超声引导下肩胛下肌联合胸大肌A型肉毒毒素注射改善偏瘫后肩痛  

Ultrasound-guided injection of botulinum toxin type A into the subscapularis and pectoralis major muscles alleviates hemiplegic shoulder pain

作　　者：潘录录 朱含章 高立轩 林苏进 程志清[1] 蒋玉燕[1] 潘蓉蓉[1] 支英豪[1] PAN Lulu;ZHU Hanzhang;GAO Lixuan;LIN Sujin;CHENG Zhiqing;JIANG Yuyan;PAN Rongrong;ZHI Yinghao(Department of Rehabilitation 3,Wenzhou TCM Hospital of Zhejiang Chinese Medical University,Wenzhou 325000,China)

机构地区：[1]浙江中医药大学附属温州市中医院康复科3,浙江温州325000

出　　处：《温州医科大学学报》2024年第5期363-370,共8页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y2023128);浙江省基础性公益研究计划项目(LGF20H170001)。

摘　　要：目的:探讨超声引导下肩胛下肌联合胸大肌A型肉毒毒素(BoNT-A)注射对偏瘫后肩痛的影响。方法:选取2023年2月至2024年1月在温州市中医院康复科住院确诊为脑梗死和脑出血的患者为研究对象,采用随机对照原则,将符合纳入标准的36例患者随机分成干预组和对照组,每组18例。干预组在超声引导下向肩胛下肌和胸大肌分别注射100 U(2 mL)的BoNT-A,共200 U(4 mL),对照组则使用等量的0.9%氯化钠溶液。观察治疗后2周、1个月、3个月和6个月偏瘫侧肩部的VAS、无痛被动关节活动范围(pROM)、肌张力(MAS)、上肢功能评分(FMA-UE)和日常生活活动能力评分(MBI)的变化,以及治疗后相关不良反应发生情况。结果:36例患者均顺利完成治疗。两组患者的基线值差异无统计学意义(P>0.05),干预组的VAS和MAS在治疗后2周开始低于对照组(P<0.05),pROM在治疗后1个月开始大于对照组(P<0.05),FMA-UE和MBI在治疗后各个时间点的两组间差异均无统计学意义(P>0.05)。结论:超声引导下肩胛下肌联合胸大肌BoNT-A注射可缓解偏瘫患者的肩痛,减少痉挛,改善肩关节活动度。Objective:To investigate the impact of ultrasound-guided injection of botulinum toxin type A(BoNT-A)into the subscapularis and pectoralis major muscles on shoulder pain in patients with hemiplegia.Methods:Patients diagnosed with cerebral infarction and cerebral hemorrhage admitted to the Rehabilitation Department of Wenzhou TCM Hospital from February 2023 to January 2024 were selected as the research subjects.Using the random control principle,36 eligible patients were divided into the intervention group and the control group,with 18 patients in each.In the intervention group,100 U(2 mL)of BoNT-A was injected into the subscapularis and pectoralis major muscles under ultrasound guidance,totaling 200 U(4 mL).The control group received an equal amount of normal saline injection.The changes in VAS,painless joint range of motion(pROM),muscle tone(MAS),upper limb function score(FMA-UE),and activities of daily living score(MBI)were observed at 2 weeks,1 month,3 months,and 6 months after treatment,along with the occurrence of related adverse reactions.Results:All 36 patients completed the treatment successfully.There was no statistically significant difference in baseline values between the two groups(P>0.05).The VAS and MAS in the intervention group were lower than those in the control group starting from 2 weeks after treatment(P<0.05).The pROM was higher in the intervention group than in the control group starting from 1 month after treatment(P<0.05).There was no significant difference in FMA-UE and MBI between the two groups at each time point after treatment(P>0.05).Conclusion:Ultrasound-guided injection of BoNT-A into the subscapularis and pectoralis major muscles can alleviate shoulder pain,reduce spasticity,and improve shoulder joint mobility in patients with hemiplegia.

关 键 词：偏瘫后肩痛 超声引导 A型肉毒毒素 肩胛下肌 胸大肌 

分 类 号：R493[医药卫生—康复医学]