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超声引导下肩胛上神经阻滞治疗偏瘫后肩痛的疗效。

Efficacy of ultrasound-guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder.

机构信息

Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.

Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.

出版信息

Neurol Sci. 2019 May;40(5):985-991. doi: 10.1007/s10072-019-03749-y. Epub 2019 Feb 9.

Abstract

OBJECTIVE

The aim of this study was to evaluate the efficacy of ultrasound-guided suprascapular block treatment in patients with painful hemiplegic shoulder whose pain was not reduced after conservative treatment.

DESIGN

The patients were those whose hemiplegic shoulder pain was not reduced by standard conservative treatment prior to discharge. The study group (n = 21) included patients who had undergone an ultrasound-guided suprascapular nerve block (SSNB). The control group (n = 21) were patients who had not undergone SSNB. Both groups undertook home exercise programs. All patients were evaluated at 1 week and 1 and 3 months after the discharge. Evaluations included shoulder range of motion (ROM), Visual Analog Scale (VAS) for pain, EQ-5D-3L for quality of life, the Modified Ashworth Scale (MAS), and Brunnstrom staging.

RESULTS

The shoulder ROM significantly increased in the SSNB group at 1-3 months, when compared with the baseline value. The shoulder ROM significantly decreased (p ˂ 0.05) in the control group at 1-3 months, when compared with the baseline value. The pain VAS and EQ-5D-3L scores significantly decreased (p ˂ 0.05) after treatment in the follow-ups at 1 month in the SSNB group. The control group showed no change from the baseline scores (p ˃ 0.05). The MAS scores and Brunnstrom staging did not differ between the two groups.

CONCLUSION

The ultrasound-guided SSNB is a safe and more effective treatment than conservative treatment for painful hemiplegic shoulder. Further studies are needed to compare ultrasound-guided and non-guided suprascapular blocks as treatments for hemiplegic shoulder pain.

摘要

目的

本研究旨在评估超声引导下肩胛上神经阻滞治疗对经标准保守治疗后疼痛仍未缓解的偏瘫肩痛患者的疗效。

设计

该研究纳入了在出院前经标准保守治疗后偏瘫肩痛仍未缓解的患者。观察组(n=21)患者接受了超声引导下肩胛上神经阻滞(SSNB)。对照组(n=21)患者未接受 SSNB,仅接受家庭运动方案。所有患者均在出院后 1 周和 1、3 个月进行评估。评估内容包括肩活动度(ROM)、疼痛视觉模拟评分(VAS)、生活质量 EQ-5D-3L、改良 Ashworth 量表(MAS)和 Brunnstrom 分期。

结果

与基线值相比,观察组在 1-3 个月时肩 ROM 显著增加。与基线值相比,对照组在 1-3 个月时肩 ROM 显著下降(p<0.05)。观察组在 1 个月随访时,疼痛 VAS 和 EQ-5D-3L 评分在治疗后显著降低(p<0.05)。对照组在随访中无基线评分变化(p>0.05)。两组 MAS 评分和 Brunnstrom 分期无差异。

结论

与保守治疗相比,超声引导下 SSNB 治疗偏瘫肩痛更安全、更有效。需要进一步研究来比较超声引导与非引导肩胛上神经阻滞治疗偏瘫肩痛的效果。

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