2015-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660790摘要：惡性腫瘤轉移近端肱骨或肩關節所造成之頑固肩痛，是腫瘤病患常見卻難處理的問題，除疼痛 惱人，更會妨礙曰常生活功能的執行，影響生活品質。然因病患身體情況往往不適合手術而須以神 經阻斷止痛。肩部的疼痛由上肩胛神經傳遞，針對此神經進行例如高頻熱凝阻斷的疼痛介入處置， 安全有效並可提供長時間止痛。然傳統處置是以X光定位上肩胛神經可能位置之上肩胛骨凹，並非 精準確認神經，且處置時需病患採趴位，往往不能為末期腫瘤病患配合。以高解析度超音波於鎖骨 上窩處可清楚目視評估近端上肩胛神經自臂神經叢分出，近來已有解剖學研究證實可於此處進行介 入性治療。然目前並無腫瘤肩部轉移癌痛使用此一技術止痛的相關研究，也無嚴謹之前瞻性隨機分 派臨床試驗以驗證近端上肩胛神經介入法優於傳統方式。冷凍肩為顯著影響病患生活功能與品質之常見疾病，復健成效與功能回復往往因劇烈疼痛而大 幅受限。部分病患即使合併肩關節類固醇注射的方式仍效果不佳。因此這群頑固性冷凍肩病患會轉 診至疼痛門診接受上肩胛神經阻斷術，而採用近端上肩胛神經阻斷術，理論上將比傳統從上肩胛骨 凹處去介入，更能提供止痛並達到功能恢復的成效。本研究預計於第一年進行病歷回溯研究，分析過去兩年於本院接受近端上肩胛神經高頻熱凝阻斷 的癌末病患，並自資料庫中萃取病患資料及操作影像，來建立該術式治療療效的預測模型。於第二 年將以頑固疼痛的冷凍肩病患為研究族群，利用隨機分派的研究模式，比較兩種上肩胛神經阻斷方 式的效果與優劣點，同時輔以術後即時的關節鬆動術，與完整的復健處方發展頑固性疼痛冷凍肩的 整合治療模式，加速患者疼痛改善與功能恢復。<br> Abstract: Recalcitrant shoulder pain from metastatic lesions is a common but difficult-to-manage problem amongpatients with advanced malignancy and affects their quality of life substantially. Nerve block with radiofrequency lesioning of the suprascapular nerve is a surrogate procedure to provide pain relief when surgical management is not feasible. The classical suprascapular nerve block is performed under fluoroscope or CT guidance, targeting the suprascapular notch where the nerve passes through. The main limitation is lack of direct visualization of the suprascapular nerve. In addition, the procedure is conducted in a prone position which may not be tolerated by patients with end-stage cancers. Due to the development of high resolution ultrasound, the proximal segment of the suprascpular nerve can be visualized at the supraclavicular fossa when it branches from the brachial plexus. A recent cadaveric study has demonstrated that intervention at this area is approachable. To date, there is no study investigating the effect of the new technique in patients with malignancy-associated shoulder pain.Recalcitrant painful frozen shoulder is a common but disabling disease. The result of rehabilitation is usually limited by poor-controlled pain, even after intra-articular steroid injections. Those patients will be referred for suprascapular nerve blocks. The supraclavicular approach is theoretically better than the traditional approach aiming at the suprascapular fossa due to wider coverage of shoulder sensory innervations.In first year of this two-year project, we will conduct a retrospective study by reviewing the cases with end-stage cancers after ultrasound guided proximal suprascapular nerve block for recalcitrant shoulder pain. The sonographic images, details of interventions and factors associated with treatment success retrieved from our database will be analyzed for establishing the prediction model. In the second year, we will conduct a randomized control trial to compare the safety and efficacy of the classical and new supraclavicular suprascapular nerve blocks for patients with recalcitrant painful frozen shoulders. All the patients will be prescribed with shoulder mobilization and a well-organized rehabilitation program. Our intention is to develop a new treatment paradigm by integrating interventional pain management and rehabilitation to maximize the treatment effectiveness and restore shoulder function for the population with recalcitrantpainful frozen shoulders.上肩胛神經超音波惡性腫瘤頑固肩痛疼痛介入處置Suprascapular nerveUltrasoundMalignancyRecalcitrant shoulder painInterventional pain management