關節內注射玻尿酸鈉製劑對沾黏性肩關節囊炎患者療效之評估

Intraarticular Injection of Sodium Hyaluronate in Adhesive Capsulitis of the Shoulder

孫淑芬(Shu-Fen Sun) ； 黃巧雯(Chiao-Wen Hwang) ； 許培德(Pei-Te Hsu) ； 許雅雯(Ya-Wen Hsu) ； 蔡欣龍(Shin-Lung Tsai) ； 王志龍(Jue-Long Wang) ； 許健威(Chien-Wei Hsu) ； 周怡君(Yi-Jiun Chou)

《台灣復健醫學雜誌》 33卷4期 (2005/12) Pp. 221-227

https://doi.org/10.6315/2005.33(4)05

摘要

沾黏性肩關節囊炎易造成病人肩部疼痛及肩關節活動障礙。傳統治療法包括保守性內科藥物治療及復健治療，但嚴重的肩痛往往造成復健鬆動術治療進展緩慢；肩關節注射類固醇對早期疾病雖有效，但對晚期病人療效不彰，且有許多不良副作用，故目前對中重度沾黏性肩關節囊炎之治療並無特定及令人滿意的方法。
本研究收集60位沾黏性肩關節囊炎之患者，隨機分配為實驗組及對照組，兩組皆接受三個月之復健治療，實驗組並接受每週一次，每次2.5cc（含25mg sodium hyaluronate）連續5週之肩關節注射治療。我們比較病人治療前，及注射3個月後肩關節疼痛程度、活動度及日常生活肩功能。完成追蹤評估的病人共有47位。結果顯示對中重度肩沾黏性關節囊炎患者，使用關節內注射玻尿酸鈉製劑配合傳統復健運動治療，不僅在關節活動度、疼痛及失能方面都比只用傳統復健運動有較佳之治療效果，且病人無不適反應。以上結果可做為臨床醫師治療中重度肩沾黏性關節囊炎患者之參考，在經濟情況許可下，使用關節內注射玻尿酸鈉製劑配合傳統復健運動治療，比只用傳統復健運動有較佳之治療效果。

關鍵字

沾黏性肩關節囊炎 ； 玻尿酸鈉

並列摘要

The etiology and natural history of adhesive capsulitis remain obscure, which limited subsequent management. Traditional treatments include conservative medical therapy and physical therapy, but severe shoulder pain may constitute an obstacle to joint mobilization. Local steroid injection into or around the shoulder joint has been shown to alleviate pain in early stages of the disease. Late disease appears less responsive and there are many known risks of complications. Many different protocols to treat the disease have been reported, but the results are generally unsatisfatcory and difficult to compare.
Our goal was to determine the efficacy of a combined treatment-intraarticular injection of sodium hyaluronate plus rehabilltation treatment-in the management of adhesive capsulitis of the shoulder. To this end, sixty patients with established adhesive capsulitis were enrolled. The patients were randomly allocated to receive intraarticular injection of sodium hyaluronate and rehabilitation or rehabilitation alone. Intraarticular injections with 2.5 cc sodium hyaluronate (25 mg) were performed once weekly for 5 weeks by injection into the glenoid cavity using an anterior approach. Physiotherapy was performed for 12 weeks in both groups. Of 60 patients seen between January 2003 and October 2004, follow-up was completed for 47 (78%). The results show an improvement in both groups on most measures of treatment effectiveness, including joint mobility, pain and disability after 3 months, even more so in the patients treated with combined sodium hyaluronate and physiotherapy. No adverse effects were reported. These results strongly suggest that combined sodium hyaluronate and rehabilitation treatment are effective for the treatment of patients with adhesive capsulitis.

並列關鍵字

adhesive capsulitis ； sodium hyaluronate