医用聚乙二醇小檗碱肩关节注射修复肩峰下撞击综合征:6个月随访
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摘要
背景:医用聚乙二醇小檗碱是一种抗组织粘连生物材料,具有抗炎作用,可预防瘢痕组织形成,减轻局部炎症反应。目的:根据医用聚乙二醇小檗碱的作用机制及特点,观察其肩关节注射修复肩峰下撞击综合征的临床疗效。方法:纳入40例Ⅰ、Ⅱ期肩峰下撞击综合征患者,根据自愿的原则进入生物材料治疗组(n=20)和保守治疗组(n=20)。保守治疗组进行复方倍他米松混合盐酸利多卡因肩峰下间隙封闭治疗1次后,口服塞来昔布200 mg/次,2次/d,药物治疗1周;生物材料治疗组采用3 mL医用聚乙二醇小檗碱肩关节注射治疗1次。门诊随访两组目测类比评分、肩关节活动度及美国肩肘外科学会肩关节评分。结果与结论:两组治疗后的目测类比评分、肩关节活动度及美国肩肘外科学会肩关节评分均较治疗前明显改善(P<0.05),并且生物材料治疗组修复后2周、4周、3个月、6个月的目测类比评分、肩关节活动度及美国肩肘外科学会肩关节评分均较保守治疗组改善更明显(P<0.001)。说明医用聚乙二醇小檗碱肩关节腔内注射修复肩峰下撞击综合征可有效缓解肩部疼痛,提高肩关节活动度,促进肩关节功能恢复。
BACKGROUND: Medical polyethylene glycol berberine is a biomaterial against tissue adhesion, with anti-inflammatory effects, which can prevent scar formation and reduce local inflammation. OBJECTIVE: To observe the clinical efficacy of medical polyethylene glycol berberine via shoulder joint injections on subacromial impingement syndrome.BACKGROUND: Medical polyethylene glycol berberine is a biomaterial against tissue adhesion, with anti-inflammatory effects, which can prevent scar formation and reduce local inflammation. OBJECTIVE: To observe the clinical efficacy of medical polyethylene glycol berberine via shoulder joint injections on subacromial impingement syndrome. METHODS: Forty patients with subacromial impingement syndrome I, II were voluntarily divided into two groups: biomaterial group(n=20), single intra-articular injection of 3 m L medical polyethylene glycol berberine; conservative treatment group(n=20), single subacromial space closed treatment of betamethasone combined with lidocaine hydrochloride followed by oral administration of celecoxib 200 mg once, twice a day, totally for 1 week. Patients were followed up clinically for visual analog scale scores, range of motion of the shoulder and the American Shoulder and Elbow Surgeons scores. RESULTS AND CONCLUSION: Both of two groups had a great improvement in visual analog scale scores, range of motion of the shoulder and the American Shoulder and Elbow Surgeons scores after treatment(P < 0.05), and these scores were improved more significantly in the biomaterial group than the conservative treatment group at 2 weeks, 4 weeks, 3 months, 6 months after treatment(P < 0.001). These findings indicate that the intra-articular injection of medical polyethylene glycol berberine for subacromial impingement syndrome can effectively alleviate shoulder pain, improve shoulder mobility, and promote functional recovery of the shoulder.
