臂丛麻醉下四步手法松解联合关节腔痛点注射治疗冻结肩的临床研究

Clinical research of four steps manipulation under brachial plexus anesthesia combined with injection of articular cavity pain point in treating frozen shoulder

目的观察关节腔痛点注射联合臂丛麻醉下四步手法松解治疗冻结肩的临床疗效。方法将90例冻结肩患者随机分为观察组和对照组,每组45例。对照组采用臂丛麻醉下四步手法松解治疗,观察组在此基础上联合关节腔痛点注射治疗。两组疗程均为8天,治疗后随访3个月,观察临床疗效,比较疼痛视觉模拟(VAS)评分、肩关节活动度的变化情况。结果 (1)观察组、对照组总有效率分别为100.0%、86.6%;观察组临床疗效优于对照组(P<0.05)。(2)治疗前后组内比较,两组VAS评分均较治疗前降低(P<0.05),观察组肩关节外展、前屈、后伸、内旋范围均较治疗前增加(P<0.05),对照组仅肩关节外展、前屈范围较治疗前增加(P<0.05);治疗前与治疗后3个月组内比较,两组VAS评分及肩关节活动度差异均有统计学意义(P<0.05)。组间治疗后3个月比较,VAS评分及肩关节活动度差异均有统计学意义(P<0.05)。结论关节腔痛点注射联合臂丛麻醉下四步手法松解治疗冻结肩疗效满意,较单纯四步手法松解能更明显地缓解疼痛,增加肩关节活动范围,值得推广运用。

Objective To observe the clinical efficacy of four steps manipulation under brachial plexus anesthesia combined with injection of articular cavity pain point in treating frozen shoulder. Methods 90 patients with frozen shoulder were randomly divided into the observation group and control group,45 cases in each group. The control group was treated with four steps manipulation under brachial plexus anesthesia,and the observation group was treated with injection of articular cavity pain point based on the treatment for the control group,with a treatment course of 8 days and follow-up of 3 months. The clinical efficacy was observed. The changes on the visual analogue scale( VAS) score and the range of motion( ROM) of shoulder were compared. Results(1)The total effective rates were 100.0%in the observation group and 86.6% in the control group,the clinical efficacy of the observation group was better than that of the control group( P<0.05).(2)Compared with treatment before,the VAS score was decreased in both groups after treatment( P<0.05),the ROM of shoulder including abduction,forward flexion,extension and internal rotation were increased in the observation group( P<0.05),while only the abduction and forward flexion in ROM were increased in the control group( P<0.05). In both groups,there were statistically significant differences on the VAS score and ROM of shoulder between treatment before and after treatment for 3 months( P<0.05). After treatment for 3 months,there were statistically significant differences on the VAS score and ROM of shoulder between the two groups( P<0.05). Conclusion The therapy of four steps manipulation under brachial plexus anesthesia combined with injection of articular cavity pain point shows satisfactory efficacy in treating frozen shoulder. Compared with four steps manipulation alone,this therapy can more obviously relieve the pain and increase the range of motion of shoulder,which is worthy of promotion and application.