应用肩胛背神经阻滞联合肩胛下滑囊痛点注射治疗肩胛肋骨综合征的疗效观察

目的观察肩胛背神经阻滞联合肩胛下滑囊痛点注射方法治疗肩胛肋骨综合征临床效果。方法选择肩胛肋骨综合征患者31例,随机分为两组:单纯肩胛下滑囊注射组(A组,n=15),肩胛背神经阻滞联合肩胛下滑囊痛点注射组(B组,n=16)。治疗方法:(1)肩胛背神经阻滞;(2)肩胛下滑囊痛点阻滞(肩胛骨下滑囊或/和前锯肌下滑囊);治疗时间:1次/周,共4次。观察指标:(1)治疗前、后(2周和4周)局部静止时VAS疼痛评分;(2)治疗前、后(2周和4周)肩关节外展活动时VAS疼痛评分;(3)治疗前、后(2周和4周)肩胛周围放射痛。结果 (1)组内比较:A组治疗后4周与治疗前比较,三项VAS评分均明显降低,差异有统计学意义(P0.05);B组治疗后2周、4周与治疗前比较,三项VAS评分均明显降低,差异有统计学意义(P0.05)。(2)组间比较:B组治疗后2周和4周三项VAS疼痛评分均明显低于A组,差异有统计学意义(P0.05)。结论应用肩胛背神经阻滞联合肩胛下滑囊痛点阻滞方法可以有效控制肩胛肋骨综合征的临床症状,临床疗效确定。     

超声介导下肩峰下滑囊联合肩胛上神经注射治疗肩周炎的价值

观察超声介导下肩峰下滑囊联合肩胛上神经注射治疗肩周炎的临床效果.方法:40例患者随机分为对照组(A组)和超声组(B组),B组在超声介导下行肩峰下滑囊和肩胛上神经注射术,A组根据解剖定位行肩胛上神经和痛点注射.结果:两组治疗后较治疗前VAS评分有明显下降(P＜0.01),治疗后B组较A组疼痛缓解较明显(P＜ 0.05),两组治疗后较治疗前肩关节活动度有明显好转(P＜0.05),治疗后B组与A组肩关节活动度无明显差异(P＞0.05).结论:超声引导下注射治疗肩周炎具有较好的临床疗效,是一种很有前景的治疗方法.     

X线直视下肩关节腔注射治疗在肩周炎中的应用

目的:观察比较X线直视下肩关节腔注射玻璃酸钠联合复方倍他米松或医用臭氧对肩周炎的治疗效果。方法:将90例肩周炎患者随机分为3组,A组在X线直视下肩关节腔注射玻璃酸钠联合复方倍他米松镇痛复合液,B组在X线直视下肩关节腔注射玻璃酸钠联合医用臭氧,C组根据解剖位置进行肩关节腔注射玻璃酸钠联合复方倍他米松镇痛复合液。结果:与治疗前相比较,3组患者治疗后肩关节疼痛缓解,活动障碍有所改善(P<0.05),治疗效果A组>B组>C组。结论:X线直视下肩关节腔注射玻璃酸钠联合复方倍他米松或医用臭氧对肩周炎有显著疗效。     

超短波联合臭氧注射治疗肩周炎的临床研究

目的 通过临床对比观察研究,比较单纯肩关节腔及肩周痛点臭氧注射和肩关节腔及肩周痛点臭氧注射联合超短波治疗肩周炎的临床疗效.方法 83例单侧肩周炎患者,随机分为单纯肩关节腔及肩周痛点臭氧注射治疗组（A组;n=42）和关节腔及肩周痛点臭氧注射联合超短波治疗组（B组;n=41）,A组每周治疗1次,连续3次为1个疗程;B组关节腔及痛点臭氧注射治疗同A组,超短波治疗：采用前后对置法,选用无热量或微热量治疗时间每次20 min,每日1次,10次为1个疗程,注射治疗后第2天开始超短波治疗.结果 A组42例患者治疗后1周：优36例,良6例,优良率为100%;B组41例患者治疗后1周：优35例,良6例,优良率为100%,两组比较无统计学差异.A组在各随访时期的疗效：治疗后1个月、3个月的NRS评分分别为2.6±2.1,3.4±1.3,优良率分别为88.1%、80.9%;B组在各随访时期的疗效：治疗后1个月、3个月的NRS评分分别为1.2±1.3,1.6±1.4,优良率分别为95.1%、92.7%;两组治疗后1、3个月时段比较NRS评分及优良率均有统计学差异.结论 单纯肩关节腔及肩周痛点臭氧注射和肩关节腔及肩周痛点臭氧注射联合超短波均能有效地治疗肩周炎,但关节腔及痛点臭氧注射联合超短波的疗效明显优于单纯臭氧注射组,其作为一种微创、安全、有效的治疗方法,中远期疗效佳,值得临床推广.     

