肩三针配合康复训练治疗肩手综合征随机对照研究

A Randomized Controlled Trial of Shoulder Three Needles Combined with Rehabilitation Training for Shoulder Hand Syndrome

目的:随机对照观察肩三针配合康复训练治疗肩手综合征临床疗效,探讨临床价值,以期丰富肩手综合征的治疗方案。方法:选取2016年1月至2017年12月黄石市第四医院收治的肩手综合征急性期患者82例作为研究对象,按照就诊顺序编号,采用数字随机表法分为对照组和观察组,每组41例。2组患者均予以神经营养、个性化控糖降脂降压治疗,及运动疗法和作业疗法等康复训练,观察组在此基础上再以肩三方案可有效提高急性期肩手综合征患者病情康复质量,提升临床症状改善效率,提升临床疗效,针为主穴配合对症穴位进行针刺治疗,1次/d,每周连续治疗6 d停1 d。2组患者均连续治疗8周为1个疗程。观察2组患者治疗前、后肩痛视觉模拟评分(VAS)、上肢动作研究量表(ARAT)、上肢关节活动度Fugl-Meyer评分(FMA)、中国临床神经功能缺损程度评分标准(CSS)评分及血清炎性反应因子变化,并行治疗前后比较、组间比较;每周对患者肩痛、活动受限、手腕红肿热痛症状、手指屈曲受限状况进行测评,统计2组患者上述临床症状改善时间。完成治疗后综合评价2组患者临床疗效并比较。结果:1)治疗8周后,2组患者肩痛VAS评分、CSS评分均较治疗前明显降低,且观察组低于对照组,差异有统计学意义(P<0.05);2)治疗后2组患者血清炎性反应因子IL-2、IL-6、TNF-α均较治疗前明显降低,且观察组低于对照组,差异有统计学意义(P<0.05);3)完成治疗后,2组患者ARAT评分、FMA评分均较治疗前提高,且观察组高于对照组,差异有统计学意义(P<0.05);4)观察组患者肩痛、活动受限、手腕红肿热痛症状、手指屈曲受限临床症状改善时间明显较对照组短,差异有统计学意义(P<0.05);5)完成治疗后,观察组患者临床总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论:肩三针配合康复训练可后效改善患者机体炎性反应状态,促进患者临床症状改善效率,提高资料效果,具有较高临床价值。

Objective:To observe the clinical effects of three needles of shoulder combined with rehabilitation training on shoulder-hand syndrome and to explore its clinical value in order to enrich the treatment of shoulder-hand syndrome.Methods:From January 2016 to December 2017,82 patients with acute shoulder-hand syndrome in the Fourth Hospital of Huangshi City were selected as the research object.According to the order of visiting,they were divided into a control group and an observation group,with 41 cases in each group.Patients in both groups were given rehabilitation training such as neuronutrition,individualized glucose control and lipid lowering therapy,exercise therapy and occupational therapy.In the observation group,on the basis of this,shoulder three schemes can effectively improve the rehabilitation quality of patients with acute shoulder-hand syndrome,improve the efficiency of clinical symptoms,enhance the clinical efficacy,and acupuncture as the main acupoint.Acupuncture at symptomatic points was given once a day for 6 days a week.2 groups of patients were treated for 8 weeks for a course of treatment.Visual analogue score(VAS),upper extremity action research scale(ARAT),upper extremity joint activity Fugl-Meyer score(FMA),Chinese clinical neurological deficit score(CSS)score and serum inflammatory factors were observed before and after treatment,and were compared before and after treatment and between groups.The symptoms of shoulder pain,limited movement,wrist swelling,fever and pain,and limited flexion of fingers were evaluated,and the improvement time of the above symptoms was counted.After completion of treatment,the clinical efficacy of the 2 groups was evaluated and compared.Results:1)After 8 weeks of treatment,the VAS score and CSS score of shoulder pain in both groups were significantly decreased than those before treatment,and the observation group was lower than the control group(P<0.05).2)After treatment,the serum inflammatory factors IL-2,IL-6 and TNF-αin the 2 groups were significantly decreased than before treatment,and the observation group was lower than the control group(P<0.05).3)After treatment,the ARAT score and FMA score of the 2 groups were increased than those before treatment,and the observation group was higher than the control group(P<0.05).4)The clinical symptoms of shoulder pain,limited movement,redness and swelling of wrist and limited finger flexion were significantly shorter in the observation group(P<0.05).5)After the completion of treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:Shoulder three needles combined with rehabilitation training can improve the inflammation of patients,promote the improvement of clinical symptoms,improve the data effect,and has high clinical value.