Effects of transcatheter arterial micro-embolization for chronic night shoulder pain refractory to non−surgical management
Effects of transcatheter arterial micro-embolization for chronic night shoulder pain refractory to non−surgical management
复制标题
经导管动脉微栓塞治疗非手术治疗难治性慢性夜间肩痛的效果
DOI：
10.11154/pain.29.233
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Y. Okuno
中科院分区：
文献类型：
--
作者：
Y. Okuno
目的：新生血管和伴行神经可能是疼痛的来源。先前的研究表明，经导管动脉微创−栓塞术(TAME)对粘连性囊炎患者有很好的止痛效果。我们推测，异常新生血管在夜间肩痛和其他情况下的肩痛以及粘连性囊炎中也起着重要作用，而驯服可以缓解疼痛。材料和方法：应用亚胺培南⁄西司他丁钠作为栓塞剂，对16例患者17肩进行了TAME治疗，其中粘连性囊炎6例，肩峰下撞击综合征7例，肩袖无手术指征撕裂2例，肩关节僵硬1例，肩周骨骨折后慢性疼痛1例。所有患者均有夜间肩部疼痛，既往保守治疗至少持续三个月，治疗前持续中度−至−重度疼痛(视觉模拟评分50 mm)。在术后1周、1个月、3个月和6个月评估不良事件、夜间疼痛视觉模拟量表评分的变化以及自我报告睡眠质量评分的变化。结果：所有病例均发现异常新生血管。没有与这些程序相关的重大不良事件。经导管动脉微−栓塞术后1周夜间疼痛视觉模拟评分由72±7 mm降至42±26 mm，术后1、3、6个月进一步改善(分别为28±22 mm、19±24 mm、16±23 mm)。自我报告睡眠质量评分和夜间疼痛频率改善并维持6个月。结论：所有患者均可观察到异常新生血管。这种病变的驯化是可行的，有效地缓解了顽固性的慢性夜间肩痛。
Purpose : Neovessels and accompanying nerves are possible sources of pain. Previous work demonstrated that transcatheter arterial micro− emboliza tion (TAME) for patients with adhesive capsulitis resulted in excellent pain relief. We hypothesized that abnormal neovessels also play an important role in nighttime shoulder pain with other conditions as well as adhesive capsulitis and that TAME can relieve pain. Material and Methods: TAME using imipenem ⁄ cilastatin sodium as an embolic agent proceeded to seventeen shoulders in sixteen patients, including adhesive capsulitis (n=6), subacromial impingement syndrome (n=7), rotator cuff tear without surgical indication (n=2), stiff shoulder (n=1), and chronic pain post scapula fracture (n=1). All patients had nighttime shoulder pain and previous conservative therapies applied for at least three months and persisted moderate−to−severe pain (Visual Analog Scale > 50 mm) before treatments. Adverse events, changes in Visual Analog Scale scores of night pain, and changes in self reporting sleep quality scores were assessed at 1 week and at 1, 3, and 6 months after the procedure. Results : Abnormal neovessels were identified in all cases. No major adverse events were related to the procedures. Transcatheter arterial micro− embolization rapidly decreased nighttime pain visual analog scale scores from 72 ± 7 mm to 42 ± 26 mm at 1 week after the procedure, with further improvement at 1, 3 and 6 months (28 ± 22 mm, 19 ± 24 mm, and 16 ± 23 mm respectively). Self reporting sleep quality scores and nighttime pain frequency improved and maintained for 6 months. Conclusion: Abnormal neovessels were observed in all patients. TAME of this lesion was feasible, effectively relieved unrelenting chronic night shoulder pain.