分期顺势针刀、针灸治疗肩关节周围炎的比较

Needle scalpel versus acupuncture for scapulohumeral periarthritis in a staged treatment

目的:观察分期顺势治疗肩关节周围炎,针刀与针灸治疗的差异性。方法:选择2004-11/2005-11四川省广元市中医院疼痛、针灸门诊患者,除自己要求针刀外,一般单数日为针刀治疗组,双数日为针灸对照组。诊断标准参照国家中医管理局1994年中医病证诊断疗效标准,肩周炎分期参照康复医学教材(3版),疼痛功能评估参考1990美国医学会永久病损指南及谟懒常数法。一般由3位医生同时分期、评估,排除神经根型颈椎病、结核、肿瘤(肺癌骨转移),骨折脱位,经常数量分法75分以下者为纳入病例。其中针刀治疗组疼痛期16例,平均功能积分31.6,粘连期20例,平均功能积分30.1;针灸对照组疼痛期15例,平均功能积分28.6,粘连期28例,平均功能积分30.4。两组积分经统计学处理,无显著性意义(其积分χ2=0.089,P>0.75),说明两组具有可比性。分期多参照时区为主,结合症状,因个别因素不一致,如有的已推拿、针灸、封闭等干预治疗过、有的有不同程的外伤史。顺势主要顺应疾病的本身过程,具体体现在治疗疼痛期不配合手法,恢复期不预治疗。针灸对照组采取针灸基本治疗,针刀治疗组采取针刀五点三维法治疗。针刀治疗7～10d1次,一般一两次;针灸1次/d,6次/周,连续3周;两组均在20～30d内进行功能评估,均按35分以下为无效,36～55分为有效,56～75分为显效,76～95分为痊愈。结果:79例患者,有6例未在规定时期复诊,纳入分析72例。针刀治疗组痊愈26例,显效10例,治愈率72%;针灸对照组痊愈15例,显效21例,治愈率42%。两组疗效比较,差异显著(P<0.05)。结论:分期顺势治疗肩周炎疗效均较好,针刀明显优于针灸治疗。

AIM： To observe the differences in staged comhination tberapy of scapulohumeral periarthritis between with needle-scalpel and acupuncture. METHODS： Outpatients were selected from the Clinic for Acupuncture and the Clinic for Pain, Guangyuan TCM Hospital of Sichuan Province between November 2004 and November 2005, and all of them were divided into needle-scalpel treatment group （checked in odd days） and acupuncture control group （checked in even days） except those required of needle-scalpel treatment. Patients were diagnosed according to Clinical Research on Criteria for TCM Syndromes of Climacteric Syndrome made by State TCM Administration in 1994, and the staging of scapulohujeral periarthritis referred to the teaching materials of rehabilitation medicine of the third edition, The pain was evaluated by referring to the GEPI devised by American Medical Association in 1990. Patients were staged, evaluated and excluded of cervicalspondylotic radiculopathy, tubercle, tumor （osseous metastasis of lung cancer） and fracture dislocation. Patients with the score below 75 points were included, including 16 patients in the pain stage with an average score of 31.6 points and 20 patients in the adhesion stage with an average score of 30.14 points in the needle-scalpel group; 15 patients in the pain stage with an average score of 28.6 points and 28 patients in the adhesion stage with an average score of 30.4 points in the acupuncture control group. The scores of both groups were statistically processed, and there was no significant difference （x^2=0.089,P 〉 0.75）, which indicated that they were comparable. Patients were staged by mainly referring to the time zone and different syndromes, such as some patients were interfered by Tuina and acupuncture and block therapy with different interventions. Combination therapy mainly complied with the disease, whicb specifically manifested as uncooperative manipulation in pain stage and non-pretreatment in the convalescence stage. Patients in the acupuncture control group were treated by acupuncture and moxibustion, while patients in the needle-scalpel group were treated by 3D method with needle-scalpel at 5 sites once every 7-10 days for totally once or twice. Patients in the acupuncture control group were acupunctured once a day and six times a week for 3 continuous weeks. Patients in both groups were evaluated on the function within 20-30 days, and 35 points was considered as ineffective, 36-55 points as effective, 56-75 points as excellent and 76-95 points as healed. RESULTS： Of 79 patients, 6 ones failed in regular visiting, and 72 patients were involved in the analysis of results, In the needle-scalpel control group, 26 patients healed, 10 patients were excellent in effect with the healing rate of 72%. In the acupuncture control group, 15 ones healed and 21 ones were excellent in effect with the healing rate of 42%, There was no significant difference in the curative effect between the two groups （P 〈 0.05）. CONCLUSION： Great curative effect can be achieved in treatment of scapulohumeral periarthritis with staged combination therapy, and it is significantly better by using needle-scalpel than with acupuncture.