超声引导下多点药物注射联合肩关节腔液压扩张治疗冻结肩的疗效观察

Multi-point drug injection combined with hydraulic dilation of the shoulder joint cavity in the treatment of frozen shoulder

目的观察超声引导下肩峰下滑囊、喙突下滑囊和肩关节腔药物注射联合生理盐水液压扩张法治疗冻结肩(FS)的临床疗效。方法选取FS患者116例,按随机数字表法随机分为注射治疗组和联合治疗组,每组患者58例。注射治疗组第1天行超声引导下的肩峰下滑囊、喙突下滑囊和肩关节腔类固醇混合药物注射,联合治疗组在注射治疗组治疗方案的基础上增加肩关节腔30 ml生理盐水注入行液压扩张治疗,然后2组患者再行居家肩关节功能训练15 d。2组患者均于治疗前、注射结束后和居家肩关节功能训练结束后(治疗结束后)进行肩痛评估[疼痛视觉模拟评分(VAS)]、肩关节功能评估[肩关节被动活动度(PROM)],并于治疗过程中进行安全性评价。结果注射结束后和治疗结束后,2组患者的VAS评分和PROM评分较组内治疗前,差异均有统计学意义(P<0.05);且联合治疗组注射结束后和治疗结束后的VAS评分和PROM评分均显著优于注射治疗组同时间点,差异均有统计学意义(P<0.05)。结论超声引导下肩峰下滑囊、喙突下滑囊和肩关节腔药物注射联合液压扩张治疗可显著改善FS患者的肩痛和肩关节活动度,且疗效优于单纯的药物注射。

Objective To observe any effect of combining ultrasound-guided drug injection into the subacromial bursa,coracoid bursa and shoulder joint cavity with hydraulic dilation of the glenohumeral joint in the treatment of frozen shoulder(FS).Methods A total of 116 persons diagnosed with FS were randomly divided into an injection treatment group and a combined treatment group,each of 58.On the first day,both groups received ultrasoundguided steroid injections into the subacromial bursa,coracoid bursa and shoulder joint cavity.The combined treatment group was also injected with 30ml of normal saline into the glenohumeral joint for hydraulic dilation.All then followed a family-based program of shoulder function training for 15 days.Shoulder pain assessment(VAS)and shoulder function assessment(PROM)were performed for both groups before the treatment,after the injections and after the shoulder function training.Results The average VAS and PROM scores of both groups were significantly different after the treatment,with those of the combined treatment group significantly better than the injection group's averages at each time point.Conclusion Combining ultrasound-guided drug injection with hydraulic dilation of the subacromial bursa,the coracoid bursa and the shoulder joint cavity can significantly relieve pain of FS and improve shoulder mobility.It is more effective than drug injection alone.