两种神经阻滞联合臭氧注射治疗顽固性肩周炎

目的观察肩胛上神经阻滞、腋神经阻滞联合臭氧痛点注射治疗顽固性肩周炎的疗效。方法 80例肩周炎患者,随机分为治疗组42例和对照组38例,治疗组行肩胛上神经阻滞、腋神经阻滞联合臭氧痛点注射,对照组行痛点注射消炎镇痛液及臭氧治疗。结果治疗组的治愈率和有效率分别为66.67%和92.86%,明显高于对照组的50.00%和76.32%（P〈0.05）。结论肩胛上神经阻滞、腋神经阻滞联合臭氧痛点注射治疗顽固性肩周炎,安全有效,疗效优于常规治疗方法。     

三联法治疗顽固性冻结肩56例

冻结肩为临床常见疾病，主要表现为肩周疼痛和肩关节活动障碍。顽固性冻结肩虽经单纯痛点注射、针刀松解、理疗按摩能缓解疼痛改善功能，但疗程长、效果差，尤其功能恢复困难。山东省立医院疼痛科自2000年以来收治56例顽固性冻结肩患者，采用三联法：即行痛点注射 针刀松解后，在异丙酚静脉全麻 臂丛神经阻滞下行肩关节手法松解术，取得满意效果。     

肩关节粘连松解术后气压弹道式冲击波治疗冻结肩的疗效观察

肩周炎是一种中老年人常见疾病,其主要临床特征为肩周疼痛和肩关节活动障碍.冻结肩是由于肩关节周围肌肉、肌腱、滑囊和关节囊等软组织的慢性炎症、粘连引起的以肩关节周围疼痛、功能障碍为主要症状的一组临床表现[1],其治疗方法很多.如物理、针灸等治疗,臂丛神经阻滞下行肩关节粘连松解术是治疗肩周炎冻结肩的有效方法之一,但术后部分患者存在再次粘连,术后恢复较慢等问题.本研究旨在比较臂丛神经阻滞下行肩关节粘连松解术后冲击波治疗与肩胛上神经阻滞治疗冻结肩的疗效差异.     

肩胛上神经联合肩胛背神经阻滞治疗颈肩部疼痛综合征的临床观察

目的观察应用肩胛上神经联合肩胛背神经阻滞治疗颈肩部疼痛综合征的临床疗效。方法选择颈肩部疼痛患者30例,随机分为局部痛点封闭组(LB组,n=15)和肩胛上神经联合肩胛背神经阻滞组(NB组,n=15),其中LB组接受局部痛点封闭与耸肩运动康复治疗,而NB组接受肩胛上神经联合肩胛背神经阻滞与耸肩运动康复治疗。对比观察两组治疗前、治疗后1周、治疗后3周的疼痛程度、颈部及肩关节活动度。结果两组治疗后疼痛程度均较治疗前显著降低(P0.05),且NB组治疗后1周和3周的疼痛程度显著低于LB组(P0.05)。NB组颈椎及肩关节功能活动度在治疗后显著升高(P0.05),且治疗后1周和3周的颈椎及肩关节功能活动度明显高于LB组(P0.05)。结论肩胛上神经联合肩胛背神经阻滞治疗颈肩部疼痛综合征可以有效减轻疼痛症状,并明显改善因疼痛所致的颈椎及肩关节功能活动受限。     

肩关节粘连松解后臭氧注射治疗冻结肩疗效的观察

冻结肩是由于肩关节周围肌肉,肌腱,滑囊和关节囊等软组织的慢性炎症,粘连引起的以肩关节周围疼痛,功能障碍为主要症状的一组临床表现,其治疗方法很多.本研究的目的旨在比较臂丛神经阻滞下行肩关节粘连松解术后注射臭氧与肩胛上神经阻滞治疗冻结肩的疗效差异.     

