超声引导下脉冲射频联合富血小板血浆注射治疗肩周炎的长期临床疗效观察

The observation of long-term clinical efficacy of ultrasound-guided pulsed radiofrequency combined with injection of platelet-rich plasma in the treatment of periarthritis of shoulder

摘要:

目的 评估超声引导下脉冲射频联合富血小板血浆(platelet-rich plasma,PRP)注射治疗肩周炎的长期临床疗效 方法 回顾性分析2020年3月至2023年3月收治的肩周炎患者61例,根据治疗方式分为两组,其中对照组31例,试验组30例。对照组行超声引导下肩胛上神经+腋神经脉冲射频,试验组在对照组的基础上行PRP注射,PRP治疗每周1次,共治疗2次。采用视觉模拟评分法(visual analogue scale,VAS)、Constant-Murley肩关节功能评分(CM评分)、红外热成像图患侧与健侧皮肤温度差值(ΔT)、血清炎症因子白细胞介素-6(IL-6)水平及基质金属蛋白酶-3(MMP-3)水平评估两组患者的疼痛程度、肩关节功能、炎症及纤维化水平变化。 结果 与治疗前(T0)相比,两组患者VAS评分在治疗后1周(T1)、1月(T2)、3月(T3)时均明显降低(P＜0.05)；T1时,两组VAS评分无统计学差异,T2、T3时,试验组低于对照组(P＜0.05)。与T0相比,两组患者CM评分在T1、T2、T3时均明显升高(P＜0.05)；T1时,两组CM评分无统计学差异,T2、T3时,试验组高于对照组(P＜0.05)。与T0相比,两组患者ΔT值在T1、T2、T3时均明显降低(P＜0.05)；T1时,两组ΔT值无统计学差异,T2、T3时,试验组低于对照组(P＜0.05)。治疗后1月,两组患者血清IL-6、MMP-3水平明显降低(P＜0.05),且试验组IL-6、MMP-3水平低于对照组(P＜0.05)。治疗后,试验组的总有效率为93.3%,对照组总有效率为83.9%,试验组疗效优于对照组(P＜0.05)。 结论 与脉冲射频相比,联合PRP治疗在缓解肩周炎患者疼痛基础上,能进一步减轻炎症水平,显著改善肩关节功能,长期疗效明显。

Abstract:

Objectives To evaluate the long-term clinical efficacy of ultrasound-guided pulsed radiofrequency combined with injection of platelet-rich plasma (PRP) in the treatment of periarthritis of shoulder. Methods A retrospective analysis of 61 patients with periarthritis of shoulder treated from March 2020 to March 2023 was performed. They were divided into two groups according to the treatment methods, of which 31 were in the control group and 30 were in experimental group. The control group received ultrasound-guided pulsed radiofrequency of suprascapular nerve + axillary nerve , while the experimental group received injection of PRP on the basis of the control group, and PRP treatment was performed once a week, a total of 2 times. Using the visual analogue scale (VAS), Constant-Murley shoulder function score (CM score), infrared thermal imaging of skin temperature difference between the affected side and the healthy side (ΔT), inflammatory factor interleukin-6 (IL-6) and matrix metalloproteinase-3 (MMP-3) in serum of patients in the two groups were evaluated for pain degree, shoulder function, and changes in inflammation and fibrosis levels. Results Compared with before treatment (T0), VAS in two groups were significantly decreased at 1 week (T1), 1 month (T2) and 3 months (T3) after treatment (P < 0.05); VAS of experimental group had no significant difference at T1 compared with control group, but was lower at T2 and T3 than control group (P < 0.05). Compared with T0, CM scores in two groups were significantly increased at T1, T2 and T3 (P < 0.05); There was no significant difference in CM score between experimental group and control group at T1, but it was higher than control group at T2 and T3 (P < 0.05). Compared with T0, ΔT in T1, T2 and T3 were significantly decreased in both groups (P < 0.05). The ΔT of the experimental group had no significant difference at T1 compared with control group, but was lower at T2 and T3 than the control group (P < 0.05). One month after treatment, IL-6 and MMP-3 in serum in two groups were significantly decreased (P < 0.05); The IL-6 and MMP-3 in experimental groups were lower than those in control group (P < 0.05). After treatment, the total effective rate of the experimental group was 93.3%, and that of the control group was 83.9%. The curative effect of the experimental group was better than that of the control group (P < 0.05). Conclusion Compared with pulsed radiofrequency, which combined with PRP treatment can further reduce inflammation and significantly improve the shoulder joint function on the basis of relieving the pain of patients with shoulder periarthritis. It"s long-term effect is obvious.