不同强度体外冲击波结合理筋手法治疗肩峰撞击综合征的疗效分析

Analysis of therapeutic effect of different intensity extracorporeal shock wave combined with tendon regulating manipulation in treatment of shoulder impingement syndrome

目的探讨不同强度体外冲击波结合理筋手法治疗肩峰撞击综合征(shoulder impingement syndrome,SIS)的疗效及其差异性。方法选择2016年12月—2019年12月中国人民解放军总医院第八医学中心康复科的SIS患者128例,其中理筋手法治疗32例为对照组,96例体外冲击波配合理筋手法,按不同体外冲击波治疗强度再分为低强度组、中强度组和高强度组,每组32例。对所有患者关节活动度(range of motion,ROM)进行比较;采用国际通用视觉模拟评分法(visual analogue scale,VAS)评定所有患者的疼痛变化,并比较不同治疗周期疼痛评分变化;采用生活质量量表(short form 36 questionnair,SF-36)评价患者整体健康状况及日常社会生活活动能力。结果治疗后4组患者的关节外展活动度ROM均明显增加,疼痛评分VAS明显降低,低强度组较于对照组改善明显,中强度组比低强度组改善明显,高强度组比中强度改善明显,各组比较差异均有统计学意义(P<0.05);不同强度的体外冲击波,治疗第2周VAS值出现明显降低,第3周高于第2周,于第4周、第5周又出现大幅降低,不同周期VAS值差异均有统计学意义(P<0.05);采用重复测量检验发现低、中、高强度组的VAS值差异均有统计学意义(P<0.05)。治疗后3个月,所有患者SF-36评分均明显提高,对照组与低、中、高强度组比较,差异均有统计学意义(P<0.05)。结论体外冲击波配合理筋手法对SIS临床疗效优于单纯理筋手法治疗,不同强度间疗效差异均有统计学意义。

Objective To observe and analyze different intensity extracorporeal shock wave combined with tendon regulating manipulation in the treatment of shoulder impingement syndrome(SIS).Methods In December 2016-December 2019,our hospital rehabilitation section 128 SIS patients as the research object,is divided into reinforcement technique group(control group,32 cases)and low,mid,high intensity of shock waves with reasonable reinforcement in vitro manipulation group with 32 cases for each.Changes in range of motion,pain score,and pain score were compared between the groups.Sf-36 quality of life scale was used to evaluate the ability of daily social activities and the overall health status of the patients in the three observation groups.Results After the treatment,the joint abduction activity and pain score of the 4 groups were significantly improved,and the improvement of the low-intensity group was more significant than that of the control group(P<0.05).Different intensity of extracorporeal shock wave,the VAS value of the second week of treatment decreased significantly,the third week was higher than the second week,and the fourth and fifth weeks decreased significantly(P<0.05).Pain improvement in the high-intensity group was the best,followed by the mid-and low-intensity group(P<0.05).Three months after the treatment,SF-36 scores in the low-intensity group,middle-intensity group and high-intensity group were significantly improved.Conclusion The clinical effect of extracorporeal shock wave combined with proper tendon manipulation on shoulder impingement syndrome is better than that of simple tendon manipulation.