超声引导筋结点、激痛点穴位注射治疗急性期肩关节周围炎(寒湿痹阻、血瘀气滞)随机平行对照研究

Ultrasound Guided Tendon Node and Acupoint Injection for Treatment of Acute Periarthritis of Shoulder(Cold Dampness Obstruction/寒湿痹阻, Blood Stasis and Qi Stagnation/血瘀气滞): Randomized Parallel Control Study

[目的]观察超声引导筋结点、激痛点穴位注射治疗急性期肩关节周围炎(寒湿痹阻、血瘀气滞)疗效。[方法]使用随机平行对照方法,将90例门诊患者按就诊顺序号方法随机分为三组;穴位注射:曲安奈德10mg+2%利多卡因3m L+甲钴胺1mg+生理盐水20m L,直刺入穴位,寻找针感,3穴/次,1.5m L/穴,1次/周,注射后均在院休息20min。对照组30例,肩髃、肩髎、天宗、秉风等。激痛点组30例,患侧肩部肌肉肌腹部按压探查疼痛点,斜方肌在C6~C7和T1棘突及肩胛冈下缘,提肩胛肌激痛点在C1~C4横突后结节与肩胛骨内角,菱形肌在C6~C7和T1棘突及肩胛骨脊椎侧下,超声引导,推注到激痛点肌肉层。筋结点组30例,循患侧上肢及肩关节探查,出现明显压痛并伴条索或局部组织肿胀增厚处为针刺筋结点,主要包括手太阳筋结点肩贞次、臑俞次、肩痛点次;手少阳筋结点肩髎次、天宗次;手阳明筋结点肩髃次、巨骨次、秉风次等,超声引导推注到激痛点肌肉层。连续治疗4周为1疗程。观测临床症状、VAS评分、CMS评分、不良反应。治疗1疗程(4周),判定疗效。随访30d,观测VAS指标。[结果]激痛点组治愈9例,显效11例,有效7例,无效3例,总有效率90.00%;筋结点组治愈11例,显效10例,有效7例,无效2例,总有效率93.33%;对照组治愈4例,显效8例,有效10例,无效8例,总有效率73.33%,临床疗效筋结点组优于对照组(P<0.05),筋结点组与激痛点组、激痛点组与对照组无显著差异(P>0.05);VAS评分三组均有改善(P<0.01),激痛点组、筋结点组改善均优于对照组(P<0.01),激痛点组与筋结点组无明显差异(P>0.05);疼痛、ADL、ROM、MMT、总分三组均有改善(P<0.01),激痛点组、筋结点组改善均优于对照组(P<0.01),激痛点组与筋结点组无明显差异(P>0.05)。[结论]超声引导下筋结点、激痛点穴位注射治疗急性期肩关节周围炎(寒湿痹阻、血瘀气滞),激痛点组、筋结点组疗效均优于对照组,激痛点组与筋结点组具有等效性,无严重不良反应,值得推广。

[Objective] to observe the effect of acupoint injection of ultrasound guided tendon and point stimulation on acute shoulder periarthritis（cold damp obstruction, blood stasis and Qi stagnation）. [Methods] 90 cases of outpatients were randomly divided into three groups by random parallel control method. Acupoint injection： Cu Ann Ned 10 mg＋2% lidocaine 3 m L＋ mecobalamin 1 mg＋ physiological saline 20 mL, straight into acupoint, looking for needle sensation, 3 acupoints/times, 1.5 m L/points, 1 times per week, after the injection of 20 min at the hospital. The control group consisted of 30 cases, such as shoulder, shoulder, heaven, and wind. A pain point group of 30 cases, suffering from the pain point of the shoulder muscle muscle in the sideof the shoulder muscles, the trapezius muscle at C6 to C7 and T1 spinous process and the lower edge of the scapula, the pain point of the scapula muscle was raised after the C1 to C4 transverse process and the inner corner of the scapula. The rhombus muscle was under C6 to C7 and T1 spinous process and the scapular spine. 30 cases in the group of tendons and joints were examined on the side of the upper limb and shoulder joint of the affected side. There were obvious tenderness, and the swelling and thickening of the local tissue were the node of the needling tendons. And so on, ultrasound guidance is pushed to the muscle layer of the pain point. Continuous treatment for 4 weeks was the 1 course of treatment. Clinical symptoms, VAS scores, CMS scores and adverse reactions were observed. The 1 course of treatment （4 weeks） was treated and the curative effect was determined. The VAS index was observed for 30 days. [Results] 9 cases were cured, 11 cases were markedly effective, 7 cases were effective, 3 cases were invalid, the total effective rate was 90%, 11 cases were cured in the group of tendons, 10 cases were cured, 7 cases were effective, 2 cases were invalid, the total effective rate was 93.33%, the control group cured 4 cases, effective 8 cases, valid 10 cases, invalid 8 cases, total effective rate, clinical efficacy tendons node group is superior to the right group. （P〈0.05）, there was no significant difference between the group of tendons and the pain point group and the pain point group and the control group （P〉0.05）, and the three groups of the VAS scores were improved （P〈0.01）. The pain point group and the reinforcement node group were better than the control group （P〈0.01）. The pain point group and the muscle node group had no significant difference （P〉0.05）; pain, ADL, ROM, MMT. The total score of three groups were improved （P〈0.01）. The improvement of the pain point group and the reinforcement node group were better than the control group （P〈0.01）. There was no significant difference between the sore point group and the muscle node group （P〉0.05）. [Conclusion] the treatment of acute periarthritis of shoulder （cold dampness dampness obstruction, blood stasis and stagnation of blood stasis） in acute stage of periarthritis of shoulder （cold dampness obstruction and blood stasis） is better than that of the control group. The effect of the group of exciting point and the group of tendons is equivalent, and there is no serious adverse reaction. It is worth popularizing.