发散型体外冲击波治疗青少年游泳运动员冈上肌肌腱病的前瞻对照研究

Prospective controlled trial on radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers

目的评价发散型体外冲击波应用于青少年游泳运动员冈上肌肌腱病的疗效及安全性。方法采用前瞻性随机对照研究方法,将16名经临床及核磁共振确诊为肩袖冈上肌肌腱病并排除冈上肌撕裂的青少年游泳运动员随机分配到对照组及发散型体外冲击波治疗组(r ESWT组),对照组7例采用冰敷、按摩、中频治疗仪治疗,r ESWT组9例采用冰敷、发散型体外冲击波治疗。在治疗前及随访期内评估运动员可视化疼痛评分(VAS),简明肩关节测试评分(SST),Constant评分,治疗后复查肩关节MRI评价冈上肌肌腱的肌腱病分级。采用独立样本t检验进行组间对照,P<0.05为差异具有统计学意义。结果 r ESWT组治疗后6周及12周时VAS评分显著低于对照组(6周:t=3.757,P<0.01;12周:t=3.982,P<0.01)。与治疗前相比,治疗后MRI复查未见冈上肌肌腱信号改变。未发生冲击波治疗相关并发症。结论发散型体外冲击波可以在短期内有效改善青少年游泳运动员冈上肌肌腱病的肩痛症状,远期效果尚不明确。

Objective To evaluate the efficacy and safety of radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers. Methods The study was designed as a prospective randomized controlled trial. After supraspinatus tear was excluded,16 juvenile swimmers who were diagnosed supraspinatus tendinopathy by clinical examination and magnetic resonance imaging were enrolled in the study and were divided into control group and radial extracorporeal shockwave therapy（r ESWT） group randomly. Ice compress, massage,modulated medium frequency electrotherapy were prescribed in the control group and meanwhile ice compress and r ESWT were applied in the r ESWT group.Visual analogue scale（VAS）,simple shoulder test score,Constant score were used to evaluate before the treatment and at six weeks and 12 weeks after the last treatment. Independent t test was applied for comparing the results of both groups. P 〈 0. 05 was considered as significant difference. Results Compared to the control group,the VAS score of r ESWT group was significantly lower at six weeks（t = 3. 757,P 〈 0. 01） and12 weeks（t = 3. 982,P 〈 0. 01） after the last r ESWT. Compared to baseline,MRI scan after r ESWT showed no significant change of supraspinatus. None of the complications related to r ESWT was observed. Conclusion It shows a better short-term result of r ESWT in releasing shoulder pain in juvenile swimmers with supraspinatus tendinopathy; the long term results are not clear.