超声引导下肩上神经松解术配合葛根汤加味熏洗对肩部撞击症合并肩胛上神经卡压综合征患者肩关节功能和日常生活能力的影响  

Effect of ultrasound-guided shoulder nerve release combined with Pueraria decoction by washing and fumigation on shoulder function and daily living ability in patients with shoulder collision injury combined with suprascapular nerve compression syndrome

作　　者：李勇 张胜利 戴勇华 靳西勇 LI Yong;ZHANG Shengli;DAI Yonghua;JIN Xiyong(The 946th Hospital of Chinese PLA, Yining 835000, Xinjiang, China)

机构地区：[1]解放军第946医院

出　　处：《现代中西医结合杂志》2019年第19期2096-2101,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察超声引导下肩上神经松解术配合葛根汤加味熏洗对肩部撞击症合并肩胛上神经卡压综合征(SNE)患者肩关节功能和日常生活能力的影响。方法将60例肩部撞击症合并SNE患者随机分为观察组30例和对照组30例,对照组给予超声引导下肩上神经松解术治疗,观察组在对照组基础上给予葛根汤熏洗治疗,疗程均为3个月。观察2组治疗前后疼痛、肩关节活动度(ROM)、上肢肌力、MRI检查指标、Neer肩关节功能评分和日常生活能力量表(ADL)评分变化,比较2组临床疗效。结果2组治疗后现有疼痛强度(PPI)分级、评分均较治疗前显著降低(P均<0.05),且观察组均显著低于对照组(P均<0.05)。2组治疗后肩关节活动度中前屈(上举)、外展(上举)、后伸、内收、外旋、内旋角度均显著增大(P均<0.05),观察组治疗后以上角度均大于对照组(P均<0.05);2组治疗后上肢肌力分级、平均分级均较治疗前显著改善(P均<0.05),观察组的改善情况显著优于对照组(P均<0.05);2组治疗后肩关节MRI检查显示肩肱间距显著提高(P均<0.05),肩峰下积液厚度、肩峰角、肩锁关节骨赘高度、喙肩韧带厚度均显著降低(P均<0.05),观察组改善情况显著优于对照组(P均<0.05)。2组治疗后Neer肩关节功能评分中疼痛、关节功能、活动范围、解剖稳定性评分和总分均较治疗前显著增高(P均<0.05),观察组治疗后以上评分均高于对照组(P均<0.05);2组治疗后ADL量表中洗漱、穿脱衣服、床椅转移、进食、上厕所、上下楼梯、平地行走、洗澡评分和总分均较治疗前显著升高(P均<0.05),观察组前5项单项评分和总评分均显著高于对照组(P均<0.05)。观察组临床疗效显著优于对照组(P<0.05)。结论超声引导下肩上神经松解术配合葛根汤加味熏洗可显著缓解肩部撞击症合并SNE患者肩关节疼痛症状,改善上肢肌力与肩关节活动度,提高肩关节功能与日常生活能Objective It is to observe the effect of ultrasound-guided shoulder nerve release combined with Pueraria decoction by washing and fumigation on shoulder function and daily living ability in patients with shoulder collision injury combined with suprascapular nerve compression syndrome (SNE). Methods Sixty patients with shoulder collision injury and SNE were randomly divided into observation group (30 cases) and control group (30 cases). The control group was treated with ultrasound-guided supra-scapular nerve lysis. The observation group was given Pueraria decoction by washing and fumigation on the basis of the control group. The courses of treatment were 3 months. The changes of pain, rang of motion (ROM) of should joint, upper limb muscle strength, MRI examination index, Neer shoulder function score and daily life ability scale (ADL) scores of the two groups before and after treatment were observed, the clinical efficacy of the two groups was compared. Results The classification and scores of present pain intensity (PPI) were significantly lower after treatment than those before treatment in the two groups( P <0.05), and decrease in the observation group was more significant than the control group ( P <0.05). After treatment, the angle of anterior flexion (uplift), abduction (uplift), posterior extension, adduction, external rotation and internal rotation in the shoulder joint motion were significantly increased in the two groups( P <0.05), the angles were larger in the observation group than the control group ( P <0.05). The upper limb muscle strength and average grade were significantly improved after treatment in the two groups( P <0.05), the improvement of the observation group were significantly better than that of the control group ( P <0.05);MRI examination of the shoulder joint after treatment showed a significant increase in the distance between the scapulae ( P <0.05), and the thickness of the subacromial effusion, the shoulder angle, the height of the acromioclavicular joint, and the thickness of the

关 键 词：超声引导 神经松解术 葛根汤 肩部撞击症 肩胛上神经卡压综合征 肩关节功能 日常生活能力 

分 类 号：R684[医药卫生—骨科学]