超声引导下肩袖间隙与痛点注射消炎镇痛混合液治疗肩袖损伤的效果比较

单玲玲; 徐琼; 王鹏飞; 张丽; 杜信; 杜奋飞

doi:10.16766/j.cnki.issn.1674-4152.003130

超声引导下肩袖间隙与痛点注射消炎镇痛混合液治疗肩袖损伤的效果比较

doi: 10.16766/j.cnki.issn.1674-4152.003130

东阳市人民医院康复科，浙江金华 322100

基金项目:

浙江省医药卫生科技计划项目 2022ZH065

金华市科学技术局科技计划项目 2022-3-026

详细信息

通讯作者:
杜奋飞，E-mail：dilj42@163.com

中图分类号: R681.7 R493
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出版历程
- 收稿日期: 2023-03-30
- 网络出版日期: 2023-09-13

Comparison of the effects of ultrasound-guided injection of anti-inflammatory and analgesic mixture into the rotator cuff space and pain points in the treatment of rotator cuff injuries

Rehabilitation Department of Dongyang People ' s Hospital, Jinhua, Zhejiang 322100, China

摘要

摘要: 目的肩关节注射疗法作为肩袖损伤的主要治疗手段，可分为超声引导下肩袖间隙与传统痛点注射治疗，本研究主要比较二者的效果差异。方法选取2020年4月—2022年10月在东阳市人民医院接受肩关节注射治疗的92例肩袖损伤患者，采用随机数字表法分为超声引导注射组(46例)和传统痛点注射组(46例)，分别在超声引导下肩袖间隙、依据传统痛点注射法进行消炎镇痛混合液注射，均每2周1次，持续注射3次。比较2组治疗前后视觉模拟疼痛(VAS)评分、血清C-反应蛋白(CRP)、肩关节Constant-Murley评分、需口服镇痛药物及皮下瘀斑发生率。结果 2组治疗2、4、6周VAS评分和血清CRP水平均低于治疗前(均P＜0.05)，且超声引导注射组上述时间点VAS评分和血清CRP水平均显著低于传统痛点注射组(均P＜0.05)。2组治疗2、4、6周肩关节Constant-Murley评分均高于治疗前(均P＜0.05)，且超声引导注射组治疗4、6周肩关节Constant-Murley评分明显高于传统痛点注射组(均P＜0.05)。超声引导注射组口服镇痛药物占21.74%(10/46)低于传统痛点注射组的41.30%(19/46，P＜0.05)；组间皮下瘀斑发生率比较差异无统计学意义(P＞0.05)。结论超声引导下肩袖间隙与痛点注射消炎镇痛混合液治疗肩袖损伤均有较好的效果，但前者在减轻肩袖疼痛、下调血清CRP水平、改善肩关节功能和减少口服镇痛药物方面有明显优势。
- 肩袖损伤 /
- 超声引导 /
- 肩袖间隙 /
- 痛点注射法
Abstract: Objective Shoulder joint injection therapy, as the main treatment for rotator cuff injuries, can be divided into ultrasound-guided rotator cuff space injection therapy and traditional pain point injection therapy. This study mainly compares the therapeutic differences between the two treatments. Methods From April 2020 to October 2022, 92 patients with rotator cuff injury who received conservative treatment with drug injection in Dongyang People ' s Hospital were divided into ultrasound-guided injection group (n=46) and traditional pain spot injection group (n=46) using the random number table method. The anti-inflammatory and analgesic mixture was injected into the rotator cuff space under ultrasound guidance and according to the traditional pain spot injection method once every 2 weeks and continuously 3 times, respectively. The visual analogue pain (VAS) score, serum C-reactive protein (CRP), Constant Murley shoulder joint score, need for oral analgesics and incidence of subcutaneous ecchymosis were compared between the two groups before and after treatment. Results VAS scores and serum CRP levels were lower in the two groups at 2, 4 and 6 weeks of treatment than before treatment (all P < 0.05), and VAS scores and serum CRP levels at the above-mentioned time points were significantly lower in the ultrasound guided injection group than in the traditional pain point injection group (all P < 0.05). The shoulder joint Constant-Murley score in the two groups at 2, 4, 6 weeks of treatment was higher than that before treatment (all P < 0.05), and the shoulder joint Constant-Murley score in the ultrasound-guided injection group at 4, 6 weeks of treatment was significantly higher than that in the traditional pain point injection group (all P < 0.05).In the ultrasound-guided injection group, 21.74% (10/46) of oral analgesic drugs were less than 41.30% (19/46) in the traditional pain point injection group (P < 0.05), and there was no statistically significant difference in the incidence of subcutaneous ecchymosis between groups (P>0.05). Conclusion Ultrasound-guided injection of an anti-inflammatory and analgesic mixture into the rotator cuff space and pain points has a good effect in the treatment of rotator cuff injuries, however, the former has significant clinical advantages in reducing rotator cuff pain, lowering serum CRP levels, promoting the recovery of shoulder joint function and reducing oral analgesic drugs.
- Shoulder sleeve injury /
- Ultrasound guidance /
- Shoulder sleeve gap /
- Pain point injection method

