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陆军军医大学第一附属医院门诊部,重庆,400038
纸质出版日期:2019,
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吴晓青, 张玲, 钟红玲, 等. 改良Nevaiser入路联合肩峰下滑囊入路双注射治疗冻结肩疗效分析[J]. 局解手术学杂志, 2019,(8):626.
WU Xiaoqing, ZHANG Ling, ZHONG Hongling, et al. Curative effect analysis of modified Nevaiser approach combined with subacromial bursa approach on treatment of frozen shoulder[J]. null, 2019,(8):626.
目的 探讨改良Nevaiser入路联合肩峰下滑囊入路双注射治疗冻结肩的临床疗效。 方法 选择2017年11月至2018年12月于我院接受肩关节穿刺注射治疗的147例冻结肩患者,根据不同穿刺入路分为前方穿刺入路、改良Nevaiser入路、肩峰下滑囊入路和改良Nevaiser入路联合肩峰下滑囊入路,比较不同入路穿刺成功率以及注射治疗后疼痛及肩关节活动功能改善情况。 结果 前方穿刺入路、改良Nevaiser入路、肩峰下滑囊入路、改良Nevaiser入路联合肩峰下滑囊入路穿刺成功率分别为62.75%、91.67%、75.68%、86.67%,差异具有统计学意义(χ2=32.262,P<0.05);改良Nevaiser入路组、改良Nevaiser入路联合肩峰下滑囊入路组穿刺成功率高于前方穿刺入路组、肩峰下滑囊入路组(P<0.05),改良Nevaiser入路组成功率与改良Nevaiser入路联合肩峰下滑囊入路组比较差异无统计学意义(χ2=1.351,P>0.05);其中前方穿刺入路组穿刺成功率最低(62.75%)。注射治疗后,改良Nevaiser入路联合肩峰下滑囊入路组VAS及CMS评分改善情况显著优于其他3组(P<0.05),其中肩峰下滑囊入路组VAS及CMS评分改善情况最差,前方穿刺入路组和改良Nevaiser入路VAS、CMS评分差异无统计学意义(F=285.73/439.72,P>0.05)。 结论 关节腔穿刺治疗冻结肩过程中,较单一前方穿刺入路、改良Nevaiser入路和肩峰下滑囊入路而言,改良Nevaiser入路联合肩峰下滑囊双注射入路在保证较为理想的穿刺成功率前提下可使药物充分浸润盂肱关节、肩峰下滑囊,有利于患者疼痛缓解和肩关节功能恢复。
Objective To investigate the effect of modified Nevaiser approach combined with subacromial bursa approach in treating frozen shoulder. Methods A total of 147 patients with frozen shoulder who accepted different intraarticular injective therapy from November 2017 to December 2018 were analyzed,and they were divided into the anterior approach group,the modified Nevaiser approach group,the subacromial bursa approach group and the modified Nevaiser approach combined with subacromial bursa approach group upon the different puncture methods. The success rate of different puncture approaches,as well as improvement on pain and shoulder joint function after injective treatment were compared. Results The success rate of anterior approach group,the modified Nevaiser approach group,the subacromial bursa approach group and modified Nevaiser approach combined with subacromial bursa approach were 62.75%
91.67%
75.68% and 86.67% respectively,and the difference was statistically significant (χ2=32.262,P<0.05). The puncture success rate of modified Nevaiser approach group and modified Nevaiser approach combined with subacromial bursa approach group were significantly higher than the other two groups (P<0.05); the success rate of modified Nevaiser approach group was higher than that of modified Nevaiser approach combined with subacromial bursa approach group,but there was no significant difference between the two groups (χ2=1.351,P>0.05); the anterior approach group showed the lowest success rate (62.75%).After injective treatment,it showed the best improvement in VAS and CMS via modified Nevaiser approach combined with subacromial bursa approach compared with the other three approaches (P<0.05); there was no significant difference in terms of VAS and CMS scores between the anterior approach group and the modified Nevaiser approach group (F=285.73/439.72,P>0.05); and it showed the worst improvement of VAS and CMS scores in the subacromial bursa approach group. Conclusion During the process of intraarticular injection for treatment of frozen shoulder,the modified Nevaiser approach combined with subacromial bursa approach may achieve better medicine infiltration of glenohumeral joint and subacromial bursa in the premise of ensuring a better success rate of injection compared to single anterior approach,modified Nevaiser approach or subacromial bursa approach,which is beneficial to pain relief and recovery of shoulder joint function.
肩关节腔注射改良Nevaiser入路冻结肩肩关节活动功能
anticular injectionmodified Nevaiser approachfrozen shouldershoulder joint function
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