超声引导下针刀联合温针灸治疗粘连性肩关节囊炎短期疗效的前瞻性研究

Prospective Study of Short-term Efficacy of Ultrasound-guided Precision Acupotomy Combined with Needle Warming Moxibustion for the Treatment of Adhesive Capsulitis of Shoulder

摘要:

目的 探讨超声引导下精准针刀松解术联合高回声钙化区温针灸治疗粘连性肩关节囊炎的临床疗效。方法 选取2016年01月至2018年01月在武汉市第三医院收治的78例粘连性肩关节囊炎患者,按照随机数字表法分为观察组(n=39)和对照组(n=39)。对照组应用超声定位“肩前四点”,并实时引导针刀松解术治疗1次,而观察组在对照组治疗方法的基础上,加用超声引导下“高回声钙化区”温针灸治疗1次。比较两组患者治疗前、治疗后1周、1月、3月和6月VAS疼痛评分、CMS肩功能评分和整体疗效。结果 随访半年内,两组患者VAS评分在不同时间之间总体呈降低趋势,差异有统计学意义(F时间=8.823,P时间=0.003)；从术后各个时间点看,对照组VAS评分显著高于观察组(F组间=11.937,P组间=0.001)；不同时间点与分组之间存在交互作用(F交互=16.571,P交互=0.000)。两组患者CMS评分在不同时间之间总体呈升高趋势,从各个时间点来看,两种患者术后CMS评分比较无明显差异(F组间=9.638,P组间=0.115),不同时间与手术方式不存在交互作用(F交互=8.721,P交互=0.092)。观察组患者治疗1周后总体有效率为97.44％,与对照组94.87％相比,差异无统计学意义(χ²=0.347,P=0.556)。结论 超声引导下精准针刀松解术联合高回声钙化区温针灸疗法在治疗粘连性肩关节囊炎中效果显著,可明显改善患者术后肩关节疼痛程度,而在改善患者短期肩功能无明显优势。

Abstract:

Objective: To explore the clinical effect of ultrasound-guided precision acupotomy combined with needle warming moxibustion in the hyperechoic calcification region for the treatment of adhesive capsulitis of shoulder. Methods: 78 patients with adhesive capsulitis of shoulder who were admitted to the Wuhan Third Hospital from January 2016 to January 2018 were randomly divided into observation group (n=39) and control group (n=39). The control group used ultrasonic to position the “4 points ahead of the shoulder”, and to guided the one-time therapy of acupotomy in real time. While the observation group used the ultrasonic to guided the one-time therapy of needle warming moxibustion in the hyperechoic calcification region, on the basis of the treatment of the control group. The VAS of pain and CMS of shoulder function were used to evaluate the degree of shoulder pain and dysfunction and overall efficacy before treatment and after treatment of 1 week, 1 month, 3 months, and 6 months in the two groups. Results:During the follow-up period of six months, the VAS scores of the two groups showed a trend of decreasing at different times, and the difference was statistically significant (F time = 8.823, P time = 0.003); From the time points after operation, the VAS score of the control group was significantly higher than that of the observation group (F = 11.937, P = 0.001), and there is interaction between the different time points and the group (F = 16.571, P = 0.000).The CMS scores of the two groups showed a trend of increasing at different times, From the time points after operation, there was no significant difference in CMS scores between the two group (F = 9.638, P = 0.115).There was no interaction between the different time and the surgical procedure (F = 8.721, P = 0.992).The overall effective rate of the observation group was 97.44% after 1 week of treatment. Compared with the control group of 94.87%, the difference was not statistically significant (χ²=0.347,P=0.556). Conclusion: The ultrasound-guided precision acupotomy combined with needle warming moxibustion in the hyperechoic calcification region has significant effects in the treatment of Adhesive Capsulitis of Shoulder, which can significantly improve the degree of postoperative shoulder joint pain, but has no obvious advantage in improving patients" short-term shoulder function.