改良超声引导下肩袖间隙注射治疗冻结肩的疗效分析

Therapeutic effect of modified ultrasound-guided rotator cuff injection in the treatment of frozen shoulder

目的探讨改良超声引导下肩袖间隙注射法治疗早期冻结肩的可行性与疗效。方法选取2022年12月1日至2023年5月31日江苏省苏北人民医院疼痛科门诊原发性冻结肩患者70例, 采用抽签法随机分为改良超声引导下肩袖间隙注射组(改良组)和传统超声引导下肩袖间隙注射组(传统组), 每组35例。改良组患者采用改良超声引导下, 传统组患者采用传统超声引导下实施肩袖间隙及盂肱关节腔注射治疗, 并根据患者疼痛缓解程度治疗1~2次, 每次治疗间隔1周时间。记录治疗前、治疗后1 d、治疗后4、8、12周时的肩袖间隙厚度指数、喙肱韧带厚度、肩袖间隙血流、腋囊厚度、视觉模拟量表疼痛评分(VAS)、肩关节主动活动范围(AROM)及Constant-Murley肩关节功能评分(CMS)的变化情况, 观察并发症发生情况。结果两组患者治疗前肩袖间隙厚度指数、喙肱韧带厚度、肩袖间隙血流、腋囊厚度、VAS评分、AROM及CMS评分比较, 差异均无统计学意义(P均>0.05)。与治疗前相比, 两组患者治疗后第4、8、12周时的超声检测指标包括肩袖间隙厚度指数、喙肱韧带厚度、肩袖间隙血流、腋囊厚度均显著改善(P均<0.05), 临床症状包括VAS评分、AROM及CMS评分也均显著改善(P均<0.05)。改良组在各观察时间点的肩袖间隙厚度指数、喙肱韧带厚度、腋囊厚度、VAS评分、AROM中的外旋和后伸及CMS评分改善中, 均优于传统组(P均<0.05), 但在肩袖间隙血流及AROM中的外展、前屈均无明显差异(P均>0.05)。结论改良超声引导下肩袖间隙注射治疗冻结肩是一种安全有效的治疗方法。

ObjectiveTo explore the feasibility and clinical efficacy of modified ultrasound-guided injection method in the treatment of primary frozen shoulder,and to provide reference for the clinical practice.Methods Seventy patients with primary frozen shoulder in the Department of Painology of Subei People's Hospital,Jiangsu Province,were randomly divided into modified ultrasound guided group(modified group)and traditional ultrasound guided group(traditional group)by a lottery method,with 35 cases in each group.Patients were treated by modified ultrasound guidance in the modified group and were treated by traditional ultrasound guidance in the traditional group to perform the injection therapy in the rotator cuff space and glenoid humeral joint cavity,1-2 times depending on the degree of pain relief,and 1-week interval between each treatment.The changes of the thickness index in the rotator cuff,thickness of the coracoid brachial ligament,blood flow in the rotator cuff,thickness of the axillary sac,visual analogue scale(VAS),active range of motion(AROM),and Constant-Murley shoulder joint score(CMS)were recorded before treatment,4 weeks,8 weeks,and 12 weeks after treatment,and the occurrence of complications were observed.Results The parameters were comparable in two groups before the treatment(all P>0.05).Compared with before the treatment,all parameters were significantly improved in the two groups at the 1 day,4th,8th,and 12th weeks after the treatment(all P<0.05)in the thickness index of the rotator cuff space,the thickness of the coracobrachial ligament,the blood flow in the rotator cuff space,and the thickness of the axillary sac.VAS,AROM,and CMS were also significantly improved(all P<0.05).The modified group are better than the traditional group in improving the thickness index of the rotator cuff,thickness of the coracoid brachial ligament,thickness of the axillary sac,VAS score,external rotation and posterior extension in AROM,and CMS at various follow-up time points(all P<0.05),but no significant difference in rotator cuff blood flow and external and anterior flexion in AROM(all P>0.05).Conclusion The modified ultrasound-guided injection therapy is a safe and effective method for treatment of frozen shoulder.