肩关节腔注射富血小板血浆联合新Bobath技术治疗脑卒中后肩痛疗效及对疼痛相关因子的影响

Effect of Intra-articular Injection of Platelet Rich Plasma Combined with New Bobath Technique in the Treatment of Post stroke Shoulder Pain and Its Influence on Pain Related Factors

目的评价肩关节腔注射富血小板血浆(PRP)联合新Bobath技术治疗脑卒中后肩痛疗效及对疼痛相关因子的影响。方法取2017年6月至2020年2月于河南三门峡市中心医院康复医学科就诊的脑卒中后肩痛患者88例,按随机数字表法将其分为研究组(45例)及对照组(43例)。入院后所有受试者均予以常规治疗措施,在此基础上,研究组予超声引导下肩关节腔内注射PRP联合新Bobath技术治疗,而对照组仅予新Bobath技术治疗,均连续治疗4周。于治疗前及治疗后2、4周,采用Fugl-Meyer运动功能量表上肢部分(FMA-UE)、视觉模拟评分法(VAS)、通用量角器检测所有受试者肩关节被动活动范围,同时采用酶联免疫吸附法测定血清中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)及基质金属蛋白酶-3(MMP-3)水平。结果两组患者治疗后的VAS评分、FMA-U评分、肩关节前屈、外展及外旋被动ROM以及MMP-3水平、TNF-α水平、IL-1β水平随着时间的推移,改善程度是不相等的,但以研究组的改善程度最大(F时间=15.692,F时间=12.082,F时间=8.640,F时间=9.033,F时间=16.025,F时间=7.695,F时间=8.359,F时间=7.448,P时间<0.01)。结论与新Bobath技术干预比较,辅以超声引导下肩关节腔内注射PRP治疗更能够缓解脑卒中后肩痛,改善肩关节功能,同时可以显著降低血清疼痛相关因子水平。

Objective To evaluate the effect of intra-articular injection of platelet rich plasma(PRP)combined with new Bobath technology on shoulder pain after stroke and its influence on pain related factors.Methods 88 patients with shoulder pain after stroke were selected from June 2017 to February 2020 in our hospital.According to the random digital table method,it was divided into study group(45 cases)and control group(43 cases).After admission,all subjects were given routine treatment measures.On this basis,the study group was treated with ultrasound-guided intra-articular injection of PRP and new Bobath technology,while the control group was treated with new Bobath technology only,all for 4 weeks.Before treatment,2 weeks and 4 weeks after treatment,visual analogue scoring method(VAS),Fugl-Meyer motor function scale upper extremity part(FMA-UE),universal protractor were used to detect the passive range of motion of the shoulder joint of all subjects,and at the same time to determine serum interleukin-1β(IL-1β)by enzyme-linked immunosorbent assay,Tumor necrosis factor-α(TNF-α)and matrix metalloproteinase-3(MMP-3)levels.Results After treatment,the VAS score,FMA-U score,shoulder joint flexion,abduction,and external rotation passive ROM and MMP-3 levels,TNF-αlevels,and IL-1βlevels of the two groups of patients after treatment have improved over time.Not equal,but the study group has the greatest improvement(Ftime=15.692,Ftime=12.082,Ftime=8.640,Ftime=9.033,Ftime=16.025,Ftime=7.695,Ftime=8.359,Ftime=7.448,Ptime<0.01).Conclusion Compared with the intervention of the new Bobath technology,the treatment supplemented with ultrasound-guided intra-articular injection of PRP into the shoulder joint can alleviate the shoulder pain after stroke,improve the function of the shoulder joint,and significantly reduce the level of serum pain related factors.