脑卒中患者行肩胛上神经和腋神经脉冲射频治疗后偏瘫肩痛的管理：一项初步研究。

The management of hemiplegic shoulder pain in stroke subjects undergoing pulsed radiofrequency treatment of the suprascapular and axillary nerves: a pilot study.

机构信息

Analgesia Department of Shandong Provincial Hospital Affiliated to the Shandong First Medical University, Jinan, China.

Imaging Department of Shandong Provincial Hospital Affiliated to the Shandong First Medical University, Jinan, China.

出版信息

Ann Palliat Med. 2020 Sep;9(5):3357-3365. doi: 10.21037/apm-20-1618. Epub 2020 Sep 15.

DOI:10.21037/apm-20-1618

PMID:32954762

Abstract

BACKGROUND

Our trial aims to provide evidence for pain management and rehabilitation in patients with hemiplegic shoulder pain (HSP). HSP is one of the most common pains and disabilities occurring after a stroke. With accumulating evidence, the management of the suprascapular nerve (SSN) or axillary nerve (AN) might effectively relieve the pain and disability associated with HSP. However, no study has compared the effects of pulsed radiofrequency and nerve block of SSN and AN.

METHODS

Twenty patients with chronic stroke (over one year from onset) and HSP [visual analog scale (VAS) for pain ≥30 mm] randomly underwent ultrasound-guided SSN and AN pulsed radiofrequency or nerve block treatment. All patients were evaluated before treatment (T0) and at 4 (T1) and 16 (T2) weeks of follow-up. The primary outcome was the VAS score. Secondary outcomes were the Modified Ashworth Scale (MAS) score, passive shoulder range of motion (PROM), Disability Assessment Scale (DAS) score, and EuroQol-5 dimension questionnaire (EQ-5D).

RESULTS

Significant improvements in the VAS score were observed in both groups at T1 and T2. However, a significant difference was not observed between the two groups (T1: P=0.43; T2: P=0.23). No statistically significant differences were observed in the MAS score between the two groups at T1 (P=0.06) and T2 (P=0.07). In the PROM of shoulder abduction and external rotation, statistically, significant differences were observed between the two groups at T1 (P=0.02*, & P=0.04*) and T2 (P=0.02*, & P=0.00*). Statistically significant differences in shoulder flexion and extension were not observed between the two groups at T1 (P=0.23, & P=0.35) and T2 (P=0.14, & P=0.14). Statistically significant differences in the DAS score were not observed between the 2 groups at T1 (P=0.51, & P=0.33, & P=0.36, & P=0.75) and T2 (P=0.12, & P=0.54, & P=0.41, & P=0.86). No statistically significant differences in the EQ-5D responses were observed between the two groups at T1 (P=0.42) and T2 (P=0.11).

CONCLUSIONS

Pulsed radiofrequency of SSN and AN achieves similar therapeutic effects to the nerve block. Pulsed radiofrequency modulation is superior to nerve block in improving the PROM of shoulder abduction and external rotation.

摘要

背景

我们的试验旨在为偏瘫肩痛（HSP）患者的疼痛管理和康复提供证据。HSP 是中风后最常见的疼痛和残疾之一。随着证据的积累，肩胛上神经（SSN）或腋神经（AN）的管理可能会有效缓解与 HSP 相关的疼痛和残疾。然而，尚无研究比较脉冲射频和 SSN 和 AN 神经阻滞的效果。

方法

20 名慢性中风（发病后一年以上）和 HSP[疼痛视觉模拟量表（VAS）≥30mm]的患者随机接受超声引导下 SSN 和 AN 脉冲射频或神经阻滞治疗。所有患者在治疗前（T0）和 4（T1）和 16 周（T2）随访时进行评估。主要结局指标为 VAS 评分。次要结局指标为改良 Ashworth 量表（MAS）评分、被动肩部活动范围（PROM）、残疾评估量表（DAS）评分和 EuroQol-5 维度问卷（EQ-5D）。

结果

两组在 T1 和 T2 时 VAS 评分均有显著改善。然而，两组之间没有观察到显著差异（T1：P=0.43；T2：P=0.23）。两组在 T1（P=0.06）和 T2（P=0.07）时 MAS 评分无统计学差异。在肩外展和外旋的 PROM 中，两组在 T1（P=0.02*，& P=0.04*）和 T2（P=0.02*，& P=0.00*）时存在统计学显著差异。两组在 T1（P=0.23，& P=0.35）和 T2（P=0.14，& P=0.14）时肩前屈和伸展无统计学差异。两组在 T1（P=0.51，& P=0.33，& P=0.36，& P=0.75）和 T2（P=0.12，& P=0.54，& P=0.41，& P=0.86）时 DAS 评分无统计学差异。两组在 T1（P=0.42）和 T2（P=0.11）时 EQ-5D 反应无统计学差异。