超声下肩胛上神经手术松解与盲探法针刀松解治疗肩胛上神经卡压综合征的疗效比较

Comparison of the efficacy between ultrasound-guided suprascapular nerve lysis and blind acupotomy lysis for the treatment of suprascapular nerve compression syndrome

目的:比较超声引导下前入路法肩胛上神经手术松解治疗肩胛上神经卡压综合征与盲探法针刀松解治疗的临床效果.方法 选择肩胛上神经卡压综合征患者64例,年龄20～75岁,体重45～85 kg,ASA分级Ⅰ或Ⅱ级,按随机数字表法分为两组,每组32例,单纯针刀组给予传统针刀治疗法;手术松解组在超声引导下经前入路法切断中斜角肌以及肩胛横韧带.术后应用视觉模拟评分法(VAS)、现时疼痛强度(PPI)及疼痛分级指数(PRI)评价疗效,以肩关节功能评分、手术时间和日常生活能力量表(ADL)评价患者预后及综合满意度.结果 手术松解组手术时间(38±8)min显著短于针刀组(56±5)min(P＜0.05);术后手术松解组患者VAS、PPI、PRI评分均低于单纯针刀组,ADL及JOA量表评分高于单纯针刀组(P＜0.05),总有效率为93.8％,高于单纯针刀组62.8％(P＜0.05),患者的综合满意度96.9％高于单纯针刀组65.6％(P＜0.05).结论 超声引导下前入路法肩胛上神经手术松解治疗肩胛上神经卡压综合征的疗效较盲探法单纯针刀松解显著提高.

Objective To compare the efficacy between ultrasound-guided suprascapular nerve lysis and blind acupotomy lysis for the treatment of suprascapular nerve compression syndrome.Methods Sixty-four,ASA Ⅰ or Ⅱ,patients with suprascapular nerve compression syndrome,aged 20-75 yr,weighing 45-85 kg,were divided into two groups using the random number table,32 cases in each.The patients in acupotomy group were treated with traditional acupotomy,and cutting off musculi scalenus medius and ligamenta transversum scapulae superius via ultrasound-guided anterior approach to suprascapular nerve in operative lysis group.The efficacy was evaluated by visual analogue scale (VAS),present pain intensity (PPI) and pain grading index (PRI) after the operation.Japanese orthopaedic association score (JOA),operative time and activity of daily living scale (ADL) were used to evaluate the prognosis and comprehensive satisfaction of the patients.Results The operative time in operative lysis group (38±8) min was significantly shorter than that in acupotomy group (56±5) min (P＜0.05).VAS,PPI and PRI scores were lower in the operative lysis group than those in acupotomy group,and ADL and JOA scores were higher (P＜0.05).The total effective rate was 93.8％ in operative lysis group,and 62.8％ in acupotomy group (P＜0.05).The satisfaction rate was higher in operative lysis group (96.9％) than that in acupotomy group (65.6％) (P＜0.05).Conclusion The efficacy of ultrasound-guided suprascapular nerve lysis is superior to that of simple acupotomy for the treatment of suprascapular nerve compression syndrome.