[1]曹寅生,万云峰,易强,等.肩关节腔内药物联合注射治疗原发性冻结肩[J].中医正骨,2019,31(07):40-43.
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肩关节腔内药物联合注射治疗原发性冻结肩()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年07期
页码:
40-43
栏目:
临床报道
出版日期:
2019-07-20

文章信息/Info

作者:
曹寅生万云峰易强文猛魏腾飞
(湖南中医药大学第一附属医院,湖南 长沙 410007)
关键词:
肩凝症 注射关节内 倍他米松 玻璃酸钠
摘要:
目的:探讨肩关节腔内药物联合注射治疗原发性冻结肩的临床疗效及安全性。方法:2017年9月至2018年12月,采用肩关节腔内药物联合注射治疗原发性冻结肩患者35例。男16例,女19例; 年龄46~68岁,中位数54岁; 左侧13例,右侧22例; 病程3~11个月,中位数7个月。以喙突与肩峰前外侧角连线的中点为进针点穿刺进入肩关节腔后,先后注入复方倍他米松注射液和利多卡因注射液的混合药液及玻璃酸钠注射液,1周1次,共注射4次(后3次均单纯注射玻璃酸钠注射液)。并在治疗期间进行肩关节功能锻炼。记录不良反应发生情况,随访观察肩关节疼痛缓解和功能改善情况。结果:本组35例患者,1例因注射后出现头晕、恶心等晕针反应而退出,共34例患者完成治疗和治疗结束后8周的随访。肩关节疼痛视觉模拟量表评分,治疗前(7.26±0.44)分、治疗4周后(3.24±0.43)分、治疗结束后4周(1.82±0.38)分、治疗结束后8周(1.56±0.50)分; 肩关节Constant-Murley评分,治疗前(28.94±2.64)分、治疗4周后(51.71±3.29)分、治疗结束后4周(58.21±3.62)分、治疗结束后8周(62.76±2.82)分。肩关节被动前屈活动度,治疗前100.02°±4.58°治疗4周后123.09°±4.08°、治疗结束后4周129.41°±4.14°、治疗结束后8周134.21°±5.12°; 肩关节被动外展活动度,治疗前79.24°±3.56°、治疗4周后101.12°±4.21°、治疗结束后4周115.01°±4.54°、治疗结束后8周120.00°±4.54°; 肩关节被动内旋活动度,治疗前42.74°±1.72°、治疗4周后50.76°±1.93°、治疗结束后4周60.18°±2.15°、治疗结束后8周64.94°±2.28°; 肩关节被动外旋活动度,治疗前24.09°±2.08°、治疗4周后44.01°±1.74°、治疗结束后4周50.06°±2.82°、治疗结束后8周51.15°±2.65°。结论:肩关节腔内药物联合注射治疗原发性冻结肩,可有效缓解患肩疼痛、改善肩关节功能,且不良反应少。

参考文献/References:


[1] SUH C H,YUN S J,JIN W,et al.Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder[J].Eur Radiol,2019,29(2):566-577.
[2] WHITE D,CHOI H,PELOQUIN C,et al.Secular trend of adhesive capsulitis[J].Arthritis Care Res(Hoboken),2011,63(11):1571-1575.
[3] HABIB G S,SALIBA W,NASHASHIBI M.Local effects of intra-articular corticosteroids[J].Clin Rheumatol,2010,29(4):347-356.
[4] ITOI E,ARCE G,BAIN G I,et al.Shoulder stiffness:current concepts and concerns[J].Arthroscopy,2016,32(7):1402-1414.
[5] JO C H,SHIN Y H,SHIN J S.Accuracy of intra-articular injection of the glenohumeral joint:a modified anterior approach[J].Arthroscopy,2011,27(10):1329-1334.
[6] TAMBORRINI G,MÖLLER I,BONG D,et al.The rotator interval-a link between anatomy and ultrasound[J].Ultrasound Int Open,2017,3(3):E107-E116.
[7] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:67-68.
[8] HAND C,CLIPSHAM K,REES J L,et al.Long-term outcome of frozen shoulder[J].J Shoulder Elbow Surg,2008,17(2):231-236.
[9] HETTRICH C M,DICARLO E F,FARYNIARZ D,et al.The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis[J].J Shoulder Elbow Surg,2016,25(8):1274-1279.
[10] 刘合亮,魏艳珍,郑世雄,等.中药热奄包热敷联合玻璃酸钠关节腔内注射治疗膝骨关节炎[J].中医正骨,2017,29(8):68-71.
[11] 王凯利,万家兴,李萍.玻璃酸钠联合曲安奈德关节腔内注射配合推拿手法治疗冻结肩[J].中医正骨,2012,24(10):40-41.
[12] NAGO M,MITSUI Y,GOTOH M,et al.Hyaluronan modulates cell proliferation and mRNA expression of adhesion-related procollagens and cytokines in glenohumeral synovial/capsular fibroblasts in adhesive capsulitis[J].J Orthop Res,2010,28(6):726-731.
[13] LIM T K,KOH K H,SHON M S,et al.Intra-articular injection of hyaluronate versus corticosteroid in adhesive capsulitis[J].Orthopedics,2014,37(10):e860-e865.
[14] LHO Y M,HA E,CHO C H,et al.Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder[J].J Shoulder Elbow Surg,2013,22(5):666-672.
[15] RYAN V,BROWN H,MINNS LOWE C J,et al.The pathophysiology associated with primary(idiopathic)frozenshoulder:a systematic review[J].BMC Musculoskelet Disord,2016,17(1):340.
[16] OH J H,OH C H,CHOI J A,et al.Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder:a prospective,randomized short-term comparison study[J].J Shoulder Elbow Surg,2011,20(7):1034-1040.
[17] CHO C H,KIM D H,BAE K C,et al.Proper site of corticosteroid injection for the treatment of idiopathic frozen shoulder:results from a randomized trial[J].Joint Bone Spine,2016,83(3):324-329.
[18] SHIN S J,LEE S Y.Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis[J].J Shoulder Elbow Surg,2013,22(4):521-527.
[19] 蒋勰,陈志超,黄华强,等.不同关节腔注射方法治疗早期冻结肩疗效与安全性分析[J].华西医学,2018,33(12):1495-1499.
[20] SUN Y,LIU S,CHEN S,et al.The Effect of corticosteroid injection into rotator interval for early frozen shoulder:a randomized controlled trial[J].Am J Sports Med,2018,46(3):663-670.

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备注/Memo

备注/Memo:
通讯作者:曹寅生 E-mail:573503083@qq.com(收稿日期:2019-03-17 本文编辑:杨雅)
更新日期/Last Update: 2019-07-20