肩袖撕裂保守治疗的临床疗效观察

目的评估肩峰下间隙注射长效激素、盂肱关节内注射玻璃酸钠结合物理疗的方法治疗肩袖损伤的临床疗效。 方法选取2014年10月至2015年4月期间在内蒙古医科大学第二附属医院因肩袖撕裂接受保守治疗的患者，予以肩峰下间隙注射长效激素(复方倍他米松)＋利多卡因、盂肱关节内注射玻璃酸钠，以及物理治疗方法，包括热疗、拉伸训练、主被动的关节活动度练习和肌肉力量练习。所有患者至少经过6个月的保守治疗，保守治疗前后使用美国加州大学肩关节功能评分(UCLA)，肩关节功能评分(Constant)，视觉模拟评分法(VAS)，对保守治疗前及随访时的肩关节进行评估。保守治疗前和随访时数据采用配对t检验分析。 结果共有75例患者经过14～20个月随访，患者的平均年龄(62±11)岁。40%的患者疼痛消失，30%的患者疼痛减轻不需要口服止疼药治疗。70%的患者的日常生活没有影响。保守治疗前UCLA评分(22.1±1.5)、Constant评分(59.2±5.9)、VAS评分(3.9±0.3)，最后一次随访时UCLA评分(35.5±1.3)、Constant评分(87.4±1.3)、VAS评分(1.8±0.5)，差异有统计学意义(t＝-5.436、-8.935、-4.136，均为P<0.01)。 结论肩峰下间隙注射长效激素、盂肱关节内注射玻璃酸钠结合物理疗治疗肩袖撕裂的方法对于早期肩袖全层撕裂的患者治疗效果较好。

Clinical results of conservative treatment for rotator cuff tear

ObjectiveTo evaluate the clinical efficacy of conservative treatment for rotator cuff tear associated with mediation injection and physiotherapy. MethodsThe patients with full rotator cuff tear were given conservative treatment in the Second Affiliated Hospital of Inner Mongolia Medical University from October 2014 to April 2015. The subacromial spaces were injected with long-acting hormone (compound betamethasone) + lidocaine, and the glenohumeral joints were injected with sodium hyaluronate, combining with the physical therapy, such as hyperthermia, stretching, active and passive joint motions and muscle strength exercise. All the patients received conservative treatment for at least six months. Shoulder joint function score (Constant), University of California at Los Angeles shoulder rating scale (UCLA)and visual analogue scale (VAS) were used before and after conservative treatment to evaluate the shoulder joint before and during follow-up. Paired t test was used to analyze the data before and during conservative treatment. ResultsA total of 75 patients were followed up for 14 to 20 months. The mean age of the patients was (62±11) years. Among the patients, 40% had no pain relief and 30% did not require oral pain medication. Seventy percent of the patients had no impact on their daily lives. Before conservative treatment, UCLA score (22.1±1.5), Constant score (59.2±5.9), VAS score (3.9±0.3), and UCLA score (35.5±1.3), Constant score (87.4±1.3), and VAS score (1.8±0.5) at the last follow-up showed statistically significant differences (t=-5.436, -8.935, -4.136, all P<0.01). ConclusionThe subacromial spaces injection of long-acting hormone + lidocaine and the glenohumeral joints injection with sodium hyaluronate combining with the physical therapy may have good clinical effects for rotator cuff tear.