介入性超声与微波治疗脑卒中后肩手综合征疗效比较研究

发布时间：2018-08-02 20:52

【摘要】：目的:1.研究介入性超声注射治疗联合康复训练对脑卒中后肩手综合征Ⅰ期患者的临床疗效,同时与微波治疗联合康复训练组的临床疗效对比。2.对肩手综合征发病原因及发病机制进行初步探讨。方法:选取2014年1月至2016年7月我科收治的脑卒中肩手综合征Ⅰ期患者42例,分为微波联合常规康复训练组(19例)和介入性超声联合常规康复训练组(23例)。治疗组在常规康复治疗基础上予以偏瘫侧肩关节周围软组织肌骨超声引导下介入注射复方倍他米松注射液治疗,对照组在常规康复治疗基础上予以偏瘫侧肩关节微波治疗。采用治疗前后对比,分别于治疗前、治疗后3和10天采用视觉模拟评分(VAS)评价肩关节疼痛程度、测量手背和掌指小关节水肿程度,分别于治疗前和治疗后10天采用简化的Fugl-Meyer上肢运动功能评价量表(FMA)和Barthel指数(BI)评价上肢运动功能和日常生活活动能力。结果:冶疗前治疗组与对照组两组患者在VAS、FMA、BI、手背及掌指小关节水肿情况各项评分比较,差异无明显统计学意义(p0.05)。两组患者VAS评分、水肿评分在治疗后随着时间均呈下降改变,治疗组下降幅度大且速度快,尤其是治疗后3天治疗组的水肿评分已有明显下降;而对照组未见明显改变。两组患者组在治疗后3天及10天在VAS、手背及掌指小关节水肿情况评分比较治疗组较对照组各时点相比均有明显下降,差异均有统计学意义(P0.05)。两组患者FMA、BI评分在治疗后随着时间均呈上升改变,但治疗组治疗后10天在FMA、BI评分同对照组相比,差异无统计学意义(P0.05)。结论:1.超声介入注射治疗在改善脑卒中后肩手综合征Ⅰ期患者肩关节疼痛、手背及掌指小关节水肿方面有明显效果,且超声介入组效果优于微波组。2.超声介入注射能在短时间内改善脑卒中后肩手综合征患者肩痛、手背及掌指小关节水肿,进一步促进患侧上肢运动功能恢复,提高日常生活能力,改善患者生活质量。3.肩手综合征发病与肩袖损伤、肩关节腔积液、肱二头肌长头肌腱鞘积液(尤其是肩峰下-三角肌下滑囊积液)有相关性。
[Abstract]:Purpose 1. To study the clinical effect of interventional ultrasound injection combined with rehabilitation training in patients with shoulder hand syndrome after stroke, and compared with microwave therapy combined with rehabilitation training group. 2. The etiology and pathogenesis of shoulder-hand syndrome were discussed. Methods: from January 2014 to July 2016, 42 patients with shoulder hand syndrome were divided into two groups: microwave combined with conventional rehabilitation group (19 cases) and interventional ultrasound combined group (23 cases). The treatment group was treated by interventional injection of compound betamethasone injection under the guidance of ultrasound in the soft tissue around the shoulder joint of hemiplegic side on the basis of routine rehabilitation treatment, while the control group was treated with microwave therapy on the basis of routine rehabilitation treatment for the shoulder joint of hemiplegic side. Visual analogue score (VAS) was used to evaluate the degree of shoulder pain and edema of the dorsal and metacarpophalangeal joints before and after treatment. The upper limb motor function and ADL were evaluated by simplified Fugl-Meyer motor function evaluation scale (FMA) and Barthel index (BI) before and 10 days after treatment. Results: there was no significant difference in the scores of VASFMA BI, hand dorsal and metacarpophalangeal facet joint edema between the treatment group and the control group before treatment (p0.05). The VAS score and edema score of the two groups decreased with time after treatment, and the decrease was large and rapid in the treatment group, especially in the treatment group 3 days after treatment, but the edema score in the control group did not change significantly. The scores of edema in VAS, dorsal hand and metacarpophalangeal facet joints in the treatment group were significantly lower than those in the control group at 3 and 10 days after treatment (P0.05). The FMABI scores of the two groups increased with time after treatment, but the FMABI scores in the treatment group were not significantly different from those in the control group 10 days after treatment (P0.05). Conclusion 1. Ultrasound interventional injection was effective in ameliorating pain of shoulder joint, edema of palmar and phalangeal facet joints in patients with shoulder and hand syndrome after stroke, and the effect of ultrasound intervention group was better than that of microwave group. Ultrasound interventional injection can improve shoulder pain, edema of palmar and phalangeal facet joints in patients with shoulder and hand syndrome after stroke in a short period of time, further promote the recovery of motor function of the affected upper limbs, improve the ability of daily life, and improve the quality of life of patients. The incidence of shoulder and hand syndrome was correlated with rotator cuff injury, fluid accumulation of shoulder joint cavity, and accumulated fluid of tendon sheath of long head muscle of biceps brachii (especially subacromian-deltoid muscle glide sac).
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R493

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