松解三法联合功能锻炼治疗黏连期肩周炎的临床研究

Clinical study on manipulative release combined with functional exercises for treatment of adhesion-stage periarthritis humeroscapularis

目的:探讨松解三法联合功能锻炼治疗黏连期肩周炎的临床疗效。方法:将符合要求的90例黏连期肩周炎患者随机分为2组,每组45例。联合治疗组采用松解三法联合功能锻炼治疗,手法治疗组采用松解三法治疗。松解三法治疗和功能锻炼均每日1次,10次为1个疗程,间隔3日后进入下一疗程,共治疗3个疗程。分别于治疗前和治疗结束后采用视觉模拟量表(visual analogue scale,VAS)和Melle评分量表评定患者的肩部疼痛情况和肩关节活动度,并于治疗结束后采用《中医病证诊断疗效标准》中肩周炎的疗效标准评定综合疗效。结果:治疗前2组患者肩关节疼痛VAS评分比较,差异无统计学意义[(8.22±1.42)分,(8.36±1.33)分,t=0.483,P=0.631];治疗结束后2组患者的肩关节疼痛VAS评分均降低(t=20.073,P=0.000;t=20.047,P=0.000),联合治疗组的VAS评分低于手法治疗组[(1.52±0.86)分,(3.24±1.08)分,t=8.357,P=0.000]。治疗前2组患者肩关节Melle评分比较,差异无统计学意义[(10.22±3.02)分,(10.46±2.83)分,t=0.389,P=0.698];治疗结束后2组患者的Melle评分均降低(t=7.734,P=0.000;t=5.900,P=0.000),联合治疗组的Melle评分低于手法治疗组[(4.96±1.42)分,(6.67±1.25)分,t=2.434,P=0.017]。治疗结束后,联合治疗组治愈23例、好转20例、未愈2例,手法治疗组治愈11例、好转31例、未愈3例,联合治疗组的综合疗效优于手法治疗组(R_(联合治疗组)=39.52,R_(手法治疗组)=51.48,Z=-2.483,P=0.013)。结论:松解三法联合功能锻炼能有效减轻黏连期肩周炎患者的肩部疼痛,改善肩关节活动度,疗效优于单纯松解三法治疗。

Objective： To explore the clinical curative effects of manipulative release combined with functional exercises for treatment of adhesion-stage periarthritis humeroscapularis. Methods： Ninety patients with adhesion-stage periarthritis humeroscapularis were enrolled in the study and were divided into combination therapy group and manipulation therapy group,45 cases in each group. The patients in combination therapy group were treated with manipulative release combined with functional exercises,while the patients in manipulation therapy group were treated with manipulative release,once a day for consecutive 3 course of treatment,10 times for each course with a 3-day rest-insertion between courses. The shoulder pain and shoulder range of motion were evaluated by using visual analogue scale（ VAS） and Melle scoring scale before treatment and after the end of treatment respectively,and the total curative effects were evaluated after the end of the treatment according to the therapeutic effect evaluation standard of periarthritis humeroscapularis which was extracted from Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes. Results： There was no statistical difference in shoulder pain VAS scores between the 2 groups before the treatment（ 8. 22 ＋/-1. 42 vs 8. 36 ＋/-1. 33 points,t = 0. 483,P = 0. 631）. The shoulder pain VAS scores decreased in both of the 2 groups after the end of the treatment（ t = 20. 073,P = 0. 000; t = 20. 047,P = 0. 000）.The VAS scores were lower in combination therapy group compared to manipulation therapy group（ 1. 52 ＋/-0. 86 vs 3. 24 ＋/-1. 08 points,t = 8. 357,P = 0. 000）. There was no statistical difference in Melle shoulder scores between the 2 groups before the treatment（ 10. 22 ＋/-3. 02 vs 10. 46 ＋/-2. 83 points,t = 0. 389,P = 0. 698）. The Melle shoulder scores decreased in both of the 2 groups after the end of the treatment（ t = 7. 734,P = 0. 000; t = 5. 900,P = 0. 000）. The Melle scores were lower in combination therapy group compared to manipulation therapy group（ 4. 96 ＋/-1. 42 vs 6. 67 ＋/-1. 25 points,t = 2. 434,P = 0. 017）. After the end of the treatment,23 patients obtained an excellent result,20 good and 2 poor in combination therapy group; and 11 patients obtained an excellent result,31 good and 3 poor in manipulation therapy group. The combination therapy group surpassed the manipulation therapy group in the total curative effect（ Rcombination therapy group^-= 39. 52,Rmanipulation therapy group^-= 51. 48,Z =-2. 483,P = 0. 013）. Conclusion： The combination therapy of manipulative release and functional exercises can effectively alleviate the shoulder pain,improve the shoulder range of motion in patients with adhesion-stage periarthritis humeroscapularis,and its curative effect is better than that of monotherapy of manipulative release.