关节松动技术联合综合康复治疗黏连期肩周炎的临床研究

Clinical study of joint mobilization therapy combined with comprehensive rehabilitation in the treatment of periarthritis of shoulder in adhesion period

目的观察关节松动术联合综合康复方法治疗黏连期肩周炎的临床疗效。方法选取2018年12月至2019年10月期间在复旦大学附属闵行医院康复医学科和骨科就治的60例黏连期肩周炎患者作为研究对象,采用随机数表法分为观察组和对照组各30例。对照组患者给予持续关节被动运动、多功能电脑中频治疗、冷疗处理,观察组在此治疗基础上联合应用关节松动术治疗,10次为一个疗程,共治疗3个疗程。分别于开始治疗前和治疗3个疗程结束后采用视觉模拟评分法(VAS)评估两组患者患肩的疼痛程度,采用日本骨科协会评分(JOA)肩关节疾患治疗成绩判定标准量表和肩关节主动活动度(AROM)评定肩关节功能改善情况。结果治疗后,观察组患者的VAS评分为(1.43±0.32)分,明显低于对照组的(3.78±0.36)分,差异有统计学意义(P<0.05);治疗后,观察组患者JOA评分中的疼痛、外展肌力和耐力、日常生活活动能力、肩关节活动度和总分明显优于对照组,差异均具有统计学意义(P<0.05);治疗后,观察组患者患肩AROM中的前屈、外展、后伸、内旋、外旋评定明显优于对照组,差异均具有统计学意义(P<0.05)。结论关节松动术联合综合康复治疗能明显改善黏连期肩周炎患者的肩关节疼痛和关节活动障碍。

Objective To observe the clinical effect of joint mobilization therapy combined with comprehensive rehabilitation on periarthritis of shoulder in adhesion period.Methods Sixty patients with periarthritis of shoulder in adhesion period were selected as the research subjects,who were treated in the Department of Rehabilitation Medicine and Department of Orthopedics at Shanghai Minhang Hospital Affiliated to Fudan University from December 2018 to October 2019.They were divided into observation group(30 patients)and control group(30 patients)by random number table.Patients in the control group were treated with continuous passive motion,multifunctional computer intermediate frequency therapy,and cryotherapy.On the basis of this therapy,patients in the observation group were additionally treated with joint mobilization therapy.Each treatment course includes 10 sessions,and the patients were treated for a total of three courses.Before the beginning of treatment and at the end of 3 treatment courses,Visual Analogue Scale(VAS)was used to assess the pain degree of shoulder of the two groups.The improvement of shoulder joint function was assessed with Japanese Orthopedic Association(JOA)score and Active Range of Motion(AROM).Results After treatment,the VAS score was significantly lower in the observation group than in the control group:(1.43±0.32)vs(3.78±0.36),P<0.05.After treatment,the pain,abductor strength and endurance,activities of daily living,shoulder joint mobility,and total score in the JOA scores were significantly better in the observation group than in the control group(P<0.05).After treatment,the flexion,abduction,extension,internal rotation,and external rotation scores in the AROM scores were significantly better in the observation group than in the control group(P<0.05).Conclusion Joint mobilization therapy combined with comprehensive rehabilitation can significantly improve shoulder joint pain and joint mobility in patients with periarthritis of shoulder.