超声引导下肩胛上神经及腋神经射频脉冲治疗对关节镜下肩袖损伤修复术后恢复质量的影响

Effect of ultrasound-guided radio frequency pulse on suprascapular and axillary nerves for postoperative recovery quality following arthroscopic rotator cuff repair

摘要:

目的 探讨超声引导下肩胛上神经及腋神经射频脉冲治疗对关节镜下肩袖修复术后患者恢复质量及安全性的影响。方法 选取2023年7月－2025年1月于该院接受关节镜下肩袖修复术的患者60例，采用随机数表法，将患者分为观察组和对照组，各30例。在全身麻醉诱导前的干预阶段，观察组接受超声引导下肩胛上神经及腋神经射频脉冲治疗，对照组实施超声引导下肌间沟臂丛神经阻滞。两组患者术后均采用患者自控静脉镇痛（PCIA）进行干预。观察两组患者手术时间、术中阿片类药物使用量、补救镇痛例数和术后48 h PCIA按压次数。记录术后12 h、24 h、48 h、1周、1个月和2个月活动状态下（上臂外展和外旋时）的数字分级评分法（NRS）评分，术后48 h、1周、1个月和2个月的牛津肩关节评分（OSS）。并记录麻醉恢复室（PACU）带管时间和PACU停留时间，以及不良反应（神经损伤、穿刺部位感染、呃逆、局部麻醉药毒性反应、恶心呕吐、声音嘶哑和霍纳综合征）发生情况。结果 两组患者手术时间、PACU停留时间和术中舒芬太尼使用量比较，差异均无统计学意义（P > 0.05）。观察组术后48 h PCIA按压次数和补救镇痛例数明显少于对照组，PACU带管时间明显短于对照组，差异均有统计学意义（P < 0.05）。观察组术后12 h活动状态下的NRS评分明显高于对照组，差异有统计学意义（P < 0.05）；观察组术后24 h活动状态下的NRS评分高于对照组，但差异无统计学意义（P > 0.05）；观察组术后48 h、1周、1个月和2个月活动状态下的NRS评分明显低于对照组，差异均有统计学意义（P < 0.05）。两组患者术后48 h和1周的OSS比较，差异均无统计学意义（P > 0.05）；观察组术后1和2个月的OSS明显低于对照组，差异均有统计学意义（P < 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P > 0.05）。结论 超声引导下肩胛上神经及腋神经射频脉冲治疗，可为关节镜下肩袖损伤修复术患者提供确切的镇痛效果，有利于肩关节功能的恢复，安全有效，值得临床推广应用。

Abstract:

Objective To explore the influence of ultrasound-guided radio frequency pulse treatment of the suprascapular nerve and axillary nerve on the recovery quality and safety of patients after arthroscopic rotator cuff repairr.Methods 60 patients who underwent arthroscopic rotator cuff repair from July 2023 to January 2025 were selected. The patients were divided into the observation group and the control group by random number table method, with 30 cases in each group. During the intervention stage before general anesthesia induction, the observation group received ultrasound-guided combined radio frequency pulse treatment of the suprascapular nerve and axillary nerve, while the control group received ultrasound-guided intermuscular groove brachial plexus nerve block. Both groups of patients were intervened with patient controlled intravenous analgesia (PCIA) after the operation. Observe the time of operation, intraoperative opioid dosage and the number of cases of remedial analgesia in the two groups of patients, the number of PCIA compressions 48 hours after the operation, and the numerical rating scale (NRS) score in the active state (during upper arm abduction and external rotation) at 12 hours, 24 hours, 48 hours, 1 week, 1 month and 2 months after the operation, and Oxford shoulder score (OSS) at 48 hours, 1 week, 1 month and 2 months after the operation, postanesthesia care unit (PACU) intubation time and PACU dwell time, and the occurrence of adverse reactions (nerve injury, infection at the puncture site, hiccups, toxic reactions of local anesthetics, nausea and vomiting, hoarseness and Horner syndrome).Results There were no statistically significant differences in the time of operation, PACU indwelling time and the dosage of sufentanil during the operation between the two groups of patients (P > 0.05). The number of PCIA compressions 48 hours after surgery and the number of cases of remedial analgesia in the observation group were significantly less than those in the control group, and the PACU intubation time was significantly shorter than that in the control group, the differences were statistically significant (P < 0.05). The NRS score of the observation group in the active state 12 hours after the operation was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). The NRS score of the observation group in the active state 24 hours after the operation was higher than that of the control group, but the difference was not statistically significant (P > 0.05). The NRS scores of the observation group in the active state at 48 hours, 1 week, 1 month and 2 months after the operation were significantly lower than those of the control group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in OSS between the two groups of patients at 48 hours and 1 week after surgery (P > 0.05). The OSS of the observation group at 1 and 2 months after the operation was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (P > 0.05).Conclusion Ultrasound-guided radio frequency pulse treatment of the suprascapular nerve and axillary nerve provides definite analgesic effects for patients undergoing arthroscopic rotator cuff injury repair, is conducive to the recovery of shoulder joint function, and is safe. It is worthy of clinical promotion and application.