超声引导下肩袖间隙阻滞治疗原发性冻结肩患者的临床效果

Efficacy of ultrasound-guided rotator interval block in the treatment of primary frozen shoulder

目的通过与后路关节腔注射对照,评估超声引导下肩袖间隙阻滞治疗原发性冻结肩在疼痛改善、关节活动度及功能方面的疗效。方法收集2020年6月至2021年6月金湖县人民医院疼痛科住院治疗的原发性冻结肩患者60例,采用随机数字表法分为肩袖间隙组和关节腔组,每组30例。肩袖间隙组进行2次超声引导下肩袖间隙阻滞治疗,关节腔组进行2次超声引导下后路肩关节腔注射治疗。评估并对比两组患者治疗前及治疗后1、2、3个月时疼痛视觉模拟评分(VAS)、肩关节被动活动度(PROM)、疼痛干扰睡眠评分(SIS)、Constant-Murley关节功能与患者感知疗效评分。结果治疗前两组患者VAS评分、各方向PROM、SIS评分、Constant-Murley评分差异均无统计学意义(P均>0.05)。两组治疗后1、2、3个月时VAS评分、SIS评分较治疗前均明显下降,差异有统计学意义(P均<0.05)。治疗后各时点两组间VAS评分、SIS评分差异无统计学意义(P均>0.05)。治疗后3个月时两组关节功能评分较治疗前均明显改善,肩袖间隙组明显高于关节腔组,差异有统计学意义(P均<0.05)。与治疗前相比,治疗后1、2、3个月时两组患者前屈、外展、后伸、内旋活动度均明显改善,治疗后2、3个月时外旋活动度明显改善,治疗后各时点肩袖间隙组前屈、外展、外旋活动度均明显大于关节腔组,差异均有统计学意义(P均<0.05)。治疗后3个月时肩袖间隙组GPEs评分明显高于关节腔组(P<0.05)。结论超声引导下肩袖间隙阻滞与后路肩关节腔注射均能有效改善原发性冻结肩患者疼痛、活动度及关节功能。肩袖间隙阻滞在前屈、外展及外旋功能方面更具有优势,临床疗效更佳。

Objective To evaluate the efficacy of ultrasound-guided rotator interval block in the treatment of primary frozen shoulder in terms of pain improvement,range of motion and function recovery.Methods During the period from June 2020 to June 2021,Sixty patients with acute stage primary frozen shoulder were selected and randomly divided by randomized digital table into rotator interval(RI)group and intra-articular(IA)group,with 30 patients in each group.Patients were treated with rotator interval block for twice under ultrasound guidance in the RI group,and treated with posterior intra-articular injection for twice in the IA group.The visual analogue scale(VAS),passive range of motion(PROM),sleep interference score(SIS),constant-Murley joint function and patient global perceived effect scale(GPEs)were evaluated and compared between the groups before the treatment,and 1,2 and 3 months after the treatment.Results(1)There were no significant differences in VAS,PROM,SIS and Constant-Murley score between the two groups before the treatment.The VAS and SIS were significantly lower in 1,2 and 3 months after the treatment than those before the treatment in both groups,but no significant difference between the two groups at each time point after the treatment.(2)At 3 months after the treatment,The Constant-Murley score was significantly improved in both groups,and was significantly higher in the RI group than that in the IA group.(3)Compared with baseline,the flexion,abduction,extension and pronation activity of the shoulder were significantly improved in the two groups at 1,2 and 3 months after the treatment,and the extortion activity was significantly improved at 2 and 3 months after the treatment.The flexion,abduction and extortion activity of the shoulder were significantly greater in the RI group than those in the IA group at each time point after the treatment.Three months after the treatment,the GPEs score were significantly higher in the RI group than those in the IA group.Conclusion Both ultrasound-guided rotator interval block and posterior intra-articular injection can effectively improve pain,range of motion and joint function of patients with primary frozen shoulder,and rotator interval block has more advantages in flexion,abduction and extortion function recovery.