超声引导下肩胛上神经卡压症液压松解的疗效评估及复发因素分析

Analysis on the efficacy and recurrence factors of hydraulic release of suprascapular nerve entrapment guided by ultrasound

目的评估超声引导下肩胛上神经卡压症液压松解的疗效,分析其术后复发的危险因素。方法收集我院经临床及肌电图确诊的肩胛上神经卡压症患者52例,其中应用超声引导下肩胛上神经液压松解为研究组(29例),超声引导下肩胛上神经阻滞为对照组(23例)。分析两组治疗前、治疗后4周和12周冈上肌诱发电位反应潜伏时间(Lat)、视觉模拟疼痛评分(VAS)、Constant-Murley肩关节功能评分(CMS)的变化情况,采用Logistic回归分析治疗后复发的危险因素。结果治疗后4周,两组VAS、CMS比较差异均无统计学意义,研究组Lat较对照组明显缩短,差异有统计学意义(P<0.05);治疗后12周,研究组较对照组VAS减低、Lat缩短、CMS升高,差异均有统计学意义(均P<0.05)。研究组治疗后4周、12周较治疗前VAS减低、Lat缩短、CMS升高,差异均有统计学意义(均P<0.05);治疗后12周较治疗后4周VAS减低、Lat缩短、CMS升高,差异均有统计学意义(均P<0.05)。对照组治疗后4周、12周较治疗前VAS减低、Lat缩短、CMS升高,差异均有统计学意义(均<0.05)。治疗后12周研究组疗效优良率93%,复发1例;对照组疗效优良率70%,复发8例。多因素回归分析显示:治疗方法、病程是术后复发的危险因素(OR=26.518、1.385,P=0.019、0.021)。结论超声引导下肩胛上神经卡压症液压松解治疗效果显著,并可减少治疗后复发风险。

Objective To investigate the effect of hydraulic release of suprascapular nerve entrapment guided byultrasound,and analyze to the risk factors of postoperative recurrence.Methods Fifty-two patients with suprascapular nerveentrapment diagnosed by clinical and EMG were collected.The suprascapular nerve was hydrolyzed under the guidance of ultrasound as the study group(n=29),and the suprascapular nerve block under the guidance of ultrasound as the control group(n=23).The changes of response latency of supraspinatus evoked potential(Lat),visual analogue pain score(VAS)and Constant-Murley shoulder function score(CMS)were analyzed before treatment,4 weeks and 12 weeks after treatment betweenthe two groups.Logistic regression analysis was used to analyze the risk factors of recurrence after treatment.Results Therewas no significant difference in VAS and CMS between the two groups at 4 weeks after treatment,but Lat in the study group wassignificantly shorter than that in the control group(P<0.05).Compared with the control group,VAS and Lat decreased,while CMS was increased after 12 weeks of treatment.The difference were statistically significant(all P<0.05).In the study group,VAS decreased,Lat shortened and CMS increased at 4 and 12 weeks after treatment(all P<0.05),while VAS decreased,Lat shortened and CMS increased at 12 weeks after treatment(all P<0.05).In the control group,VAS decreased,Lat shortened and CMS increased at 4 and 12 weeks after treatment(all P<0.05).12 weeks after treatment,the excellent and good rate in the study groupwas 93%,with 1 case of recurrence,while in the control group,the excellent and good rate was 70%,and 8 cases recurred.Multivariate regression analysis showed that the method of treatment and course of disease were the risk factors of postoperative recurrence.Conclusion Ultrasound-guided hydraulic release of suprascapular nerve is effective in the treatment of suprascapular nerve entrapment and can reduce the risk of recurrence after treatment.