Stellate ganglion block increases the brachial plexus of small needle-knife lysis

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Objective To investigate the stellate ganglion block with a small needle-knife loosen the treatment of brachial plexus post-stroke shoulder-hand syndrome, the clinical efficacy. Methods 48 cases of post-stroke shoulder-hand syndrome were randomly divided into study group 28 cases, the control group, 20 cases in both groups for routine rehabilitation treatment, study group co-stellate ganglion block with a small needle-knife loosen the brachial plexus treatment, 1 w-1, 2 times for a course of treatment. Before and after treatment using visual analogue scales assessed pain levels, at the same time assessment of upper extremity Brunnstrom classification. The results of visual analogue scale before treatment groups after treatment than those in a very significant decrease (t research = 51.323, t right = 12.879, P are "0.01), but the study group decreased more significantly than the control group (t = 32.54, P < 0.01). Upper extremity Brunnstrom grading assessment study group before and after treatment by the non-parametric test was significant difference (P <0.05), upper limb motor function> Ⅳ grade increased from 32.14% to 92.86%; the control group increased from 70.0% to 80.0% . research group excellent and good rate was 96.4% in the control group was 35.0%, the two groups was significant difference (χ 2 = 21.31, P <0.01). Conclusion stellate ganglion block with a small needle-knife loosen the brachial plexus in patients with shoulder-hand syndrome is simple, fast onset of action, combined with rehabilitation training can speed up the recovery process.
[Keywords:] shoulder-hand syndrome; stellate ganglion block; needle knife loosen

Shoulder-hand syndrome (Shoulder hand Syndome, SHS) also known as reflex sympathetic dystrophy or Sudeck syndrome, cerebrovascular disease is a serious complication following a common, accounting for 12.5% ~ 24.0%, up to 70% for individual coverage, and gender, age, cause nothing to do. 66% of patients after onset occurred in 1 mo ~ 3 mo, after the onset of late can only appeared 6 mo [2], currently no effective treatment. To explore the treatment of shoulder-hand syndrome, effective therapies, we have adopted a stellate ganglion block increases the brachial plexus with the little knife releasable means such as rehabilitation therapy to achieve more satisfactory results. These are as follows.
1 Data and methods
1.1 Object
Select January 2006 ~ December in our hospital treated 48 cases of post-stroke SHS patient study are consistent with post-stroke SHS diagnostic criteria [1]; exclude coagulation system barriers, with severe primary disease of the heart, liver and mental illness patients. Into the group of patients will be randomly divided into two groups. Study group 28 patients, 19 males and 9 females; age of 47 a ~ 81 a, the average (62.29 ± 10.45) a; severity of disease: Ⅰ period of 12 cases, Ⅱ , 12 cases, Ⅲ period of 4 cases. Control group, 20 patients, 12 males and 8 females; age of 48 a ~ 80 a, the average (64.05 ± 10.48) a; severity of disease: Ⅰ period of 8 cases, Ⅱ , 9 cases, Ⅲ period of 3 cases. Comparison of two groups of general information there was no significant difference (P> 0.05).

1.2 Methods
1.2.1 rehabilitation treatment in the same two groups, based on the joint study group stellate ganglion block, brachial plexus and practices of small needle-knife lysis treatment, 1 w-1, 2 times for a course of treatment. Stellate ganglion block by the drugs used for the 1% lidocaine 8 ml, using anterior approach, after C6 administration, there Honer's syndrome for a successful logo. Brachial plexus using a small needle-knife releasable touch-induced axillary brachial plexus surgical approach, individual use of touch-induced subclavian brachial plexus surgery into the road, cross striations in the ipsilateral axillary artery pulse at the strongest point of the lateral (or inside) vertical into the needle-knife, breaking the axillary artery sheath may have a sense of frustration, fixed minor swing needle knife needle knife deep body, to enhance the touch excited. General postoperative joint contractures will reduce or disappear, tension reduction, is very conducive to practice massage therapy and functional exercise lysis.

