significantly lower than 3 d after treatment. Compared with before treatment, both VAS score （P = 0.031） and swelling degree of dorsum of hand and metacarpophalangeal joints （P = 0.000） in 2 groups were significantly lower, while FMA-UE （P = 0.000） and BI （P = 0.000） scores were significantly higher after treatment. Conclusions Both interventional ultrasound and microwave combined with routine rehabilitation training can improve shoulder joint pain, swelling degree of dorsum of hand and metacarpophalangeal joints, upper limb motor function and ADL of patients with post-stroke SHS. The effect of interventional ultrasound with routine rehabilitation training is better than that of microwave combined with routine rehabilitation training in improving shoulder joint pain, swelling degree of dorsum of hand and metacarpophalangeal joints.