基于红外热成像技术评估蒋氏活经汤治疗肩背肌筋膜炎的疗效

Evaluation on the efficacy of Jiang′s Huojing Decoction in treating shoulder and back myofasciitis based on infrared thermography

目的借助红外热成像系统评估中药活经汤治疗肩背肌筋膜炎的疗效。方法选取2018年5月至2020年5月苏州市中西医结合医院疼痛科门诊符合风寒湿型肩背肌筋膜炎诊断的患者54例,随机分为对照组和治疗组,每组各27例,对照组采用西药美洛昔康口服,治疗组予中药活经汤口服,分别记录治疗前、治疗后1周、治疗后2周、治疗后1个月两组患者疼痛视觉模拟评分(VAS)及压痛积分,并通过红外热成像仪检测患侧疼痛区域与健侧相同部位的温差,记录两组患者不良反应发生情况。结果经治疗后1周、2周、1个月随访,两组患者VAS评分及压痛积分较治疗前均显著降低,差异有统计学意义(P<0.05),治疗1周时对照组VAS评分为(2.96±0.81)分,低于治疗组的(3.41±0.80)分,对照组压痛积分为2(1,2),低于治疗组2(2,3),差异有统计学意义(P<0.05),而治疗2周及1个月随访时,治疗组与对照组间比较,差异无统计学意义(P>0.05);经治疗后2周、1个月随访,两组患者红外热成像检测双侧肩背部温差较治疗前均有所降低,差异有统计学意义(P<0.05),治疗2周时、1个月随访时,治疗组较对照组温差降低更为显著,差异均有统计学意义(P<0.05);治疗期间,对照组出现不良反应共3例,治疗组1例,组间比较差异无统计学意义(P>0.05)。结论西药美洛昔康组较中药活经汤组止痛效果起效更快,而中长期止痛效果无显著差异,证实中药活经汤可以有效减轻风寒湿型肩背肌筋膜炎患者的疼痛,改善局部血供,改善风寒湿症状,且安全性高。

Objective To systematically evaluate the efficacy of Chinese herbal medicine Huojing decoction in the treatment of shoulder and back myofasciitis with the help of infrared thermography.Methods A total of 54 patients who were diagnosed with wind-cold-damp type shoulder and back myofasciitis in the outpatient clinic of the pain department from May 2018 to May 2020 were selected and randomly divided into the control group(n=27)and the treatment group(n=27).The control group was treated with western drug meloxicam orally,while the treatment group was treated with Chinese herbal medicine Huojing decoction orally.The pain score assessed by Visual Analogue Scale(VAS)and score of pressure pain before treatment,1 week after treatment,2 weeks after treatment,and 1 month after treatment were recorded respectively.Results During the follow-up at 1 week,2 weeks and 1 month after treatment,the VAS score and score of pressure pain in both groups were significantly lower than those before treatment,with statistically significant differences(P<0.05).After 1 week of treatment,the VAS score in the control group was(2.96±0.81)points,which was lower than that of(3.41±0.80)points in the treatment group,and the score of pressure pain in the control group was 2(1,2),which was lower than that of 2(2,3)in the treatment group,with statistically significant differences(P<0.05).During the follow-up at 2 weeks and 1 month after treatment,there were no statistically significant differences between the treatment group and the control group in the VAS score and score of pressure pain(P>0.05).During the follow-up at 2 weeks and 1 month after treatment,the temperature difference detected by infrared thermography on the bilateral shoulders and backs in the two groups of patients was reduced compared with that before treat ment,with statistically significant differences(P<0.05).At 2 weeks of treatment,during the follow-up at 1 month after treatment,the temperature difference was more significantly reduced in the treatment group than those in the control group,with statistically significant differences(P<0.05).There were 3 patients in the control group and 1 patient in the treatment group who had adverse reactions during the treatment,without statistically significant difference between the two groups(P>0.05).Conclusion The pain relief effect in the group treated with western drug meloxicam is faster than that in the group treated with Chinese herbal medicine Huojing decoction,while there is no significant difference in the mid-long term pain relief effect.This proves that Chinese herbal medicine Huojing decoction can effectively reduce pain,improve local blood supply,and improve wind-cold-damp symptoms in patients with wind-cold-damp type shoulder and back myofasciitis with high safety.