超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗偏瘫肩痛的随机对照研究

关键词：偏瘫肩痛  肩峰下滑囊  类固醇激素  神经肌肉电刺激

Keywords:hemiplegic shoulder pain  subacromial-subdeltoid bursa  corticosteroid injection  neuromuscular electrical stimulation

摘要：

      摘要 目的：研究超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗对脑卒中偏瘫后肩痛的影响。 方法：选择偏瘫肩痛的患者为研究对象，随机分为观察组和对照组，每组各30例，两组均给予常规康复，对照组给予肩峰下滑囊注射类固醇注射治疗，观察组在对照组基础上增加神经肌肉电刺激疗法。在治疗前、治疗后第1个月、3个月时对所有患者进行视觉模拟评量表（VAS）评分、被动肩关节活动度（PROM）、Fugl-Meyer（FMA）上肢功能评分及改良Barthel指数（MBI）评分。 结果：治疗前两组患者一般人口学特征无显著性差异，就病程、年龄和治疗前指标而言，两组具有可比性（P>0.05）。两组患者治疗前后VAS评分、Fugl-Meyer上肢功能评分、PROM及MBI比较，均具有显著性差异(P＜0.01)。观察组治疗后各时间点肩关节活动度（尤其外展和外旋）角度、Fugl-Meyer上肢功能评分、MBI评分均高于对照组（P＜0.01）；而VAS 评分均低于对照组，有显著性意义（P＜0.01）。 结论：超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗偏瘫肩痛能够有效缓解患者的肩痛症状，改善上肢运动功能，提高日常生活能力。

Abstract:

      Abstract Objective： To investigate the efficacy of ultrasound-guided subacromial-subdeltoid （SASD）bursa corticosteroid injection and neuromuscular electrical stimulation in patients with hemiplegic shoulder pain (HSP). Method： Patients with HSP were randomly divided into a control group (n=30) and a observation group (n=30). In two groups， the rehabilitation were adopted. Additionally， the observation group received SASD bursa corticosteroid injection and neuromuscular electrical stimulation； the control group received standard SASD bursa corticosteroid injection alone. Visual analogue scale (VAS)， passive range of motion (PROM) of the shoulder， upper extremity Fugl-Meyer assessment (FMA) score， and Modified Barthel index (MBI) score were assessed at baseline， 1 or 3 months after the injection. Result： There was no statistical difference in the general characteristics between the two groups. In the terms of duration of treatment， age， and pre-treatment indicators， the two groups were comparable (P＞0.05). Both two groups showed a significant improvement at each time point during the follow-up when compared to the baseline(P＜0.01). After the treatment，PROM including (abduction and extension rotation)， FMA， and MBI scores during follow-up were significantly higher in the observation group than in the control group(P<0.01). Moreover， comparing to the control group， the observation group showed greater VAS score reduction(P＜0.01). Conclusion： Ultrasound (US)-guided subacromial-subdeltoid bursa corticosteroid injection and neuromuscular electrical stimulation can effectively relieve pain and improve the upper limb function and activity of daily living in patients with HSP.