Effect of ultrasound-guided compound betamethasone and lidocaine hydrochloride injection on the improvement of shoulder joint pain after stroke
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摘要:
目的 分析超声引导下复方倍他米松和盐酸利多卡因注射对脑卒中后肩关节疼痛的改善作用。 方法 选取2020年1月~ 2021年6月于本院治疗的60例脑卒中后肩关节疼痛患者为研究对象，按照随机数字表法将患者分为治疗组和对照组，30例/ 组。对照组在常规康复治疗基础上进行徒手定位药物注射治疗；治疗组在常规康复治疗基础上进行超声引导下复方倍他米松和盐酸利多卡因注射。观察比较两组患者治疗前后疼痛程度、肩关节活动度、上肢功能运动情况和不良反应发生情况。 结果 治疗2周、4周后，治疗组患者视觉模拟评分低于对照组患者（P < 0.05），肩关节前屈、外展、外旋活动度大于对照组患者（P < 0.05），Fugl-Meyer运动功能量表上肢部分评分高于对照组患者（P < 0.05）；两组患者不良反应总发生率差异无统计学意义（P>0.05）。 结论 相较于徒手定位药物注射治疗，超声引导下复方倍他米松和盐酸利多卡因注射对脑卒中后肩关节疼痛患者疼痛改善效果更为明显，可有效改善肩关节活动度和上肢运动功能。 Abstract:Objective To analyze the improvement effect of ultrasound-guided compound betamethasone and lidocaine hydrochloride injection on shoulder pain after stroke under ultrasound guidance. Methods Sixty patients with shoulder pain after stroke treated in our hospital from January 2020 to June 2021 were selected as the research objects, and the patients were divided into treatment group and control group according to random number table method, with 30 patients in each group. The control group was treated with freehand localization drug injection on the basis of routine rehabilitation therapy. The treatment group was treated with ultrasound-guided compound betamethasone and lidocaine hydrochloride injection under ultrasound guidance on the basis of routine rehabilitation. The pain degree, range of motion of shoulder joint, functional motion of upper limb and the occurrence of adverse reactions were observed and compared between the two groups before and after treatment. Results After 2 and 4 weeks of treatment, the patients in the treatment group had lower visual analogue scores than those in the control group (P < 0.05), greater shoulder forward flexion, abduction and external rotation mobility than those in the control group (P < 0.05), and higher upper limb component scores on the Fugl-Meyer Motor Function Scale than those in the control group (P < 0.05). There was no statistical significance in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion Compared with hands- free localization drug injection, ultrasound- guided compound betamethasone and lidocaine hydrochloride injection is more effective in improving pain in patients with post-stroke shoulder pain, and it can effectively improve shoulder mobility. -
Key words:
- ultrasonic guidance /
- injection therapy /
- shoulder pain after stroke /
- improvement effect
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图 1 超声下肩关节解剖定位及穿刺进针点
Figure 1. Anatomical location and puncture point of shoulder joint under ultrasound.
表 1 两组患者治疗前后VAS评分比较
Table 1. Comparison of VAS scores between the two groups before and after treatment (n=30, scores, Mean±SD)
组别 治疗前 治疗后2周 治疗后4周 治疗组 5.79±1.34 2.51±0.67 1.91±0.42 对照组 5.86±1.41 3.61±0.91 3.13±0.86 t 0.197 5.332 6.981 P 0.844 < 0.001 < 0.001 
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表 2 两组患者治疗前后肩关节活动度比较
Table 2. Comparison of shoulder range of motion between the two groups before and after treatment (°, n=30, Mean±SD)
组别 前屈 外展 外旋 治疗前 治疗后2周 治疗后4周 治疗前 治疗后2周 治疗后4周 治疗前 治疗后2周 治疗后4周 治疗组 96.48±8.97 127.36±6.44 140.21±7.68 95.27±6.47 135.52±9.32 142.26±8.03 18.17±3.16 36.19±7.22 39.07±6.15 对照组 94.67±10.22 116.46±9.07 122.34±8.52 96.16±5.97 119.15±8.17 129.97±9.07 18.31±2.97 28.53±6.17 31.16±7.05 t 0.729 5.367 8.533 0.554 7.243 5.557 0.177 4.418 4.631 P 0.469 < 0.001 < 0.001 0.582 < 0.001 < 0.001 0.86 < 0.001 < 0.001
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表 3 两组患者治疗前后FMA-U评分比较
Table 3. Comparison of FMA-U scores between the two groups before and after treatment (n=30, scores, Mean±SD)
组别 治疗前 治疗后2周 治疗后4周 治疗组 17.06±4.19 32.13±7.16 38.85±6.11 对照组 17.87±5.16 26.14±6.37 31.26±7.01 t 0.667 3.423 4.470 P 0.507 0.001 < 0.001 Fugl-Meyer运动功能量表上肢部分.
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表 4 两组患者不良反应发生情况比较
Table 4. Comparison of adverse reactions between the two groups[n(%)]
组别 皮下组织坏死 肌腱断裂 皮下瘀斑 总发生率 治疗组 0 0 1 (3.33) 1 (3.33) 对照组 1 (3.33) 1 (3.33) 3 (10.00 5 (16.67) χ2 2.963 P 0.085
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