1.2.2 Efficacy Standards
Before and after treatment using visual analog score (Visual analogue scale, VAS) assessing pain, upper extremity Brunnstrom grading assessed at the same time, all assessed by the same therapists. Clinical assessment: excellent: VAS reduction of ≥ 6 points, the pain completely disappeared, shoulder-hand edema disappeared and no joint stiffness and contracture, good blood circulation, muscle strength improved (≥ Ⅲ level); good: VAS reduction of "three points, shoulder-hand significantly reduced joint pain, edema subsided, but still left a slight pain in joints, skin red, the temperature was slightly higher; General: VAS reduction of "1 minute, shoulder, hand edema has receded, but the joints still subject to certain restrictions; difference: VAS ≤ 1 min or less before treatment compared to no significant change, back pain, or edema, no improvement in joint contracture and muscle atrophy occurs.

1.2.3 Statistical Methods
All data applications SPSS11.5 statistical package, handling, and t-test, χ 2 test and non-parametric tests.

2 Results
2.1 The two groups before and after treatment VAS score comparison, in Table 1. Table 1 shows, VAS score after treatment than those in the two groups before treatment a very significant decrease (P all "0.01), but the study group decreased more significantly than the control group, the difference was significant (t = 32.54, P <0.01) . Table 1 the two groups before and after treatment VAS score (slightly) Note: The comparison between the two groups * (t = 32.54, P <0.01).

2.2 The upper two groups before and after treatment compared Brunnstrom classification shown in Table 2. Table 2 groups before and after treatment upper extremity Brunnstrom classification (slightly) Note: The study group before and after treatment of upper limb motor function after non-parametric test P <0.05.

Table 2 shows, upper Brunnstrom classification assessment, the Study Group before and after treatment by the non-parametric test was significant difference (P <0  05), upper limb motor function> Ⅳ grade from 32  14% to 92  86%; the control group by 70  0% to 80  0%.

2.3 Clinical Efficacy
Excellent study group after treatment in 16 cases, good in 11 cases, generally in 1 case, excellent and good rate was 96.4%; the control group were excellent in 4 cases, good in 3 cases, 10 cases in general, and poor in 3 cases, good rate of 35.0%. Excellent and good rate compared two groups was significant difference (χ 2 = 21.31, P <0.01).

3 Discussion
Clinical manifestations of shoulder-hand syndrome 3 mo post-stroke shoulder-hand within the ipsilateral upper extremity joint pain, limited mobility. Pathogenesis has not yet completely clear, is generally believed that acute cerebrovascular disease affect the vasomotor center, cervical sympathetic stimulation may be a direct result of limb sympathetic activity increased and vascular contraction response, resulting in local tissue dystrophy. The early clinical manifestations of shoulder, hand pain, swelling, skin temperature rise, excessive excessive pain can be aggravated when the wrist dorsiflexion; to develop the medium-term, significant atrophy of hand muscles;

late stage there are characteristic hand deformities and left permanently disabled . With stellate ganglion block with a small needle-knife loosen the treatment of brachial plexus shoulder-hand syndrome, is intended to improve the sympathetic nerve function, loosen contracture organizations, to improve the tension, easy to approach treatment. Stellate ganglion of cervical sympathetic chain ganglia, from the cervical and thoracic ganglion a combination of a nerve. Stellate ganglion block in the central role [3] through the adjustment of the hypothalamus to maintain a stable internal environment functions, regulating autonomic nervous, endocrine and immune function, so that neurological disorders to be corrected; around the role of the Department, or directly inhibit the shoulders and back, upper limb of Nutrition excitatory sympathetic to ease the cramps and expansion of blood vessels, blocking blood vessel movement disorders.

Acupotomology founded 70 years new therapies [4], is characterized by the acupuncture needles and surgical knives blend the two strengths in the treatment of chronic joint disease in the full spin-off of a knife, loosen and pin the role of right spastic diseases better results. This study showed that patients with pain after treatment than those in the two groups before treatment decreased significantly (P <0.01), but the effect of upper limb function classification and excellent rate of study group was significantly better than the control group (P <0.01), particularly in patients with early and middle stages, effective rate was 100%. This treatment uses internal and external integration of complementary advantages, simple operation, fast onset of action, combined with rehabilitation training can speed up the recovery process, it is worth further exploration.

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