超声引导下肩关节腔注射联合液压扩张治疗不同临床分期冻结肩  

Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage

作　　者：周玉兰 袁德超 吴超[2,3] 林旭[2] 李涛[2] 李英[1] 曾健 周欢 ZHOUYulan;YUAN Dechao;WU Chao;LIN Xu;LI Tao;LI Ying;ZENG Jian;ZHOU Huan(Department of Ultrasound,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China;Department of Orthopedics,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China;Digital Medical Center,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China)

机构地区：[1]自贡市第四人民医院超声科,四川自贡643000 [2]自贡市第四人民医院骨科,四川自贡643000 [3]自贡市第四人民医院数字医学中心,四川自贡643000

出　　处：《华西医学》2021年第12期1679-1685,共7页West China Medical Journal

基　　金：自贡市第四人民医院2021年院级科研计划院内培育项目。

摘　　要：目的探讨超声引导下肩关节腔注射联合液压扩张治疗不同临床分期冻结肩的疗效。方法回顾性收集2020年1月—2021年1月在自贡市第四人民医院诊断为冻结肩患者的临床资料。患者根据冻结肩临床分期分为3组(Ⅰ期、Ⅱ期、Ⅲ期);均自愿接受超声引导下肩关节腔注射联合液压扩张治疗,每2周接受1次治疗,连续治疗3次,随访6个月。在治疗前和开始治疗后2周、4周、2个月、4个月及6个月分别进行视觉模拟评分(Visual Analogue Scale,VAS)、肩关节主动活动范围评分(Active Range of Shoulder Motion,AROM)以及肩关节囊厚度测量。结果共纳入患者150例,其中Ⅰ期61例、Ⅱ期74例、Ⅲ期15例。纳入患者的患侧肩关节囊厚度均较健侧增厚(t=24.384,P<0.001),治疗后肩关节囊厚度、VAS评分均较治疗前减小(P<0.05),AROM评分均较治疗前增加(P<0.05)。治疗前,Ⅱ期患者肩关节囊厚度高于Ⅰ期、Ⅲ期患者[(4.3±1.0)vs.(2.9±0.5)vs.(3.1±0.4)mm;F=57.195,P<0.001];且Ⅱ期患者在治疗后4周、2个月、4个月、6个月时肩关节囊厚度减小值最大(P<0.05)。与Ⅱ期、Ⅲ期比较,Ⅰ期患者治疗前VAS评分最高[(7.7±0.7)vs.(5.1±0.8)vs.(4.5±0.7)分;F=233.560,P<0.001];在治疗后4周(F=1.679,P=0.190)、4个月(F=1.348,P=0.263)、6个月(F=0.940,P=0.393)时3组间VAS评分差异无统计学意义,在治疗后2周(F=66.924,P<0.001)、2个月(F=9.598,P<0.001)时3组间VAS评分差异均有统计学意义。与Ⅰ期、Ⅲ期患者比较,Ⅱ期患者治疗前AROM评分最低[(15.2±1.8)vs.(23.5±1.9)vs.(26.1±3.5)分;F=343.718,P<0.001];在治疗后4周(F=0.034,P=0.967)、2个月(F=0.222,P=0.801)、4个月(F=0.634,P=0.532)、6个月(F=0.001,P=0.999)时3组间AROM评分差异无统计学意义,在治疗后2周时3组间AROM评分差异有统计学意义(F=177.135,P<0.001)。结论超声引导下肩关节腔注射联合液压扩张治疗不同临床分期冻结肩均能取得良好疗效,尽早接受注射治疗可以缩短病程Objective To investigate the effect of ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage. Methods The clinical data of patients with frozen shoulder diagnosed in Zigong Fourth People’s Hospital from January 2020 to January 2021 were collected retrospectively. The patients were divided into three groups according to the clinical stage of frozen shoulder(stage Ⅰ, stage Ⅱ and stage Ⅲ). All patients volunteered to receive ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation for 3 consecutive times, with a 2-week interval for each treatment,and followed up for 6 months. Before treatment and 2 weeks, 4 weeks, 2 months, 4 months and 6 months after treatment,the patients were scored with Visual Analog Scale(VAS) and Active Range of Shoulder Motion(AROM), and the capsule thickness of shoulder were measured, respectively. Results A total of 150 patients were included, including 61 patients in stage Ⅰ, 74 patients in stage Ⅱ and 15 patients in stage Ⅲ. The thickness of shoulder joint capsule on the affected side was thicker than that on the healthy side(t=24.384, P<0.001). After treatment, the thickness of shoulder joint capsule and VAS score decreased(P<0.05), and the AROM score increased(P<0.05). Before treatment, the thickness of shoulder joint capsule in stageⅡpatients was higher than that in stageⅠand Ⅲ patients [(4.3±1.0) vs.(2.9±0.5) vs.(3.1±0.4) mm;F=57.195, P<0.001]. Four weeks, 2 months, 4 months and 6 months after treatment, the decrease of shoulder joint capsule thickness was the largest in stageⅡpatients(P<0.05). Compared with stageⅡand Ⅲ patients, stageⅠpatients had the highest VAS score before treatment(7.7±0.7 vs. 5.1±0.8 vs. 4.5±0.7;F=233.560, P<0.001). There was no significant difference in VAS scores among the three groups 4 weeks(F=1.679, P=0.190), 4 months(F=1.348, P=0.263) or 6 months(F= 0.940, P=0.393) after treatme

关 键 词：冻结肩 超声检查 关节腔注射 关节囊扩张 临床分期 

分 类 号：R686[医药卫生—骨科学]