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王 琳,吴艺玲,脱 淼,沈娜娜,李铁山.关节腔注射A型肉毒毒素治疗卒中后肩痛的疗效观察[J].中国康复医学杂志,2017,(1):48~52
关节腔注射A型肉毒毒素治疗卒中后肩痛的疗效观察    点此下载全文
王 琳  吴艺玲  脱 淼  沈娜娜  李铁山
青岛大学附属医院康复医学科,青岛,266003
基金项目:青岛市民生科技计划(13-1-3-34-nsh)
DOI:
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摘要:
      摘要 目的:比较关节腔注射A型肉毒毒素(botulinum toxin type A, BTA)与类固醇治疗卒中后肩痛的疗效。 方法:46例卒中后肩痛患者随机分为治疗组和对照组,超声引导下行关节腔注射,治疗组注射A型肉毒毒素和利多卡因,对照组注射曲安耐德和利多卡因。治疗前、治疗后即刻、1周后、4周后对患者进行评定。内容包括视觉模拟评分(VAS);Fugl-Meyer简式运动功能评定上肢部分;肩关节屈、外展、外旋被动关节活动度(ROM)。 结果:治疗后即刻和1周后,两组VAS降低,与治疗前差异均有显著性意义(P<0.05);4周后治疗组仍有差异(P<0.05),对照组与治疗前无差异。两组的Fugl-Meyer简式运动功能评定在治疗后即刻和1周后均无改善,4周后两组评分均提高,与治疗前差异有显著性意义(P<0.05)。治疗后即刻,两组外旋ROM改善,与治疗前差异均有显著性意义(P<0.05),治疗组4周后仍有差异(P<0.05),对照组1周后和治疗前差异无显著性意义。治疗1周后,对照组屈曲ROM改善,与治疗前差异有显著性意义(P<0.05);4周后治疗组屈曲ROM改善,与治疗前差异有显著性意义(P<0.05),对照组与治疗前无差异。两组外展ROM较治疗前无明显改善。 结论:关节腔注射BTA能减轻卒中后肩痛的疼痛程度,并改善肩关节ROM,疗效可能优于曲安耐德。
关键词:卒中后肩痛  A型肉毒毒素  关节腔注射
An observation of efficacy for intra-articular injection of botulinum toxin type A on post-stroke shoulder pain    Download Fulltext
Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266003
Fund Project:
Abstract:
      Abstract Objective: To compare the efficacy of intra-articular injection of botulinum toxin type A (BTA) or steroid on post-stroke shoulder pain (PSSP). Method: Forty-six patients with PSSP were randomly divided into treatment group and control group. BTA and steroid were injected in the glenohumeral joints under echographic guidance for all patients. BTA and lidocaine were injected for treatment group while triamcinolone acetonide and lidocaine for control group. We assessed the patients for 4 times - before treatment, after treatment immediately, 1 and 4 weeks after treatment. The evaluation methods included visual analogue score (VAS), Fugl-Meyer upper-extremity score and passive range of motion (ROM) of shoulder flexion, abduction and external rotation. Result: Immediately after treatment and 1 week later, VAS of two groups were significantly lower than those before treatment (P<0.05), and after 4 weeks the scores for treatment group were still lower than those before treatment (P<0.05) , while there was no significant difference in the control group. There were no changes in two groups for Fugl-Meyer upper-extremity scores immediately after treatment and 1 week later, but the scores increased significantly after 4 weeks in two groups (P<0.05). The ROM of external rotation in two groups improved significantly after treatment immediately (P<0.05), and after 4 weeks ROM of the treatment group were still better than that of pre-treatment (P<0.05), while there was no significant difference between pre-treatment and 1 week later in the control group. 1 week after treatment, ROM of flexion significantly improved in the control group (P<0.05). 4 weeks after treatment, the ROM of flexion of control group returned to the pre-treatment level, while the ROM of flexion of treatment group was better than that of pre-treatment (P<0.05). There was no significant improvement in abduction of two groups. Conclusion: BTA intra-articular injection reduced pain severity and improved shoulder ROM, possibly with better efficacy than triamcinolone acetonide for patients with PSSP.
Keywords:post-stroke shoulder pain  botulinum toxin type A  intra-articular injection
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