放射式体外冲击波运动靶点治疗肩关节周围炎的临床研究

A clinical study of radial type extracorporeal shockwave acting on moving targets for treatment of periarthritis of shoulder

目的:观察放射式体外冲击波运动靶点治疗肩关节周围炎的临床疗效。方法:将46例符合要求的肩关节周围炎患者随机分为2组,每组23例。2组均采用放射式体外冲击波治疗。固定靶点组选择治疗前确定的固定压痛点进行治疗;运动靶点组在固定压痛点治疗的基础上,对被动活动肩关节过程中出现的疼痛点进行治疗。采用视觉模拟评分量表(visual analogue scale,VAS)评定肩部疼痛程度,测定肩关节活动度,以Constant-Murley肩关节评分量表评定总体疗效。结果:(1)肩部疼痛VAS评分。时间因素和分组因素存在交互效应(F=103.092,P=0.000);2组患者肩部疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=4.169,P=0.000);治疗前后不同时间点间肩部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=128.706,P=0.000);2组肩部疼痛VAS评分随时间变化均呈降低趋势,但2组降低的趋势不完全一致;治疗前、治疗1次后、治疗2次后,2组肩部疼痛VAS评分的组间差异均无统计学意义[(8.00±1.21)分,(7.96±1.30)分,t=1.000,P=0.328;(6.35±1.30)分,(6.30±1.33)分,t=1.000,P=0.238;(4.48±1.34)分,(4.30±1.33)分,t=1.699,P=0.103];治疗3次后、治疗4次后,运动靶点组的肩部疼痛VAS评分均小于固定靶点组[(3.70±1.26)分,(3.43±1.04)分,t=2.787,P=0.011;(3.43±0.90)分,(3.22±0.85)分,t=2.472,P=0.022]。(2)肩关节活动度。治疗前2组患者肩关节前屈、后伸、外展、内旋、外旋活动度比较,组间差异均无统计学意义(74.74°±16.59°,75.00°±16.80°,t=0.053,P=0.958;22.13°±4.08°,22.09°±4.11°,t=0.036,P=0.971;70.09°±15.65°,70.04°±15.97°,t=0.009,P=0.993;34.91°±2.86°,34.87°±2.88°,t=0.051,P=0.959;44.43°±6.13°,44.39°±6.07°,t=0.024,P=0.981);治疗4次后,运动靶点组肩关节前屈、后伸、外展、内旋、外旋活动度均大于固定靶点组(127.13°±17.71°,138.09°±19.87°,t=-2.030,P=0.048;39.48°±6.19°,43.04°±5.49°,t=-2.067,P=0.045;91.04°±16.29°,103.48°±24.25°,t=-2.041,P=0.047;49.61°±6.52°,66.30°±9.46°,t=-6.971,P=0.000;52.09°±4.27°,70.74°±4.27°,t=-14.813,P=0.000)。(3)Constant-Murley评分。治疗前2组患者的Constant-Murley评分比较,差异无统计学意义(t=0.238,P=0.813)。治疗4次后,2组患者的Constant-Murley评分均增加[(48.96±11.07)分,(78.26±10.48)分,t=-49.290,P=0.000;(48.17±11.21)分,(84.48±10.35)分,t=-46.320,P=0.000],运动靶点组的评分大于固定靶点组(t=-2.024,P=0.049)。结论:放射式体外冲击波运动靶点治疗能有效减轻肩关节周围炎患者的肩部疼痛、改善肩关节活动度,其疗效优于放射式体外冲击波固定靶点治疗。