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图 1 超声引导下明确肩袖间隙位置

Figure 1. Ultrasound guided determination of the position of the rotator cuff gap

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图 2 超声引导下针尖到达肩袖间隙

Figure 2. Ultrasound guided needle tip reaching the shoulder sleeve gap

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图 3 超声引导下于肩袖间隙缓慢注射药物

Figure 3. Ultrasound guided slow injection of medication into the rotator cuff space

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表 1 2组肩袖损伤患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients with rotator cuff injury

组别	例数	性别(例)		年龄(x±s，岁)	病程(x±s，d)	患侧(例)		损伤类型(例)
组别	例数	男性	女性	年龄(x±s，岁)	病程(x±s，d)	左	右	部分撕裂	全层小撕裂
超声引导注射组	46	28	18	53.97±10.25	21.18±7.25	25	21	35	11
传统痛点注射组	46	31	15	55.06±11.32	19.92±8.14	22	24	37	9
统计量		0.425^a		0.484^b	0.784^b	0.392^a		0.256^a
P值		0.514		0.630	0.435	0.532		0.613
注：^a为χ²值，^b为t值。

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表 2 2组肩袖损伤患者治疗前后VAS评分比较(x±s，分)

Table 2. Comparison of VAS scores before and after treatment in 2 groups with rotator cuff injury(x±s, points)

组别	例数	治疗前	治疗2周	治疗4周	治疗6周	F值	P值
超声引导注射组	46	5.93±1.24	3.03±0.85^a	2.14±0.59^a	1.03±0.31^a	32.857	＜0.001
传统痛点注射组	46	6.04±1.32	3.75±1.04^a	2.79±0.74^a	1.42±0.35^a	24.081	＜0.001
t值		0.412	3.636	4.658	5.657
P值		0.682	＜0.001	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组肩袖损伤患者治疗前后血清CRP水平比较(x±s，mg/L)

Table 3. Comparison of serum CRP levels before and after treatment in 2 groups with rotator cuff injury(x±s, mg/L)

组别	例数	治疗前	治疗2周	治疗4周	治疗6周	F值	P值
超声引导注射组	46	43.18±6.37	21.73±5.21^a	14.62±3.53^a	11.80±3.37^a	21.387	＜0.001
传统痛点注射组	46	42.73±6.25	28.08±5.46^a	18.23±4.24^a	14.01±3.62^a	16.584	＜0.001
t值		0.342	5.707	4.257	3.031
P值		0.733	＜0.001	＜0.001	0.003
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组肩袖损伤患者治疗前后肩关节Constant-Murley评分比较(x±s，分)

Table 4. Comparison of Constant-Murley score of shoulder joint between 2 groups of patients with rotator cuff injury before and after treatment(x±s, points)

组别	例数	治疗前	治疗2周	治疗4周	治疗6周	F值	P值
超声引导注射组	46	42.37±7.01	56.72±7.37^a	68.25±7.47^a	75.41±8.05^a	25.806	＜0.001
传统痛点注射组	46	44.08±6.87	53.97±7.30^a	61.25±7.13^a	68.73±7.79^a	20.157	＜0.001
t值		1.182	1.798	4.597	4.044
P值		0.241	0.076	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 5 2组肩袖损伤患者口服镇痛药物和皮下瘀斑发生率比较[例(%)]

Table 5. Comparison of the incidence of oral analgesics and subcutaneous ecchymosis between two groups of patients with rotator cuff injury[cases(%)]

组别	例数	口服镇痛药物	皮下瘀斑
超声引导注射组	46	10(21.74)	0
传统痛点注射组	46	19(41.30)	3(6.52)
χ²值		4.079	1.378^a
P值		0.043	0.240
注：^a为采用连续性校正。

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