臂丛神经阻滞下手法松解联合高能量激光治疗肩周炎合并糖尿病的临床研究

Effectiveness of manual release under brachial plexus block combined with high‑intensity laser therapy on scapulohumeral periarthritis in patients with diabetes

目的观察臂丛神经阻滞下手法松解联合高能量激光疗法(high‑intensity laser therapy,HILT)治疗肩周炎合并糖尿病的临床疗效。方法选取2018年12月至2019年12月于秦皇岛市第一医院疼痛科门诊就诊的肩周炎合并糖尿病患者,采用随机数字表法分为试验组(T组,32例)和对照组(C组,31例)。T组行臂丛神经阻滞下手法松解联合HILT治疗,C组行臂丛神经阻滞下手法松解联合类固醇关节腔注射治疗。记录两组患者治疗前(T0)、治疗后1个月(T_(1))、治疗后2个月(T_(2))、治疗后3个月(T_(3))肩关节疼痛和功能障碍指数(shoulder pain and disability index,SPADI),并比较两组患者活动时VAS疼痛评分、肩关节功能评分(Constant‑Murley,CM评分)、显效率、不良事件及治疗后6个月的复发率。结果两组患者T_(1)、T_(2)、T_(3)时SPADI评分与T0时的差值组间差异的双侧90%CI上限均小于非劣效性界值。与T0比较,两组患者T_(1)、T_(2)、T_(3)时VAS疼痛评分均明显降低、CM评分均明显升高(P<0.05),但同一时点组间比较差异均无统计学意义(P>0.05)。两组患者T_(1)、T_(2)、T_(3)时组间显效率差异均无统计学意义(P>0.05)。两组中均无患者发生严重不良事件,T组治疗后6个月复发率明显低于C组(P<0.05)。结论手法松解联合HILT治疗肩周炎合并糖尿病的临床疗效非劣效于手法松解联合关节腔注射。

Objective To observe the clinical effectiveness of manual release under brachial plexus block combined with high‑intensity laser therapy(HILT)in the treatment of scapulohumeral periarthritis patients with diabetes.Methods Scapulohumeral periarthritis patients with diabetes who were admitted to Department of Pain,the First Hospital of Qinhuangdao from December 2018 to December 2019 were selected.According to the random number table method,they were divided into two groups:a test group(group T,n=32)and a control group(group C,n=31).Patients in group T underwent manual release under brachial plexus block combined with HILT,while those in group C received manual release under brachial plexus block combined with intra‑articular injection of corticosteroid.Their shoulder pain and disability index(SPADI)were recorded before treatment(T0),one month after treatment(T_(1)),two months after treatment(T_(2))and three months after treatment(T_(3)).Both groups were compared for their Visual Analogue Scale(VAS)scores during movement,the Constant‑Murley(CM)score of the shoulder joint,the effective rate,adverse events,and the recurrence rate six months after treatment.Results The upper limits of 90% CI for the difference between the SPADI scores of both groups at T_(1),T_(2) and T_(3) and those at T0 were less than the non‑inferiority threshold.Compared with those at T0,both groups produced remarkable decreases in VAS scores,and increases in CM scores at T_(1),T_(2) and T_(3)(P<0.05).But there was no obvious difference between the two groups at the same time points(P>0.05);there was no marked difference in the effective rate between the two groups at T_(1),T_(2) and T_(3)(P>0.05).No serious adverse events were reported in each group,while six months after treatment,the recurrence rate of group T was significantly lower than that of group C(P<0.05).Conclusions The clinical effectiveness of manual release under brachial plexus block combined with HILT is non‑inferior to manual release combined with intra‑articular injection in scapulohumeral periarthritis patients with diabetes.