超声引导肌间沟连续臂丛阻滞下手法松解治疗冻结肩和术后镇痛下功能锻炼的疗效  

Effects of ultrasound-guided continuous interscalene brachial plexus block for manipulation and post-operative analgesia for functional exercise in the treatment of patients with frozen shoulder pain

作　　者：薄存菊[1] 宫庆娟[1] 卢振和[1] 黄乔东[1] 陈金生[1] 刘少颜[1] 刘东阳[1] 

机构地区：[1]广州医科大学附属第二医院疼痛科,510260

出　　处：《实用疼痛学杂志》2015年第4期252-255,共4页Pain Clinic Journal

基　　金：广州市珠江科技新星项目资助（NO.2012J2200036）;国家临床重点专科建设项目财社（2013）240

摘　　要：目的观察超声引导连续肌间沟臂丛阻滞下肩部手法松解及术后镇痛下功能锻炼的疗效。方法在可视B型超声引导下探查肌间沟臂丛并进行臂丛置管，以2％利多卡因与1％罗哌卡因混合液15ml阻滞后行肩部手法松解术，术后3d连接镇痛泵时行肩部功能自主锻炼。术前及松解术后2周评定疼痛VAS，并以Constant—Murley肩关节功能评分对肩关节功能进行评价。结果VAS评分由术前（8．7±2．2）下降至术后（1．6±0．9）；Constant—Murley肩关节功能评分由术前平均（12．5±2．1）提高到术后平均（27．2±2．4），被动前屈、外展、外旋活动度由术前分别平均（86．0°±10．8°）、（47．4°±7．5°）、（4．3°±7．8°）提高至术后平均（142．1°±11．8°）、（92．6°±12．1°）、（57．6°±19．8°）。结论B型超声引导下肌间沟臂丛置管手法松解治疗冻结肩安全，疗效确切，术后低浓度罗哌卡因连续镇痛效果良好，能够促进患者术后自丰功能锻炼．Objective To evaluate the clinical effects of ultrasound-guided continuous intersca- lene brachial plexus block and catheterization for manipulation and postoperative analgesia for functional exer- cise in severe scapulohumeral periarthritis. Methods Manipulation of shoulder joint was operated under the nerve block with mixture of 2% lidocaine and 1% ropivacaine 15 ml after ultrasound-guided interscalene bra- ehial plexus l, loek and catheterization. A continuous pump was connected to the catheter with 0.2% ropivacaine during shoulder functional exercises. VAS and the shoulders function examination with Constant-Murley scale （CMS） were evaluated at 14 days after the operation. Results VAS dropped from preoperative （8.7 ± 2.2） to postoperative （1.6 ± 0.9）; CMS increased from preoperative （12.5 ± 2.1） to postoperative （27.2 ± 2.4）. Range of passive antexion, abduction and extorsion increased from preoperative average （86.0°± 10.8° ） , （47.4°± 7.5° ）, （4.3°± 7.8° ） to postoperative average （ 142.1 °±11.8°）, （92.6°± 12.1 ° ）, （57.6°± 19.8° ） re- spectively. Conclusion Ultrasound-guided interscalene brachial plexus block and catheterization during ma- nipulation and postoperative continuous analgesia with low concentration of ropivacaine is a safe and effective analgesic method and promotes the postoperative functional exercises.

关 键 词：超声引导 臂丛 神经传导阻滞 肌肉骨骼手法 冻结肩 

分 类 号：R614.4[医药卫生—麻醉学]