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透视引导下关节内注射、肩胛上神经阻滞及联合治疗偏瘫肩痛的疗效:一项前瞻性双盲、随机临床研究。

Effects of fluoroscopy-guıded intraartıcular injectıon, suprascapular nerve block, and combınatıon therapy ın hemıplegıc shoulder paın: a prospective double-blınd, randomızed clınıcal study.

机构信息

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, Postal code 34906, Istanbul, Turkey.

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, Erciyes Üniversitesi Tıp Fakültesi Köşk Mahallesi Dede Efendi Sokağı Melikgazi, Postal code 38030, Kayseri, Turkey.

出版信息

Neurol Sci. 2019 May;40(5):939-946. doi: 10.1007/s10072-019-03733-6. Epub 2019 Jan 28.

Abstract

OBJECTIVE

To investigate the effect and superiority of fluoroscopy-guided intraarticular shoulder injection (IAI), suprascapular nerve block (SSNB), and combination treatment in hemiplegic shoulder pain (HSP).

DESIGN

We included 30 patients diagnosed with HSP. Patients were divided into three groups: IAI, SSNB, and combination treatment. Patients were assessed using a visual analogue scale (VAS) prior to the injection and at hour 1, week 2, and month 2 after the injection, with goniometry at two angles at the moment that pain started and maximum passive range of motion (ROM) of the shoulder and Modified Barthel Index prior to the injection, at week 2 and month 2 after the injection.

RESULTS

Significant decrease in the VAS and increase in shoulder passive ROMs were detected at all follow-ups in groups. In comparison, there was no significant difference in VAS scores. Change in the internal rotation at the moment that pain started was found to be higher in the patients treated with the combined method than the other methods. Change in maximum passive ROMs was similar between treatment groups.

CONCLUSION

IAI, SSNB, and the combination treatments are reliable and effective treatment modalities that provide pain relief and an increase in shoulder passive ROMs in HSP.

摘要

目的

探讨透视引导下关节内肩部注射(IAI)、肩胛上神经阻滞(SSNB)和联合治疗对偏瘫性肩部疼痛(HSP)的疗效和优势。

设计

纳入 30 例 HSP 患者。患者分为三组:IAI 组、SSNB 组和联合治疗组。在注射前及注射后 1 小时、2 周和 2 个月,采用视觉模拟评分(VAS)进行评估,在疼痛开始时和最大被动肩部活动度(ROM)的两个角度进行测角,在注射前、注射后 2 周和 2 个月进行改良巴氏指数评估。

结果

所有随访组的 VAS 评分均显著降低,肩部被动 ROM 均显著增加。然而,VAS 评分无显著差异。与其他方法相比,联合治疗组患者疼痛开始时的内旋角度变化更大。最大被动 ROM 的变化在各组之间相似。

结论

IAI、SSNB 和联合治疗是 HSP 可靠有效的治疗方法,可缓解疼痛并增加肩部被动 ROM。

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