BACKGROUND: Medical polyethylene glycol berberine is a biomaterial against tissue adhesion, with anti-inflammatory effects, which can prevent scar formation and reduce local inflammation. OBJECTIVE: To observe the clinical efficacy of medical polyethylene glycol berberine via shoulder joint injections on subacromial impingement syndrome.BACKGROUND: Medical polyethylene glycol berberine is a biomaterial against tissue adhesion, with anti-inflammatory effects, which can prevent scar formation and reduce local inflammation. OBJECTIVE: To observe the clinical efficacy of medical polyethylene glycol berberine via shoulder joint injections on subacromial impingement syndrome. METHODS: Forty patients with subacromial impingement syndrome I, II were voluntarily divided into two groups: biomaterial group(n=20), single intra-articular injection of 3 m L medical polyethylene glycol berberine; conservative treatment group(n=20), single subacromial space closed treatment of betamethasone combined with lidocaine hydrochloride followed by oral administration of celecoxib 200 mg once, twice a day, totally for 1 week. Patients were followed up clinically for visual analog scale scores, range of motion of the shoulder and the American Shoulder and Elbow Surgeons scores. RESULTS AND CONCLUSION: Both of two groups had a great improvement in visual analog scale scores, range of motion of the shoulder and the American Shoulder and Elbow Surgeons scores after treatment(P < 0.05), and these scores were improved more significantly in the biomaterial group than the conservative treatment group at 2 weeks, 4 weeks, 3 months, 6 months after treatment(P < 0.001). These findings indicate that the intra-articular injection of medical polyethylene glycol berberine for subacromial impingement syndrome can effectively alleviate shoulder pain, improve shoulder mobility, and promote functional recovery of the shoulder.
引文
[1]Erasmo R,Guerra G,Guerra L.Fractures and fracturedislocations of the proximal humerus:A retrospective analysis of 82 cases treated with the Philos(?)locking plate.Injury.2014;45 Suppl 6:S43-48.
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[15]Marzetti E,Rabini A,Piccinini G,et al.Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome:a single-blind randomized controlled clinical trial.Eur J Phys Rehabil Med.2014;50(3):255-264.
[16]Park SI,Choi YK,Lee JH,et al.Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.J Phys Ther Sci.2013;25(11):1359-1362.
[17]Tucci HT,Martins J,Sposito Gde C,et al.Closed Kinetic Chain Upper Extremity Stability test(CKCUES test):a reliability study in persons with and without shoulder impingement syndrome.BMC Musculoskelet Disord.2014;15:1.
[18]朱江龙,苏波,王大伟.健骨注射液肩峰下注射治疗肩峰下撞击综合征的临床疗效观察[J].中医正骨,2012,24(5):60-64.
[19]戴祝,华英汇,陈世益,等.原发性冷冻肩与肩峰撞击征的鉴别诊断及治疗[J].实用骨科杂志,2012,18(1):50-52.
[20]Gebremariam L,Hay EM,van der Sande R,et al.Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.Br J Sports Med.2014;48(16):1202-1208.
[21]van Kampen DA,Willems WJ,van Beers LW,et al.Determination and comparison of the smallest detectable change(SDC)and the minimal important change(MIC)of four-shoulder patient-reported outcome measures(PROMs).J Orthop Surg Res.2013;8:40.
[22]Neviaser A,Braman J,Parsons B.What's new in shoulder and elbow surgery.J Bone Joint Surg Am.2013;95(20):1896-1901.
[23]徐海栋,付强,赵建宁.数字技术在脊柱微创外科中的应用进展[J].医学研究生学报,2014,27(2):207-210.
[24]眭杰,汪滋民.肩峰下滑囊切除在肩峰下撞击综合征手术治疗的应用价值[J].中国矫形外科杂志,2013,21(1):37-40.
[25]徐海栋,陈勇,卢俊浩,等.带线锚钉Krackow缝合法修复急性跟腱断裂的临床研究[J].医学研究生学报,2013,26(3):156-159.
[2]Singh HP,Mehta SS,Pandey R.A preoperative scoring system to select patients for arthroscopic subacromial decompression.J Shoulder Elbow Surg.2014;23(9):1251-1256.
[3]杜欢.保守治疗肩峰下撞击综合征30例[J].南京中医药大学学报,2011,27(5):487-488.
[4]费文勇,章洪喜,谢军,等.关节镜下肩峰下减压术微创治疗肩峰撞击征的临床疗效观察[J].中国内镜杂志,2013,19(12):1263-1267.
[5]傅中国,姜保国,张殿英,等.肩峰撞击征合并肩袖损伤的治疗[J].中华创伤骨科杂志,2005,7(9):817-819.
[6]Blume C,Wang SS.Comparison of changes in supraspinatus muscle thickness in persons with subacromial impingement syndrome and asymptomatic adults.Physiother Theory Pract.2014;30(8):544-551.
