探讨超声可视化注射对老年人偏瘫肩痛的疗效。

前瞻性选取2021年4月至2021年12月南京紫金医院在院的老年偏瘫肩痛患者64例。按照就诊顺序编号，用随机数字表法将64例患者分为治疗组32例和对照组32例。治疗组在肌骨超声引导下在患处注射复方倍他米松注射液和利多卡因注射液，对照组予针刺加低频脉冲电治疗联合扶他林软膏外涂；记录治疗前患者疼痛评分、肩关节活动度评分、肱二头肌长头腱以及肩峰下滑囊积液量，记录治疗24 h及第5天患者疼痛评分、肩关节活动度评分，2周后再行肌骨超声检查记录积液量变化，对比治疗效果。

60例患者完成随访，治疗组1例患者和对照组2例患者因肩关节炎症类型不符失访，治疗组另1例患者因出院失访，随访率93.75%，随访时间（14±2）d，随访男性35例，女性25例，平均年龄（55.93±5.05）岁。最后60例患者纳入最后统计，治疗组和对照组在治疗前、治疗后24 h、治疗后第5天在疼痛评分、肩关节外展度、肩关节前屈度进行重复测量设计的方差分析，结果显示治疗组和对照组组间差异有统计学意义（F=24.445，P<0.001；F=7.047，P=0.010；F=4.545，P=0.037），疼痛评分和肩关节前屈度组别与时间点间存在交互作用（F=19.125，P<0.001；F=13.593，P<0.001），肩关节外展度组别与时间点间无交互作用。各时间点除第一时间点外两组差别均有统计学意义；治疗组在各时间点间差异均有统计学意义（均P<0.05）。治疗组和对照组的肱二头肌长头腱积液和肩峰下滑囊积液治疗前后对比有统计学意义（t=-4.289，P<0.001；t=-3.722，P<0.001），治疗后2周两组间对比差异有统计学意义，治疗组优于对照组。

临床治疗老年偏瘫肩痛，采用肌骨超声可视化精准注射治疗可以快速减轻患者疼痛，改善患者肩关节活动度，促进炎性吸收，为进一步的康复治疗打下良好的基础。

To explore the efficacy of ultrasound visualization injections for hemiplegic shoulder pain in the elderly.

A total of 64 elderly patients with hemiplegic shoulder pain who were hospitalized in Nanjing Zijin Hospital from April 2021 to December 2021 were prospectively selected. The 64 patients were divided into a treatment group of 32 cases and a control group of 32 cases by a random number table method according to the order of visits. The treatment group was given a compound betamethasone injection and lidocaine injection under the guidance of musculoskeletal ultrasound, while the control group was given acupuncture plus low-frequency pulsed electrical therapy combined with external application of Voltaren ointment.The pain score, shoulder range of motion score, biceps long head tendon and subacromial bursa fluid volume were recorded before treatment, and the pain score and shoulder range of motion score were recorded at 24 hours and on the 5 days after treatment, and after 2 weeks.

Sixty patients were followed up. One patient in the treatment group and two patients in the control group were lost due to the different types of shoulder inflammation. Another patient in the treatment group was lost due to discharge. The follow-up rate was 93.75%, and the follow-up time was (14±2) d. 35 males and 25 females were followed up, with an average age of (55.93±5.05) years. The last 60 patients were included in the final statistics. Repeated measures ANOVA of visual analogue scale, shoulder joint extension and shoulder joint flexion were performed in the treatment group and the control group before treatment, 24 h after treatment and five days after treatment by analysis of variance, which showed statistically significant differences between the treatment group and the control group. There was an interaction between the visual analogue scale and the shoulder flexion group and the time point, but there was no interaction between the shoulder abduction group and the time point. Except the first time point, the difference between the two groups was statistically significant. There were statistically significant differences between the treatment groups at eachtime point. The comparison of biceps long head tendon effusion and subacromial bursa effusion before and after treatment between the treatment group and the control group was statistically significant. The comparison difference between the two groups was statistically significant two weeks after treatment, and the treatment group was better than the control group.

In the clinical treatment of elderly patients with hemiplegic shoulder pain, musculoskeletal ultrasound visualization precision injection treatment can rapidly reduce the pain of patients, improve the range of motion of patients' shoulder joints, promote inflammatory absorption, and lay a good foundation for further rehabilitation treatment.