超声引导臂丛神经水分离治疗神经型胸廓出口综合征的疗效及高密度表面肌电研究

关键词：超声引导  神经型胸廓出口综合征  表面肌电  臂丛卡压  神经水分离

Keywords:ultrasound-guided  neurogenic thoracic outlet syndrome  surface electromyography  brachial plexus entrapment  hydrodissection

摘要：

      摘要 目的：观察超声引导臂丛神经水分离治疗神经型胸廓出口综合征的临床疗效及治疗前、后胸廓出口区的表面肌电信号（surface electromyography， sEMG）变化。 方法：采用随机对照试验，将50例拟诊为神经型胸廓出口综合征患者按随机数字表法分成对照组和治疗组各25例，两组均给予消炎镇痛药物、微波照射和针灸治疗，治疗组在此基础上给予超声引导臂丛神经水分离注射治疗。记录两组治疗前、治疗后1周、1个月的疼痛视觉评分（visual analogue scale， VAS）评分，同时记录超声引导臂丛神经水分离治疗患者主观感受评价及不良反应发生率。采集治疗组治疗前、治疗后1周的胸廓出口区高密度sEMG，记录患者完成转颈动作时的sEMG，计算每个通道sEMG的均方根值（root mean square， RMS），经平滑处理后得到受试者胸廓出口区sEMG地形图， 通过对地形图的分析评估患者胸廓出口区相关神经肌肉的协同活动情况。 结果：治疗前两组疼痛VAS评分比较，差异无显著性意义（P＞0.05），治疗1周后两组疼痛VAS评分较治疗前降低，差异有显著性意义（P＜0.05），治疗后1个月治疗组疼痛VAS评分进一步改善（P＜0.05），对照组VAS评分较治疗后1周无明显变化（P＞0.05）；超声引导臂丛神经水分离治疗过程中大部分患者（70%）颈肩部酸胀、痛，部分患者（15%）颈部酸痛同时伴上臂、肩后放射痛，部分患者（15%）注射部位疼痛伴手一过性麻木，疼痛改善起效时间平均为注射后（4.0±1.5）h；治疗组治疗前，转颈动作时，患侧胸廓出口区sEMG均方根值地形图强活动区能量和的平均强度为（66.92±12.05）μV，治疗后1周平均强度为（57.34±6.04）μV，与治疗前相比下降，差异有显著性意义（P＜0.05）。 结论：超声引导臂丛神经水分离注射治疗神经型胸廓出口综合征有效，患者胸廓出口区的神经肌肉存在异常协调模式。

Abstract:

      Abstract Objective： To observe the clinical efficacy of ultrasound-guided hydrodissection of the brachial plexus in treating neurogenic thoracic outlet syndrome （nTOS） and the changes in surface electromyography （sEMG） signals in the thoracic outlet region before and after treatment. Method： In this randomized controlled trial, fifty patients diagnosed with nTOS were randomly divided into control group and treatment group（25 patients each）. Both groups received anti-inflammatory analgesics， microwave therapy irradiation， and acupuncture. The treatment group additionally received ultrasound-guided hydrodissection injection therapy of the brachial plexus. The visual analogue scale （VAS） pain scores of both groups were assessed before treatment， and at 1 week and 1 month post-treatment. Patient-reported outcomes were evaluated during the ultrasound-guided hydrodissection injection. High-density sEMG of the thoracic outlet region was collected in the treatment group before treatment and 1 week post-treatment. sEMG was recorded during head rotation. The root mean square （RMS） value of the sEMG signal for each channel was calculated. After smoothing， sEMG topographic maps of the thoracic outlet region were generated. Analysis of the RMS topographic maps was used to assess the synergistic activity of relevant neuromuscular structures in the thoracic outlet region. Result： There was no significant difference in baseline VAS pain scores between the two groups （P>0.05）. At 1 week post-treatment， VAS scores decreased significantly in both groups compared to baseline （P<0.05）. At 1 month post-treatment， the treatment group showed further significant improvement in VAS scores （P<0.05）， while the control group showed no significant change compared to their 1-week scores （P>0.05）. During ultrasound-guided hydrodissection injection， most patients （70%） experienced neck and shoulder soreness and pain； some （15%） experienced neck soreness with concurrent radiating pain to the upper arm and posterior shoulder； and some （15%） experienced injection site pain with transient hand numbness. The average onset time for pain improvement was （4.0±1.5） hours post-injection. In the treatment group before treatment， the average intensity of the high-activity region sum in the RMS sEMG topographic map of the affected thoracic outlet region during head rotation was （66.92±12.05） μV. At 1 week post-treatment， this value decreased significantly to （57.34±6.04） μV （P<0.05）. Conclusion： Ultrasound-guided hydrodissection injection of the brachial plexus was found to be effective for nTOS. Patients demonstrated abnormal neuromuscular coordination patterns in the thoracic outlet region.