三种方法治疗肩胛上神经卡压综合征

目的:探讨不同方法治疗肩胛上神经卡压综合征的疗效。方法:肩胛上神经卡压综合征患者41例,男32例,女9例;年龄32～74岁,平均48岁;右侧29例,左侧12例;病程2个月～2.5年,平均9个月。30例采用局部封闭治疗,13例采用小针刀松解(其中包括局部封闭无效者7例),8例采用手术松解(其中包括小针刀松解无效3例)。局部封闭应用1%利多卡因5ml加曲安奈德40mg,每周1次,连续2～4次;小针刀采用切断肩胛上或下横韧带,肩胛岗上孔、岗下孔松解;手术在局麻直视下行肩胛上或下横韧带切断、松解肩胛上神经。结果:41例获随访,时间3个月～1年,依据疗效标准评定治疗效果。局部封闭组30例中,治愈2例,有效16例,无效12例;小针刀组13例中,治愈5例,有效5例,无效3例;手术松解组8例中,治愈6例,有效2例。结论:病程短、症状轻的患者应首选患者易接受的局部封闭治疗;症状严重且保守治疗无效者,采取小针刀松解或手术直视下神经松解,尤其是伴有肌萎缩者手术直视下松解更有必要。

Three methods for treatment of the suprascapular nerve entrapment syndrome

Objective:To explore the therapeutic effect of different methods for treating suprascapular nerve entrapment syndrome.Methods:Forty-one patients included 32 male and 9 female with the average age of 48 years ranging from 32 to 74 years;29 right,12 left;The course of disease from 2 months to 2.5 years,mean 9 months.Thirty patients were treated with local blocking;13 with small knife solution (included 7 failures with local blocking);8 with operative solution (included 3 failures with small knife).Patients of local blocking were injected with 1% Lidocaine and Triamcinodone Acetonide 40 mg once a week,2 to 4 times continuously.Patients of small knife were amputated in the superior or inferior transvers ligament of scapula,supraspinous and inferaspinous fossa were released.In operation of local anesthesia with direct vision,superior or inferior transverse ligament of scapula was amputated and suprascapular nerve was released.Results:All patients were followed up for from 3 months to 1 year.According to the therapeutic effective standard,in local blocking group,the result were cured in 2 cases,effective in 16,failure in 12;in small knife group,cured in 5,effective in 5,failure in 3;in operation group,cured in 6,effective in 2,no failure.Conclusion:Patients of short disease course and slight symptoms can select acceptable local blockade.It is necessary for patients with severe symptoms and medicine failure to use small knife releasing or operation releasing in direct vision,especially for those with myoatrophy.