玻璃酸钠关节内注射联合隐神经阻滞治疗膝关节骨性关节炎

目的:观察玻璃酸钠关节内注射联合隐神经阻滞治疗膝关节骨性关节炎(osteoarthritis,OA)的有效性。方法:膝关节OA患者84例,随机分为联合治疗组(C组,n=42)和单纯注射组(H组,n=42)。C组行玻璃酸钠关节内注射联合隐神经阻滞,H组单纯玻璃酸钠关节内注射。评价治疗前、治疗后4周和12周时的西安大略和麦克马斯特大学关节炎指数(Western Ontario and Mc Master Universities Arthritis Index,WOMAC)评分和SF-36生活质量评分,记录治疗中和治疗后的并发症。结果:两组患者阻滞前WOMAC和SF-36评分无显著差异,治疗后4周和12周时的WOMAC评分明显低于、SF-36评分明显高于治疗前基础值(P<0.05),但C组更为显著(P<0.05)。结论:玻璃酸钠关节内注射联合隐神经阻滞可改善膝关节OA的疼痛和功能障碍,是治疗膝关节OA的有效方法。     

超声引导下注射治疗肩周炎

目的:研究超声引导下注射治疗肩周炎的临床效果.方法:33例患者接受此治疗,采用超声引导下注射曲安奈德40mg,2%盐酸利多卡因5ml.治疗前进行VAS评分和Constant & Murley肩关节功能评分,治疗后7～14天内复查.失访4例,完成全部评定29例.采用配对t检验进行统计分析,显著性水平为P<0.05,脱落病例按意向性治疗处理.结果:肩周炎经过超声引导下注射药物治疗后,VAS由治疗前的6.8±1.9降低到治疗后的VAS 3.5±2.3(P<0.01);Constant & Murley肩关节功能评分由治疗前33.7±12.0提高到治疗后45.2±12.2(P<0.01).结论:超声引导下注射治疗肩周炎取得较好的临床疗效,是一种很有前景的治疗方法.     

肩上方悬吊复合体联合损伤的治疗体会

目的探讨肩上方悬吊复合体（SSSC）联合损伤的治疗方法。方法分析2002～2006年收治的17例SSSC联合损伤病人的临床资料，2例行保守治疗，其余行手术治疗。手术治疗组中4例仅固定明显移位或脱位的锁骨或肩锁关节，11例于损伤处行联合固定。结果平均随访17．5个月，所有骨折均愈合。保守治疗组ASES评分67．1分，手术组ASES评分81．7分。结论保守治疗及手术治疗都可以取得较好疗效，但应根据不同的病人和骨折类型采用个体化的治疗方案。通过手术恢复SSSC的完整性，有利于发挥其维持上肢和躯干之间稳定性的作用。     

MICROINSTABILITY OF THE SHOULDER IN THE OVERHEAD ATHLETE

The overhead throwing athlete is an extremely challenging patient in sports medicine. The repetitive microtraumatic stresses and extreme ranges of motion observed within the athlete’s shoulder joint complex during the throwing motion constantly place the athlete at risk for injury. While gross instability of the shoulder is possible, microinstability is seen far more frequently and is associated with a variety of different pathologies, including rotator cuff tendonitis, internal impingement, and labral lesions. Treatment of the overhead athlete requires the understanding of several principles based on the unique physical characteristics of this type of athlete and the demands placed upon the static stabilizing structures during the act of throwing. The purpose of this paper is to describe these principles and incorporate them into in a multi‐phase progressive rehabilitation program designed to prevent injuries and rehabilitate the injured athlete, both non‐operatively and postoperatively.     

