超声引导肩周注射复方倍他米松与体外冲击波改善偏瘫肩痛临床疗效对比

The effect of ultrasonic guided local injection of compound betamethasone around the shoulder and extracorporeal shock wave in improving hemiplegic shoulder pain

目的:比较超声引导下肩周局部注射复方倍他米松与体外冲击波改善偏瘫患者肩痛的临床疗效。方法:选取偏瘫肩痛患者42例,随机分为注射组(21例)和冲击波组(21例)。注射组:超声定位下于肩周痛点注入复方倍他米松,共注射1次;冲击波组:于肩周痛点行冲击波治疗,20min/次,1次/周,连续4周。两组均行常规康复训练治疗。在治疗前、治疗结束后1h、1周、1个月进行视觉模拟评分(visual analogue scale,VAS)评估,治疗前、治疗后1个月评估Neer肩关节功能评分,上肢Fugl-Meyer功能评分,Barthel指数,汉密尔顿抑郁量表(Hamilton depression scale,HAMD),健康调查简表(the MOS item short from health survey,SF-36)评分,以及血清中细胞因子的表达水平。结果:干预前两组受试者一般资料及量表评分对比均无显著性差异(P>0.05)。干预后两组受试者偏瘫侧肩部疼痛及功能均得到明显改善(P<0.05),且两组间比较无显著性差异(P>0.05)。但是肩周局部注射糖皮质激素对受试者血清中细胞因子表达水平差异的影响更显著(P<0.05)。结论:肩周局部注射复方倍他米松及体外冲击波治疗对改善偏瘫肩痛均有临床疗效,从细胞因子表达水平来看,前者疗效稍显著。

Objective:To compare the clinical efficacy of ultrasound guided local injection of compound betamethasone around the shoulder and extracorporeal shock wave in improving shoulder pain in patients with hemiplegia.Method:Forty-two patients with hemiplegia and shoulder pain were randomly divided into injection group(21 cases)and shock wave group(21 cases).In the injection group,compound betamethasone was injected at the pain point around the shoulder under ultrasonic localization for one time.Shockwave group:shockwave therapy was performed at the pain points around the shoulder for 20 min/time,once a week,for 4 consecutive weeks.Both groups received rehabilitation training.visual analogue scale(VAS)evaluation was performed before treatment,1 hour after treatment,1 week,and 1 month after treatment;Neer shoulder joint function scores,upper limb Fugl-Meyer function scores,Barthel index,Hamilton Depression Scale(HAMD),the MOS item short form health survey(SF-36)scores,and serum cytokine expression level were evaluated before and 1 month after treatment.Result:There was no significant difference in general characteristics and scale scores between the two groups before intervention(P>0.05).After intervention,the pain and function of the hemiplegic shoulder of the two groups were significantly improved(P<0.05),and no significant difference between the two groups(P>0.05).However,the local injection of glucocorticoid around the shoulder had a more significant effect on the difference of cytokine expression level in serum(P<0.05).Conclusion:This study explored and initially proved the clinical efficacy of local injection of compound betamethasone and extracorporeal shock wave in the treatment of hemiplegic shoulder pain.However,the former was more effective in terms of cytokine expression level.