超声引导液压松解盂肱关节囊联合康复训练治疗冻结肩的临床效果

目的评价可视化超声引导下液压松解盂肱关节囊治疗冻结肩的有效性及安全性。资料与方法纳入55例冻结肩患者,其中Ⅰ期患者17例,Ⅱ期23例,Ⅲ期15例,在可视超声实时引导下,穿刺针经肩关节后斜上方路径液压松解盂肱关节囊,松解治疗后联合同步肩关节康复训练。初次治疗及末次治疗后4周应用肩关节功能评分(Constant-Murley)评定其治疗效果的有效性及安全性。结果55例冻结肩患者Constant-Murley评分均有效,其中评分为优37例,良18例。37例评优的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为15例(88.2%)、13例(56.5%)、9例(60.0%)。18例评良的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为2例(11.7%)、10例(43.4%)、6例(40.0%)。各期冻结肩患者治疗前后Constant-Murley评分比较,差异有统计学意义(P<0.05)。其中Ⅰ期冻结肩患者疗效显著,治疗后1周疼痛及关节活动度基本缓解,4周内症状基本消失。所有患者均在超声引导下一次性穿刺成功,治疗过程中所有患者均能耐受,未发生明显不适及并发症。结论超声引导下液压松解盂肱关节囊治疗冻结肩安全、有效,本穿刺路径治疗联合系统的肩关节康复训练有效提高冻结肩的治疗效果。

Effect of Ultrasound-Guided Hydraulic Release of Glenohumeral Joint Capsule Combined with Rehabilitation Training for Frozen Shoulder

Purpose To evaluate the efficacy and safety of visual ultrasound-guided hydraulic release of glenohumeral joint capsule for frozen shoulder.Materials and Methods Fifty-five patients with frozen shoulder were selected for the study,including 17 patients in stageⅠ,23 patients in stageⅡand 15 patients in stageⅢ.Under the guidance of real-time visual ultrasound,the sacculus of glenohumeral joint was released hydraulically by the puncture needle through the posterior oblique path of the shoulder joint.After the release treatment,it was combined with synchronous shoulder joint rehabilitation training.The efficacy and safety of the treatment were evaluated by the shoulder function score(Constant-Murley)4 weeks after the first and last treatment.Results The Constant-Murley scores of 55 patients with frozen shoulder were all effective.Among them,37 were excellent and 18 were good.Among the 37 patients with frozen shoulders,15 cases(88.2%),13 cases(56.5%)and 9 cases(60.0%)were stage Ⅰ,Ⅱ and Ⅲ,respectively.Among the 18 patients with frozen shoulders who were evaluated well,2(11.7%),10(43.4%)and 6(40.0%)were stage Ⅰ,Ⅱ and Ⅲ,respectively.There was a statistically significant difference in Constant-Murley score between patients with frozen shoulders before and after treatment in each period(P<0.05).Among them,patients with stageⅠfrozen shoulder had significant curative effect.The pain and joint mobility were basically relieved 1 week after treatment,and the symptoms basically disappeared within 4 weeks.All patients underwent successful one-time puncture under ultrasound guidance.During the course of treatment,all patients were tolerated without obvious discomfort and complications.Conclusion Ultrasound-guided hydraulic loosening of the glenohumeral joint capsule is safe and effective for frozen shoulder treatment.This puncture path treatment combined system of shoulder joint rehabilitation training can effectively improve the therapeutic effect of frozen shoulder.