Objective： To observe the clinical curative effect of radial type extracorporeal shockwave（ ESW） acting on moving targets in the treatment of periarthritis of shoulder. Methods： Forty-six patients with periarthritis of shoulder were enrolled in the study and were randomly divided into fixed targets group and moving targets group,23 cases in each group. The patients in the 2 groups were treated with radial type ESW at the confirmed fixed tenderness points,moreover,the patients in moving targets group were treated with radial type ESW at the pain-points that appeared in the process of passive activities of shoulder. The shoulder pain degree and the total clinical curative effects were evaluated by using visual analogue scale（ VAS） and Constant-Murley shoulder scoring scale respectively,and the shoulder range of motion（ ROM） was measured. Results： There was interaction between time factor and group factor in shoulder pain VAS scores（ F =103. 092,P = 0. 000）. There was statistical difference in shoulder pain VAS scores between the 2 groups in general,in other words,there was group effect（ F = 4. 169,P = 0. 0000）. There was statistical difference in shoulder pain VAS scores between different timepoints before and after treatment,in other words,there was time effect（ F = 128. 706,P = 0. 000）. The shoulder pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of shoulder pain VAS scores. There was no statistical difference in shoulder pain VAS scores between the 2 groups before the treatment and after 1-and 2-time treatment（ 8. 00 ＋/-1. 21 vs 7. 96 ＋/-1. 30 points,t = 1. 000,P = 0. 328; 6. 35 ＋/-1. 30 vs 6. 30 ＋/-1. 33 points,t = 1. 000,P = 0. 238; 4. 48 ＋/-1. 34 vs 4. 30 ＋/-1. 33 points,t = 1. 699,P = 0. 103）. The shoulder pain VAS scores were lower in moving targets group compared to fixed targets group after 3-and 4-time treatment（ 3. 70 ＋/-1. 26 vs 3. 43 ＋/-1. 04 points,t = 2. 787,P = 0. 011;3. 43 ＋/-0. 90 vs 3. 22 ＋/-0. 85 points,t = 2. 472,P = 0. 022）. There was no statistical difference between the 2 groups in the shoulder ROM（ anteflexion,backward extension,abduction,inward rotation and outward rotation） before the treatment（ 74. 74 ＋/-16. 59 vs 75. 00 ＋/-16. 80 degrees,t = 0. 053,P = 0. 958; 22. 13 ＋/-4. 08 vs 22. 09 ＋/-4. 11 degrees,t = 0. 036,P = 0. 971; 70. 09 ＋/-15. 65 vs 70. 04 ＋/-15. 97 degrees,t = 0. 009,P = 0. 993; 34. 91 ＋/-2. 86 vs 34. 87 ＋/-2. 88 degrees,t = 0. 051,P = 0. 959; 44. 43 ＋/-6. 13 vs 44. 39 ＋/-6. 07 degrees,t = 0. 024,P = 0. 981）. The shoulder ROM（ anteflexion,backward extension,abduction,inward rotation and outward rotation） were greater in moving targets group compared to fixed targets group after 4-time treatment（ 127. 13 ＋/-17. 71 vs 138. 09 ＋/-19. 87 degrees,t =-2. 030,P = 0. 048; 39. 48 ＋/-6. 19 vs 43. 04 ＋/-5. 49 degrees,t =-2. 067,P = 0. 045; 91. 04 ＋/-16. 29 vs 103. 48 ＋/-24. 25 degrees,t =-2. 041,P = 0. 047; 49. 61 ＋/-6. 52 vs 66. 30 ＋/-9. 46 degrees,t =-6. 971,P = 0. 000; 52. 09 ＋/-4. 27 vs 70. 74 ＋/-4. 27 degrees,t =-14. 813,P = 0. 000）. There was no statistical difference in Constant-Murley scores between the 2 groups before the treatment（ t = 0. 238,P = 0. 813）. The Constant-Murley scores increased in both of the 2 groups after 4-time treatment,and the scores were higher in moving targets group compared to fixed targets group（ 48. 96 ＋/-11. 07 vs 78. 26 ＋/-10. 48 points,t =-49. 290,P = 0. 000; 48. 17 ＋/-11. 21 vs84. 48 ＋/-10. 35 points,t =-46. 320,P = 0. 000; t =-2. 024,P = 0. 049）. Conclusion： The therapy of radial type ESW acting on moving targets can effectively alleviate the shoulder pain and improve the shoulder ROM in patients with periarthritis of shoulder,and its curative effect is better than that of the therapy of radial type ESW acting at fixed targets.