体外冲击波疗法辅助治疗肩袖修补术后关节僵硬

Effect of extracorporeal shock wave therapy on post-operative shoulder stiffness after rotator cuff suture

目的探讨体外冲击波(ESWT)辅助康复训练治疗肩袖修补术后关节僵硬的疗效。方法回顾性收集2016年3月至2021年6月北京民航总医院41例肩袖修补术后关节僵硬患者的临床资料,根据是否行ESWT分为冲击波组与非冲击波组,收集包括肩关节活动度(前屈、外展、外旋、体侧内旋)、治疗前及治疗后肩关节Constant-Murley评分、加州大学洛杉矶分校肩关节评分(UCLA)、视觉模拟评分(VAS)。通过两独立因素t检验、秩和检验比较两组治疗前基础资料差异及治疗前与治疗3个月肩关节活动度差异,通过重复测量方差分析比较两组治疗2周、1个月、3个月Constant-Murley评分、UCLA评分、VAS评分差异。结果冲击波组治疗3个月肩关节前屈、外旋、外展活动度以及Constant评分、UCLA评分、VAS评分为(149.3±12.7)°、(124.6±4.1)°、(42.4±2.5)°、(88.4±3.3)、(30.1±1.9)、(1.9±0.5),较治疗前(106.7±9.6)°、(77.2±4.9)°、(25.6±5.1)°、(68.6±2.1)、(17.7±2.4)、(6.5±0.9)明显改善(t=-13.907、-38.526、-7.572、-15.450,F=723.354、492.503、318.293;均为P<0.05),并且治疗3个月肩关节外展及外旋活动度、UCLA评分均较非冲击波组的(120.7±6.5)°、(37.5±7.0)°、(28.9±1.3)更优(t=2.361、3.278,F=4.937;均为P<0.05),两组前屈活动度、Constant评分及VAS评分差异无统计学意义(P>0.05)。结论体外冲击波辅助训练可有效改善肩袖修补术后关节僵硬的关节活动度及关节功能评分,并在改善外旋及外展活动度上较传统手法疗效更佳。

Objective To explore the effect of extracorporeal shock wave therapy(ESWT)on post-operative joint stiffness after treated with rotator cuff suture.Methods A retrospective study was conducted in the patient who suffered from shoulder stiffness after treated with rotator cuff suture in the Civil Aviation General Hospital from March 2016 to June 2021.Forty-one patients were enrolled in this study,the patients were divided into ESWT group and non-EWST group,and the range of motion of shoulder joint(flexion,abduction,lateral rotation,internal rotation),before operation and at two weeks,one month and three months after operation,Constant-Murley score and University of California,Los Angeles score(UCLA)and visual analogue scale(VAS)were collected.Repeated measures analysis of variance was used to analyze the data of Constant-Murley,UCLA and VAS scores.Two independent sample t test was used to compare range of motion of shoulder before surgery and at three months after surgery.Results flexion,abduction,lateral rotation,Constant-Murley,UCLA and VAS score of EWST group at three months after surgery were as followed:(149.3±12.7)°,(124.6±4.1)°,(42.4±2.5)°,(88.4±3.3),(30.1±1.9),and(1.9±0.5),which were significantly better than preoperative ones[(106.7±9.6)°,(77.2±4.9)°,(25.6±5.1)°,(68.6±2.1),(17.7±2.4),(6.5±0.9)](t=-13.907,-38.526,-7.572,-15.450;F=723.354,492.503,318.293;all P<0.05),and abduction,external rotation and UCLA score at three months after surgery were statistically better than those of non-ESWT group(120.7±6.5)°,(37.5±7.0)°,(28.9±1.3)(t=2.361,3.278,F=4.937,all P<0.05).Conclusion ESWT is an effective way to improve the range of motion and functional scores on the patient who suffered from postoperative shoulder stiffness after rotator cuff suture,which is also better than traditional rehabilitation.