RELIABILITY OF THE MYOTONOMETER FOR ASSESSMENT OF POSTERIOR SHOULDER TIGHTNESS

Background/Purpose:

The Myotonometer® is an electronic tissue compliance meter that has been used to quantify the compliance of soft tissues. The Myotonometer® may be a valuable tool to measure the effectiveness of interventions commonly used to increase tissue compliance in individuals with posterior shoulder tightness (PST). Limited data exist on reliability and responsiveness of the Myotonometer® for assessment of soft tissues about the shoulder; therefore, the purpose of this study is to determine the intra‐ and inter‐session reliability and responsiveness of the Myotonometer® in measuring tissue compliance of the posterior shoulder musculature in asymptomatic subjects with PST.

Methods:

Fifteen asymptomatic subjects with unilateral shoulder range of motion deficits attended two measurement sessions to assess the compliance of the tissues overlying the posterior deltoid, infraspinatus, and teres musculature. Analyses of reliability and responsiveness were conducted using intra‐class correlation coefficients (ICCs) and the determination of minimal detectible change (MDC).

Results:

Intra‐session ICC values ranged from 0.69 to 0.91 for all muscles with MDC never exceeding 1.0 mm. Inter‐session ICC values were best for the posterior deltoid, which averaged 0.82, compared to the infraspinatus and the teres complex, which averaged 0.42 and 0.5 respectively. Inter‐session MDC ranged from 0.55 to 1.20 mm across all muscles.

Conclusions:

Clinicians can reliably detect relatively small changes in tissue compliance within a single treatment session utilizing the Myotonometer®. The Myotonometer® can reliably detect changes between sessions for tissues overlying the posterior deltoid; however, observed change in the infraspinatus and teres musculature must be above 1 mm to achieve meaningful change and account for decreased inter‐session reliability.

Level of Evidence:

3     

CURRENT CONCEPTS IN SHOULDER EXAMINATION OF THE OVERHEAD ATHLETE

Examination of the shoulder complex has long been described as challenging. This is particularly true in the examination of the overhead athlete who has structural differences when compared to a shoulder patient who is a non‐athlete. Complexity with the examination is due to unique biomechanical and structural changes, multiple joint articulations, multiple pain patterns, and the potential of injury to structures both inside (intra‐articular) and outside (extra‐articular) the glenohumeral joint. Repetitive stresses placed on the shoulders of overhead athletes may affect range of motion, strength, scapular position, and ultimately, the integrity of soft tissue and bony structures in any of the joints that comprise the shoulder complex. Furthermore, many shoulder examination tests thought to be unique to a single structure, joint, or condition can be positive in multiple conditions. The examination of the overhead athletes shoulder, coupled with a thorough medical history will provide a solid foundation to allow a functional physical therapy diagnosis and provide clues as to the presence of the lesion (s) causing disability. The purpose of this clinical commentary is to assist the reader to understand the unique physical characteristics of the overhead athlete, which will lead to a more accurate and reproducible evaluation of athletes who sustain injuries while participating in overhead sports.

Level of Evidence:

5     

矿泉浴为主综合治疗肩关节周围炎48例

运用矿泉、音频、按摩配合功能锻炼治疗肩关节周围炎48例,收到了较好的治疗效果,大部分患者症状消失或缓解,功能恢复正常。     

放散式冲击波治疗粘连性肩关节囊炎的临床疗效研究

目的:研究放散式冲击波治疗粘连性肩关节囊炎的疗效和安全性。方法:回顾性分析2013年9月至2015年9月就诊于我科,用体外放散式冲击波治疗的粘连性肩关节囊炎病人79例。分析病人治疗前、一个疗程结束时、治疗结束后1周、治疗结束后4周、治疗结束后3个月和治疗结束后6个月的视觉模拟评分(visual analogue scale,VAS)、肩关节活动度(range of motion,ROM)、临床疗效及不良反应。结果:经冲击波治疗后,病人肩关节疼痛程度较治疗前明显改善,VAS评分显著下降(P<0.01),肩关节活动度明显改善,临床疗效显著(P<0.05),无明显不良反应。结论:体外放散式冲击波治疗粘连性肩关节囊炎能显著减轻疼痛,改善肩关节活动度,具有安全性高、风险低等特点,适合药物不能耐受和惧怕手术的病人应用。