针刀应力位经皮动态松解治疗重度肩周炎

Percutaneous dynamic release in stress position by acupotomy in treating severe scapulohumeral periarthritis

目的:探讨针刀应力位经皮动态松解治疗重度肩周炎的临床疗效。方法 :2012年4月至2016年8月对160例重度肩周炎患者分为治疗组和对照组。治疗组80例,男32例,女48例;年龄40~74(52.79±9.04)岁;病程(20.72±9.55)个月;采用针刀应力位经皮动态松解术进行干预性治疗,每周1次,共治疗4次。对照组80例,男33例,女47例;年龄42~75(53.19±10.18)岁;病程(21.98±8.99)个月;根据Maitland手法采取单纯关节松动术,Ⅲ-Ⅳ级手法治疗,每日1次,每次15~20 min,10 d为1个疗程,共2个疗程。术后均常规指导肩周肌群力量训练及肩关节活动度训练,治疗过程共计3周。观察比较两组治疗前,治疗3周、3、6个月后视觉模拟评分(VAS)、Constant-Murley肩关节功能评分。结果:治疗组治疗3周、3、6个月VAS评分均低于对照组(P<0.05)。治疗组治疗3周、3、6个月Constant-Murley肩关节功能评分均高于对照组(P<0.05);治疗组优59例,良18例,中3例;对照组优15例,良31例,中23例,差11例,两组比较差异有统计学意义(P<0.01)。结论 :针刀应力位经皮动态松解治疗重度肩周炎可明显改善肩关节活动功能及疼痛情况,根据肩关节疼痛部位和功能受限分类的不同,在治疗过程中设计并维持相对应的肩关节应力体位,边松解粘连边逐步加大应力位的角度,是确保疗效的关键。

Objective：To investigate the clinical efficacy of acupotomy stress position percutaneous dynamic release for severe shoulder periarthritis. Methods：From April 2012 to August 2016,160 patients with severe shoulder periarthritis were randomly divided into treatment group and control group. Among them,80 patients in treatment group were treated with acupotomy stress position percutaneous dynamic release including 32 males and 48 females with an average of（52.47±9.04）years old ranging from 40 to 74 years old;the courses of disease was（20.72±9.55）months on average. The other 80 patients in control group were treated with simple joint loosening according to Maitland technique in grade Ⅲ-Ⅳ therapy,once a day,15 to 20 min each time,and 10 d for 1 course,for a total of 2 courses,including 33 males and 47 females with an average of（53.19±10.18） years old ranging from 42 to 75 years old; the average course of disease was（21.98 ±8.99） months. After operation,the shoulder muscles training and shoulder joint activity training were routinely conducted,the treatment lasted for 3 weeks. The visual analogue scale（VAS） and Constant-Murley shoulder function score were observed and compared between the two groups before treatment and 3 weeks,3,6 months after treatment. Results：The VAS scores of the treatment group at 3 weeks,3 and 6 months after treatment were all lower than those of the control group（P〈0.05）. The shoulder joint function ConstantMurley scores of the treatment group at 3 weeks,3 and 6 months after treatment were higher than those of the control group（P〈0.05）;the result was excellent in 59 cases,good in 18 cases,fair in 3 cases in the treatment group; excellent in 15 cases,good in 31 cases,fair in 23 cases,poor in 11 cases in the control group,and the difference between the two groups was statistically significant（P〈0.01）. Conclusion：Treatment of severe shoulder periarthritis with acupotomy stress position percutaneous dynamic release can obviously improve the shoulder joint function and pain,according to the different parts of the shoulder joint pain and function limitation,the corresponding shoulder stress and body position should be designed and maintained during the treatment process,and the angle of stress position gradually increased by loosening the adhesion,which is the key to ensure the curative effect.