超声引导下肩关节腔联合喙肱韧带注射治疗老年人冻结肩的临床疗效

Clinical effects of ultrasound-guided intra-articular and coracohumeral ligament injections on frozen shoulder in the elderly

目的:对比超声引导下肩关节腔联合喙肱韧带注射与超声引导下单纯肩关节腔注射治疗冻结肩的临床疗效。方法:选取2019年9月至2020年6月于四川护理职业学院附属医院康复疼痛科住院治疗的老年冻结肩患者44例,随机分为试验组和对照组,每组各22例。试验组进行连续2次超声引导下肩关节腔联合喙肱韧带注射,对照组进行连续2次超声引导下单纯肩关节腔注射。评估患者治疗前、第1次注射治疗后1周(1周)、第2次注射治疗后1周(2周)、第2次注射治疗后10周(12周)肩关节被动活动度(PROM)、11点数字评分(NRS)以及肩关节疼痛和功能障碍指数(SPADI)。结果:试验组与对照组各项基线特征差异均无统计学意义(均P>0.05),具有可比性。试验组治疗后前屈、外展、后伸、外旋较治疗前均显著增加,NRS及SPADI较治疗前显著降低(F=11.341、20.965、20.403、32.470、82.970、102.154,均P<0.05);对照组与试验组情况相同(F=7.012、8.937、23.265、31.966、52.500、41.356,均P<0.05)。组间比较,试验组治疗后1周、2周、12周后伸活动度较对照组均显著增加(t=0.365、0.143、0.236,均P<0.05);试验组外旋情况与后伸相同(t=0.205、0.620、2.751,均P<0.05);试验组SPADI在12周时较对照组显著减低(t=2.063、P=0.045);试验组治疗后各时间点NRS、肩关节前屈及外展活动度较对照组差异均无统计学意义(均P>0.05)。两组在治疗过程中均未出现严重不良反应。结论:超声引导下肩关节腔注射联合喙肱韧带注射与超声引导下单纯肩关节腔注射均能有效改善冻结肩患者疼痛及功能障碍,但联合喙肱韧带注射在后伸及外旋功能的改善方面更具优势,对于后伸及外旋受限明显的患者联合喙肱韧带注射可以取得更好的临床疗效。

Objective To compare the clinical effects of ultrasound-guided intra-articular and coracohumeral ligament glucocorticoid injections versus ultrasound-guided intra-articular glucocorticoid injections alone on frozen shoulder in the elderly.Methods A total of 44 patients with frozen shoulder admitted to the rehabilitation department of the Affiliated Hospital of Sichuan Nursing Vocational College from September 2019 to June 2020 were enrolled.They were randomly divided into the experimental group and the control group,with 22 patients in each group.The experimental group received two consecutive ultrasound-guided intra-articular injections and two coracohumeral ligament injections,while the control group received two consecutive ultrasound-guided intra-articular injections.The shoulder's passive range-of-motion(PROM),the 11-point numeric rating scale(NRS)as well as the Shoulder Pain and Disability Index(SPADI)were conducted before treatment,1 week after the first treatment(1 week),1 week after the second treatment(2 weeks)and 10 weeks after the second treatment(12 weeks).Results There was no significant difference in baseline characteristics between the two groups(all P>0.05).Flexion,abduction,extension and external rotation increased whereas NRS and SPADI decreased after treatment,compared with pre-treatment in the experimental group(F=11.341,20.965,20.403,32.470,82.970 and 102.154,all P<0.05)and in the control group(F=7.012,8.937,23.265,31.966,52.500 and 41.356,all P<0.05).Compared with the control group,extension(t=0.365,0.143 and 0.236,all P<0.05)and external rotation(t=0.205,0.620 and 2.751,all P<0.05)increased at 1,2 and 12 weeks after treatment.SPADI scores were lower in the experimental group than in the control group at 12 weeks after treatment(t=2.063,P=0.045).There was no significant difference in NRS,flexion or abduction between the two groups at any time point after treatment(all P>0.05).No serious adverse reactions occurred during treatment in either group.Conclusions Both ultrasound-guided intra-articular injections plus coracohumeral ligament injections and ultrasound-guided intra-articular injections can effectively alleviate pain and improve function in elderly patients with frozen shoulder,but the former has better effects on extension.For patients with clear restricted extension and external rotation,ultrasound-guided intra-articular injections combined with coracohumeral ligament injections may achieve better clinical effects.