[7]Haik MN,Alburquerque-Sendín F,Camargo PR.Reliability and minimal detectable change of 3-dimensional scapular orientation in individuals with and without shoulder impingement.J Orthop Sports Phys Ther.2014;44(5):341-349.
[8]Haldorsen B,Svege I,Roe Y,et al.Reliability and validity of the Norwegian version of the Disabilities of the Arm,Shoulder and Hand questionnaire in patients with shoulder impingement syndrome.BMC Musculoskelet Disord.2014;15:78.
[9]Hoenecke HR Jr,Flores-Hernandez C,D'Lima DD.Reverse total shoulder arthroplasty component center of rotation affects muscle function.J Shoulder Elbow Surg.2014;23(8):1128-1135.
[10]Lee YL,Sagare AP,Lee CY,et al.Formation of protoberberinetype alkaloids by the tubers of somatic embryo-derived plants of Corydalis yanhusuo.Planta Med.2001;67(9):839-842.
[11]Lin YC,Kuo JY,Hsu CC,et al.Optimizing manufacture of liposomal berberine with evaluation of its antihepatoma effects in a murine xenograft model.Int J Pharm.2013;441(1-2):381-388.
[12]靳安民,闵少雄,高艳杰,等.医用聚乙二醇小檗碱液预防腰椎管术后硬膜外粘连的临床研究[J].黑龙江医学,2007,31(3):201-203.
[13]Wilson RD,Harris MA,Gunzler DD,et al.Percutaneous peripheral nerve stimulation for chronic pain in subacromial impingement syndrome:a case series.Neuromodulation.2014;17(8):771-776.
[14]de Witte PB,Henseler JF,van Zwet EW,et al.Cranial humerus translation,deltoid activation,adductor co-activation and rotator cuff disease-different patterns in rotator cuff tears,subacromial impingement and controls.Clin Biomech(Bristol,Avon).2014;29(1):26-32.
[15]Marzetti E,Rabini A,Piccinini G,et al.Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome:a single-blind randomized controlled clinical trial.Eur J Phys Rehabil Med.2014;50(3):255-264.
[16]Park SI,Choi YK,Lee JH,et al.Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.J Phys Ther Sci.2013;25(11):1359-1362.
[17]Tucci HT,Martins J,Sposito Gde C,et al.Closed Kinetic Chain Upper Extremity Stability test(CKCUES test):a reliability study in persons with and without shoulder impingement syndrome.BMC Musculoskelet Disord.2014;15:1.
[18]朱江龙,苏波,王大伟.健骨注射液肩峰下注射治疗肩峰下撞击综合征的临床疗效观察[J].中医正骨,2012,24(5):60-64.
[19]戴祝,华英汇,陈世益,等.原发性冷冻肩与肩峰撞击征的鉴别诊断及治疗[J].实用骨科杂志,2012,18(1):50-52.
[20]Gebremariam L,Hay EM,van der Sande R,et al.Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.Br J Sports Med.2014;48(16):1202-1208.
[21]van Kampen DA,Willems WJ,van Beers LW,et al.Determination and comparison of the smallest detectable change(SDC)and the minimal important change(MIC)of four-shoulder patient-reported outcome measures(PROMs).J Orthop Surg Res.2013;8:40.
[22]Neviaser A,Braman J,Parsons B.What's new in shoulder and elbow surgery.J Bone Joint Surg Am.2013;95(20):1896-1901.
[23]徐海栋,付强,赵建宁.数字技术在脊柱微创外科中的应用进展[J].医学研究生学报,2014,27(2):207-210.
[24]眭杰,汪滋民.肩峰下滑囊切除在肩峰下撞击综合征手术治疗的应用价值[J].中国矫形外科杂志,2013,21(1):37-40.
[25]徐海栋,陈勇,卢俊浩,等.带线锚钉Krackow缝合法修复急性跟腱断裂的临床研究[J].医学研究生学报,2013,26(3):156-159.