强度-时间曲线用于颈源性肩周炎的预后判断及疗效评价

Strength-duration curve detection on evaluation of prognosis and therapeutic effect of cervicogenic periarthritis of shoulder

目的:探讨强度-时间曲线用于颈源性肩周炎的预后判断及疗效评价的效果。方法:87例颈源性肩周炎患者均采用颈肩同治法,治疗前后均行强度-时间曲线测定,治疗后并行临床疗效评价、肩关节功能评价量表测试。比较正常神经支配与部分及完全失神经支配的肩关节在治疗后临床疗效的差异,以及肩关节功能评价量表的五方面评分[疼痛(P)、关节活动范围(R)、日常生活能力(A)、肌力(M)和关节局部形体(F)]等的变化差异;并对比治疗前后时值的变化,以及三种神经支配情况改变的差异。结果:三种神经支配情况的临床疗效差异具有显著性意义(P<0.05)。治疗后正常神经支配者在P、R、A、F方面评分改善高于部分失神经支配者(P<0.05),而M方面两者无明显差异(P>0.05);部分失神经支配者的P、R、A及M方面评分改善高于完全失神经支配者(P<0.05),而F方面两者无明显差异(P>0.05)。时值方面,正常神经支配者治疗前后时值无明显改变(P>0.05),部分失神经支配者大部分恢复正常范围(P<0.05),完全失神经支配者治疗后时值明显缩短(P<0.05),但仍>10ms。治疗后支配冈下肌和小圆肌的神经纤维均有不同程度的修复,前后差异有显著性意义(P<0.05)。结论:强度-时间曲线测定用于颈源性肩周炎治疗的预后及疗效评价有一定的临床意义。

Objective： To explore the effect of strength-duration （S/D） curve detection on evaluation of prognosis and thera- peutic effect of cervicogenic periarthritis of shoulder. Method： Eighty-seven patients with cervicogenic periarthritis of shoulder were treated on necks and shoulders together. They were detected by S/D curve before and after therapy, and evaluated by therapeutic effect and functional assessment of shoulder joint. Therapeutic effects in normal-innervation, partial-denervation and full-de- nervation groups were compared by chi square test, and score changes of pain（P）, range（R）, activity（A）, muscle strength（M） and form（F） of shoulder functional assessment in three groups were measured. Then chronaxie changes of before and after treatment and changes of three irmervation states were compared. Result： Healing and efficiency rate were different among three innervation states （P〈0.05）. Scores of P, R, A, F in normal-innervation group were higher than that in partial-denervation group after treatment （P〈0.05） but scale of M between them had no difference （P〉0.05）. Scores of P, R, A, M in partial-denervation group were higher than that in full-denervation group after treatment （P〈0.05） but scores of F between them had no differ- ence （P〉0.05）. Chronaxie of S/D curve in normal-innervation group had no significant change after treatment （P〉0.05）. Chronaxie of S/D curve in partial-denervated group shortened to normal（P〈0.05）, however in full-de- nervation group after treatment chronaxie shortened than that before treatment （P〈0.05） but yet〉10ms. After treatment nerve fibers of infraspinatus and teres minor muscles repaired variably, but significantly （P〈0.05）. Conclusion： S/D curve detection can be used to evaluate prognosis and therapeutic effect of cervicogenic periar- thritis of shoulder.