Efficacy and risk factors of ultrasound-guided low-dose compound betamethasone injection on shoulder joint function in patients with rotator cuff injury
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摘要:
目的 探究超声引导下小剂量复方倍他米松注射对肩袖损伤患者肩关节功能的改善效果，并分析影响其疗效的因素，旨在为临床提升肩袖损伤患者治疗效果提供帮助。 方法 回顾性选择2022年1月—2023年3月于东阳市人民医院接受治疗的96例肩袖损伤患者作为研究对象。患者均接受超声引导下注射小剂量复方倍他米松治疗。比较患者不同时点疼痛水平，治疗前及治疗1个月时肩关节功能、上肢运动能力、日常生活能力。根据治疗1个月时Neer肩关节功能评分评估患者临床疗效，根据评分分为优良组、中差组。统计患者基线资料，采用二元logistic回归分析影响肩袖损伤患者超声引导下小剂量复方倍他米松注射治疗后临床疗效的因素。 结果 治疗1个月时，经Neer评分评估，优良率为80.21%(77/96)。治疗1个月时患者Neer评分高于治疗前(P＜0.05)；治疗后1 h、1周、1个月时VAS评分均低于治疗前(P＜0.05)；治疗1个月时患者上肢Fugl-Meyer功能评分、Barthel指数评分均高于治疗前(P＜0.05)；治疗1个月时，患者肩关节主动关节活动度均高于治疗前(P＜0.05)；二元logistic回归分析结果显示，年龄≥60岁、劳动强度为Ⅲ~Ⅳ级、合并糖尿病均是影响肩袖损伤患者临床疗效的危险因素(OR＞1，P＜0.05)。 结论 超声引导下注射小剂量倍他米松能够有效改善肩袖损伤患者肩关节功能，提升患者上肢运动及日常生活能力，同时年龄、劳动强度、合并糖尿病与患者临床疗效密切相关。 Abstract:Objective To explore the effect of ultrasound-guided low-dose compound betamethasone injection on shoulder joint function in patients with rotator cuff injuries, and to analyze the factors affecting its efficacy, to provide help for clinical improvement of the therapeutic effect of patients with rotator cuff injury. Methods A retrospective study was conducted to select the clinical data of 96 patients with rotator cuff injuries who were treated in Dongyang People' s Hospital from January 2022 to March 2023 as the study subjects. All patients were treated with an ultrasound-guided injection of low-dose betamethasone combined with ropivacaine. The pain level at different time points, shoulder joint function, upper limb motor ability, and daily living ability before treatment and 1 month after treatment were compared. The clinical efficacy of the patients was evaluated according to the Neer shoulder function score at 1 month of treatment. According to the score, the patients were divided into an excellent group and a poor group. The baseline data of patients were statistically analyzed, and binary logistic regression analysis was used to analyze the factors affecting the clinical efficacy of ultrasound-guided low-dose hormone injection in patients with rotator cuff injury. Results After 1 month of treatment, the excellent and good rate was 80.21% (77/96) evaluated by Neer score. The Neer scores at 1 month of treatment were higher than those before treatment (P<0.05). The VAS scores at 1 hour, 1 week, and 1 month after treatment were lower than those before treatment and showed a downward trend (P<0.05). The upper limb Fugl-Meyer functional score and Barthel index score of the patients at 1 month after treatment were higher than those before treatment (P<0.05). At 1 month of treatment, the active range of motion of shoulder joint mobility was higher than that before treatment (P<0.05). The results of binary logistic regression analysis showed that age ≥ 60 years old, labor intensity of grade Ⅲ-Ⅳ, and diabetes mellitus were risk factors affecting the clinical efficacy of patients with rotator cuff injury (OR>1, P<0.05). Conclusion Ultrasound-guided injections of low-dose betamethasone combined with ropivacaine can effectively improve shoulder joint function, upper limb movement, and daily living ability of patients with rotator cuff injuries. At the same time, age, labor intensity, and diabetes are closely related to the clinical efficacy of patients. -
Key words:
- Rotator cuff injury /
- Betamethasone /
- Ultrasound guidance /
- Shoulder joint function /
- Risk factors
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表 1 肩袖损伤患者治疗前后肩关节活动情况比较(x±s，°)
Table 1. Comparison of shoulder joint activity in patients with rotator cuff injury before and after treatment (x±s, °)
时间 例数 外展AROM 前屈AROM 外旋AROM 内旋AROM 治疗前 96 104.28±11.72 130.88±7.79 30.05±6.72 42.58±4.62 治疗后 96 121.72±10.54 158.24±7.84 45.03±5.35 58.61±4.52 t值 11.020 22.247 15.607 23.498 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 
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表 2 2组肩袖损伤患者基线资料比较
Table 2. Comparison of baseline data between two groups of patients with rotator cuff injury
项目 中差组(n=19) 优良组(n=77) 统计量 P值 性别[例(%)] 1.416a 0.234 男性 9(47.37) 48(62.34) 女性 10(52.63) 29(37.66) 年龄[例(%)] 9.463a 0.002 ＜60岁 8(42.11) 60(77.92) ≥60岁 11(57.89) 17(22.08) BMI(x±s) 23.86±1.04 24.11±1.24 0.810b 0.420 发病侧[例(%)] 0.064a 0.800 左侧 7(36.84) 26(33.77) 右侧 12(63.16) 51(66.23) 主力侧[例(%)] 0.064a 0.800 是 12(63.16) 51(66.23) 否 7(36.84) 26(33.77) 劳动强度[例(%)] 5.614a 0.018 Ⅰ~Ⅱ级 10(52.63) 63(81.82) Ⅲ~Ⅳ级 9(47.37) 14(18.18) 合并糖尿病[例(%)] 15.758a ＜0.001 是 8(42.11) 4(5.19) 否 11(57.89) 73(94.81) 合并高血压[例(%)] 0.021a 0.885 是 6(31.58) 23(29.87) 否 13(68.42) 54(70.13) 合并高脂血症[例(%)] 0.117a 0.733 是 5(26.32) 15(19.48) 否 14(73.68) 62(80.52) 吸烟史[例(%)] 0.436a 0.509 有 4(21.05) 22(28.57) 无 15(78.95) 55(71.43) 饮酒史[例(%)] 0.485a 0.486 有 6(31.58) 31(40.26) 无 13(68.42) 46(59.74) 注: a为χ2值，b为t值。
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表 3 变量赋值情况
Table 3. Variable assignment
变量 赋值方法 年龄 ＜60岁=0，≥60岁=1 劳动强度 Ⅰ~Ⅱ级=0，Ⅲ~Ⅳ级=1 合并糖尿病 否=0，是=1
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表 4 肩袖损伤患者临床疗效影响因素的二元logistic回归分析
Table 4. Binary logistic regression analysis of factors influencing clinical efficacy in patients with rotator cuff injury
变量 B SE Waldχ2 P值 OR值 95% CI 年龄≥60岁 1.882 0.671 7.861 0.005 6.566 1.762~24.471 劳动强度为Ⅲ~Ⅳ级 1.483 0.668 4.928 0.026 4.404 1.190~16.304 合并糖尿病 2.473 0.797 9.628 0.002 11.855 2.486~56.526
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