2016-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660792摘要：肩痛是僅次於脊椎與膝關節痛外，第三常見的骨關節痛，慢性肩痛更會妨礙日常功能執行，影響生活品質。除積極復健外，關節腔內類固醇注射與支配肩部痛覺之上肩胛神經阻斷亦常用於緩解疼痛，且超音波導引可於診間進行，不需傳統X 光定位，大幅提升方便性。目前文獻多報導超音波導引上肩胛神經阻斷需由背後上肩胛骨凹處置。本團隊最近發表超音波於鎖骨上窩處可清楚目視評估近端上肩胛神經並進行高頻熱凝阻斷，有效減緩腫瘤肩部轉移之頑固癌痛。解剖學上比傳統從上肩胛骨凹處阻斷止痛範圍更大，然文獻尚無嚴謹前瞻隨機分派臨床試驗以驗證近端上肩胛神經介入法是否優於傳統阻斷方式。本研究預計於第一年進行系統性文獻回顧與統合分析，比較慢性肩痛採行不同治療模式的成效，包括上肩胛神經局部麻醉阻斷、高頻熱凝阻斷、脈衝式射頻與關節腔內類固醇注射及復健治療與安慰劑間療效之比較，並建立不同處置療效的預測模型。由於頑固冷凍肩影響病患日常功能與生活品質甚鉅，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仍成效不彰。本團隊將於第二年利用隨機分派研究，比較兩種超音波導引上肩胛神經阻斷的成效與優劣點，同時輔以術後即時的關節鬆動術，與完整復健處方，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: Shoulder pain is the third most prevalent type of musculoskeletal disorder following spinal and knee painand has tremendous function impairment and psychosocial impact when progresses to chronic stage.Besides oral analgesics, physical therapy and intra-articular steroid injection and suprascapular nerve (SSN)block are common approaches to manage chronic shoulder pain. The classical SSN block is performedunder fluoroscope guidance, targeting the suprascapular notch where the nerve passes through. Mostreported ultrasound guide SSN blocks were performed via traditional suprascapular notch approach. Ourgroup recently published ultrasound visualization and guided radiofrequency lesioning of proximal SSN atthe supraclavicular fossa can alleviate cancer related recalcitrant shoulder pain. Anatomically, this approachcan provide wider-area of analgesia. However, up-to-date, there is no prospective randomized trial to provethis concept.In first year of this two-year project, we will conduct a systemic review and meta-analysis to comparetreatment effect of different modalities for recalcitrant shoulder pain including SSN nerve block, pulsedradiofrequency, intra-articular steroid injection, physical therapy and placebo. We will also formulate aprediction model for shoulder pain treatment success. Recalcitrant painful frozen shoulder is a common butdisabling disease. The result of rehabilitation is usually limited by poor-controlled pain, even afterintra-articular steroid injections. In the second year, we will conduct a randomized control trial to comparethe safety and efficacy of the classical and new supraclavicular SSN blocks for patients with recalcitrantpainful frozen shoulders. All the patients will be prescribed with shoulder mobilization and a well-organizedrehabilitation program immediately after nerve block. Our intention is to develop a new treatment strategyby integrating interventional pain management and rehabilitation to maximize the treatment effectivenessand restore shoulder function for the population with recalcitrant painful frozen shoulders.上肩胛神經神經阻斷脈衝式射頻關節腔內注射物理治療復健超音波導引頑固肩痛Suprascapular nerveNerve blockPulsed radiofrequencyIntra-articular injectionPhysical therapyRehabilitationUltrasound guideRecalcitrant shoulder pain