抑郁症对粘连性肩关节周围炎治疗过程中的影响

Effects of depression on treatment progress of adhesiveness scapulohumeral periarthritis

目的观察抑郁症对粘连性肩关节周围炎(简称肩周炎)治疗及康复的影响。方法对60例进行Zung抑郁症自评量表调查积分大于40分的肩周炎患者进行综合治疗,即患肩痛点阻滞,然后在肌间沟法臂丛神经麻醉下手法松解粘连,然后进行康复训练。将60例患者按随机数分两组,治疗组及对照组各30例,治疗组在原有治疗的同时,采用5-羟色胺(5-HT)再摄取抑制剂—氟西汀口服治疗抑郁症,氟西汀20mg,1次/d,疗程连续28d。对照组只进行原有治疗不给氟西汀。然后通过对疼痛分级、肩关节活动度分级的观察进行疗效评定。结果两组患者治疗前后Zung量表积分治疗组从55.7±15.6降至28.8±10.3;对照组从54.2±17.3降至43.4±17.2,两组患者治疗前后Zung量表积分差异有显著性意义(t=7.89,P<0.01)。两组患者肩关节功能康复疗效治疗组治愈23例,显效7例,对照组治愈16例,显效8例,有效6例,两组治愈和显效率经χ2检验,差异有显著性意义(χ2=6.98,P<0.05)。结论肩周炎患者的抑郁情绪对其康复产生明显影响,对伴有抑郁情绪的肩周炎患者,应作及时诊断和治疗,这不仅可以治疗抑郁症本身,同时对肩关节功能的康复具有重要的意义。

AIM: To observe the effects of depression on the treatment and rehabilitation of adhesiveness scapulohumeral periarthritis. METHODS:Comprehensive treatment was conducted in 60 patients with pain point block, whose scores were above 40 in self rating depression scale (SDS) edited by Zung.Then scpulohumeral was cured using intermuscular sulcus brachial plexus blocking and the patients recieved rehabilitation training.The 60 patients were randomly divided into two groups,one as treatment group and the other as control group. There were 30 patients in each group.The patients in the treatment group took 5 HT releasing inhibitor,fluoxetine, to treat depression based on the normal.They took 20 mg fluoxetine each day for 28 days. The patients in the control group did not take fluoxetine but recieved normal treatment. Curative effects were evaluated through the grade of ache and motion of joint. RESULTS:The scores of SDS in the two groups were remarkably different at the end of the treatment compared with the beginning (t=7.89,P< 0.01).The scores in the treatment group decreased from 55.7+15.6 to 28.8+10.3, while the scores in the control group decreased from 54.2+17.2. The results of the two groups after treatment: 23 patients recovered in treatment group, 7 got satisfactory results. In the control group, 16 patients recovered, and 8 got satisfactory result and 6 had acceptable result. The treatment results of the two groups were significantly different(χ2=6.98,P< 0.05). CONCLUSION:Depression of patients with scapulohumeral periarthritis exerts profound effect on their treatment and rehabilitation. The depressive patients should be diagnosed and cured without delay, which will bring great benefit to the treatment of depression as well as the rehabilitation of scapulohumeral periarthritis.