体外冲击波疗法配合针刺疗法治疗糖尿病合并肩周炎的疗效观察:前瞻性对比研究

Efficacy of extracorporeal shock wave therapy combined with acupuncture therapy on diabetes with periarthritis of the shoulder:a prospective comparative study

目的采用前瞻性对比的研究方法评估体外冲击波疗法(ESWT)配合针刺疗法治疗糖尿病合并肩周炎的临床效果.方法前瞻性收集2016年1月1日至2017年12月31日,石家庄市第二医院骨科收治的54例糖尿病合并肩周炎患者,将其随机分为冲击波疗法配合针刺组(27例患者27肩)和单纯冲击波组(27例患者27肩).两组分别进行一个疗程治疗(共5次治疗,每次间隔1周)后进行常规随访,随访期分别为:治疗结束时、治疗结束后1周,治疗结束后1个月、3个月、6个月和12个月.采用视觉模拟评分法(VAS)评估患者治疗前后各时间点的疼痛症状改变.一年肩关节功能评估采用关节活动度的测量来评估治疗前和治疗后的变化.治疗1年后的总体效果采用症状缓解程度和关节活动度综合评定,分为四级:治愈、显效、好转、无效.结果共有44例患者完成了规定期的随访检查,包括冲击波疗法配合针刺组24例和单纯冲击波组20例.两组治疗前及治疗后VAS评分进行重复测量设计的方差分析显示,差异有统计学意义,组别与时间点间存在交互作用,除治疗前及治疗结束时两组差别无统计学意义(P>0.05),其余各时间点两组差异均有统计学意义(F=5.312,F=2.711,P<0.05).最后一次随访(均≥12个月)结果显示,冲击波疗法配合针刺组患者的总体效果比单纯冲击波组好,差异有统计学意义(c2=4.175,P=0.041),两组患者的治愈率分别为79.2%和50.0%.结论相对于单纯冲击波疗法,冲击波配合针刺疗法具有更好的临床效应,可考虑作为治疗糖尿病合并肩周炎的常规治疗方法.

Objective A prospective comparative study was used to evaluate the clinical effect of extracorporeal shock wave therapy combined with acupuncture therapy on diabetes with periarthritis of the shoulder.Methods 54 patients with diabetes and periarthritis who were treated in the Department of Orthopaedics,Shijiazhuang Second Hospital from January 1,2016 to December 31,2017 were prospectively collected and randomly divided into the extracorporeal shock wave therapy and acupuncture treatment group(27 Patients had 27 shoulders)and the extracorporeal shock wave group(27 patients had 27 shoulders).The two groups were given a course of treatment(a total of 5 treatments,1 week apart)for routine follow-up.The follow-up periods were:at the end of the treatment,1 week after the end of treatment,1 month,3 months,6 months and 12 months.Changes in pain symptoms at various time points before and after treatment were evaluated by visual analog scale(VAS).One-year shoulder function assessment uses joint mobility measurements to assess changes before and after treatment.The overall effect after 1 year of treatment was evaluated by comprehensive evaluation of symptom relief and joint mobility,and was divided into four levels:cured,markedly effective,improved,and ineffective.Results A total of 44 patients completed the follow-up inspections,including 24 in the experimental group and 20 in the control group.The analysis of variance of repeated measurement design of VAS score before and after treatment in experimental group and control group showed that there was statistical significance in the difference of VAS score between experimental group and control group,and there was interaction between groups and time points,except that there was no statistical significance in the difference between the two groups before and at the end of treatment(P>0.05),the difference between the two groups at other time points was statistically significant(F=5.312,F=2.711,P<0.05).The results of the last follow-up(all≥12 months)showed that the overall effect of ESW combined with acupuncture group was better than that of the control group,the difference was statistically significant(c2=4.175,P=0.041).The cure rates of the two groups were 79.2%and 50.0%,respectively.Conclusion Compared with pure shock wave therapy,shock wave combined with acupuncture therapy has better clinical effects,and it can be considered as a conventional treatment method for diabetes combined with periarthritis of the shoulder.