超声引导下肩关节注射松解术联合关节囊扩张术、手法松动术治疗顽固性冻结肩的临床研究

Ultrasound-guided shoulder injection lysis combined with joint capsule hydrodistention and manipulation loosening in the treatment of patients with intractable frozen shoulder

目的观察肩关节注射松解术联合关节囊扩张术、手法松动术治疗顽固性冻结肩患者的临床疗效以及安全性。方法前瞻性研究2018年5月至2021年5月于同济大学附属第十人民医院麻醉疼痛科确诊为顽固性冻结肩的患者66例,采用随机数字表法分组为:常规治疗组(n=34)给予超声引导下注射松解术;联合治疗组(n=32)给予超声引导下注射松解术联合关节囊扩张术、手法松动术。两组均每周治疗1次,共治疗3次。记录两组患者治疗前及治疗后1、3、6个月时静息痛和动态痛时的视觉模拟评分(VAS)、肩关节Constant-Murley评分(CMS)、疗效以及不良反应。结果全部患者均未见严重不良反应。两组患者治疗后1、3、6个月时的动态痛VAS评分均较治疗前降低(P均<0.05);常规治疗组为(2.5±0.8、2.6±0.9、2.8±0.9)分,联合治疗组为(1.0±0.8、1.4±0.5、1.9±0.6)分降低更显著,差异均有统计学意义(P均<0.05)。治疗后1、3、6个月时静态痛VAS评分,两组较治疗前明显降低(P均<0.05);常规治疗组为(0.9±0.6,1.4±0.5,1.8±0.5)分,联合治疗组为(0.8±0.7,1.0±0.8,1.4±0.5)分,比较差异无统计学意义(P均>0.05)。两组患者治疗后1、3、6个月时肩关节CMS功能评分较治疗前明显增加(P均<0.05);常规治疗组为(80.4±6.6,75.6±5.6,74.6±4.3)分,联合治疗组为(91.1±2.5,85.9±4.5,84.5±5.1)分,增加更明显,且差异有统计学意义(P均<0.05)。联合治疗组治疗后1、3、6个月时的优良率分别为(100.0%、100.0%和96.9%)均高于常规治疗组的(76.5%、64.7%和61.8%),差异均有统计学意义(P均<0.05)。结论超声引导下注射松解术联合关节囊扩张术、手法松动术治疗顽固性冻结肩具有良好的镇痛和改善肩关节活动度的临床效果且安全。

Objective To explore the clinical efficacy and safety of shoulder joint injection lysis combined with joint capsule hydrodistention and manipulation loosening in the treatment of patients with intractable frozen shoulder.Methods Sixty-six patients with intractable frozen shoulder in Department of Anesthesiology and Pain Medicine,Tenth People's Hospital of Tongji University,from May 2018 to May 2021 were prospectively analyzed and divided by random number table method into two groups.The patients were treated with ultrasound-guided adhesion lysis in the routine treatment group(n=34),while with ultrasound-guided shoulder joint injection lysis combined with joint capsule hydrodistention and manipulation loosening in the combined treatment group(n=32).All patients were treated once a week for 3 times in both groups.Visual analogue scale(VAS)in resting and moving,Constant-Murley score(CMS)of shoulder joint,curative effect and adverse reactions were recorded before the treatment,and 1 month,3 months and 6 months after the treatment.Results No serious adverse reactions were found.Compared with pre-treatment,VAS in moving were significantly lower in the two groups at 1 month,3 months and 6 months after the treatment(all P<0.05).Compared with VAS in moving were(2.5±0.8,2.6±0.9,2.8±0.9)score in routine treatment group,and were(1.0±0.8,1.4±0.5,1.9±0.6)score in the combined treatment group at 1 month,3 months and 6 months after the treatment(all P<0.05).VAS in resting decreased significantly after the treatment at 1 month,3 months and 6 months in the two groups(all P<0.05).There was no statistical significance between the two groups at each time point(all P>0.05).Compared with pre-treatment,the CMS of shoulder joints increased significantly in the two groups at 1 month,3 months and 6 months after the treatment(all P<0.05).And CMS in the combined group were(91.1±2.5,85.9±4.5,84.5±5.1)score,shown better than the routine treatment group(80.4±6.6,75.6±5.6,74.6±4.3)score(all P<0.05).The excellent and good rate(100.0%,100.0%,96.9%)in the combined treatment group at 1 month,3 months and 6 months was higher than those in the routine treatment group(76.5%,64.7%,61.8%).Conclusion Ultrasound-guided injection lysis combined with joint capsule hydrodistension and manipulation loosening can significantly reduce the pain and improve shoulder function safely in patients with intractable frozen shoulder.