中药热熨、针刀、推拿治疗肩周炎寒凝筋脉证临床研究

Clinical Study on Chinese Medicine Hot Compress,Needle Knife and Tuina for Scapulohumeral Periarthritis with Cold Congealing in the Sinews Syndrome

目的:观察中药热熨、针刀、推拿治疗肩周炎寒凝筋脉证的疗效。方法:选取136例老年肩周炎患者,按随机数字表法分为对照组及观察组各68例。对照组给予口服塞来昔布胶囊联合康复功能锻炼,观察组在对照组基础上给予中药热熨、针刀、推拿治疗,2组均连续治疗4周。比较2组临床疗效,比较2组治疗前、治疗2周、治疗4周后疼痛视觉模拟评分法(VAS)、世界卫生组织生活质量测定简表(WHOQOLBREF)的变化,比较2组治疗前、治疗4周后肩关节功能Constant-Murley评分、血液流变学指标,血清炎症因子[肿瘤坏死因子-α(TNF-α)、环氧合酶(COX-2)、白细胞介素-1β(IL-1β)]水平的变化。结果:治疗后,观察组临床疗效总有效率为92.65%,对照组为79.41%,2组比较,差异有统计学意义(P<0.05)。治疗2周、治疗4周后,观察组VAS平均评分分别为(3.22±0.43)分、(2.02±0.31)分,均低于对照组的(5.68±0.64)分、(4.13±0.75)分,2组比较,差异均有统计学意义(P<0.05)。治疗4周后,2组Constant-Murley评分中日常生活能力、肩关节活动度、肌力评分均较治疗前上升,观察组上述3项评分均高于对照组,差异均有统计学意义(P<0.05)。治疗4周后,2组全血低切黏度、全血高切黏度、血浆黏度指标值均较治疗前下降,观察组上述3项指标值均低于对照组,差异均有统计学意义(P<0.05)。治疗4周后,2组TNF-α、COX-2、IL-1β水平均较治疗前下降,观察组上述3项血清炎症因子水平均低于对照组,差异均有统计学意义(P<0.05)。治疗2周、治疗4周后,观察组WHOQOL-BREF平均评分分别为(77.11±6.48)分、(92.74±7.35)分,均高于对照组的(70.05±6.12)分、(80.48±7.59)分,差异均有统计学意义(P<0.05)。结论:中药热熨、针刀、推拿可有效减轻肩关节疼痛程度,提高肩关节功能,改善局部血液微循环状态,提高日常生活能力及生活质量。

Objective:To observe the curative effect of Chinese medicine hot compress,needle knife and tuina for scapulohumeral periarthritis with cold congealing in the sinews syndrome.Methods:A total of 136 cases of senile patients with scapulohumeral periarthritis were selected and divided into the control group and the observation group according to the random number table method,with 68 cases in each group.The control group was given oral administration of celecoxib capsules combined with rehabilitation exercise,and the observation group was additionally treated with Chinese medicine hot compress,needle knife and tuina based on the treatment of the control group.Both groups were treated for four weeks.The clinical effects in the two groups were compared.Before treatment,and after two and four weeks of treatment,the changes in Visual Analogue Scale(VAS)for pain and World Health Organization Quality of Life(WHOQOL-BREF)in the two groups were compared.Before treatment,and after four weeks of treatment,the changes in Constant-Murley Score(CMS)of shoulder function,hemorheology indexes,and levels of inflammatory factors in serum including tumor necrosis factor-α(TNF-α),cyclooxygenase-2(COX-2)and interleukin-1β(IL-1β)in peripheral blood in the two groups were compared.Results:After treatment,the total effective rate of clinical effect was 92.65%in the observation group and 79.41%in the control group,the difference being significant(P<0.05).After two and four weeks of treatment,the average VAS scores in the observation group were 3.22±0.43 and 2.02±0.31 respectively,lower than those of 5.68±0.64 and 4.13±0.75 in the control group,differences being significant(P<0.05).After four weeks of treatment,the scores of activity of daily living,shoulder joint mobility and muscle strength in Constant-Murley Score in the two groups were increased when compared with those before treatment,and the above three scores in the observation group were higher than those in the control group,differences being significant(P<0.05).After four weeks of treatment,the values of whole blood low shear viscosity,whole blood high shear viscosity and plasma viscosity in the two groups were decreased when compared with those before treatment,and the above three values in the observation group were lower than those in the control group,differences being significant(P<0.05).After four weeks of treatment,the levels of TNF-α,COX-2 and IL-1βin the two groups were decreased when compared with those before treatment,and the above three levels of inflammatory factors in serum in the observation group were lower than those in the control group,differences being significant(P<0.05).After two and four weeks of treatment,the average scores of WHOQOL-BREF were 77.11±6.48 and 92.74±7.35 respectively in the observation group,higher than those of 70.05±6.12 and 80.48±7.59 in the control group,differences being significant(P<0.05).Conclusion:Chinese medicine hot compress,needle knife and tuina can effectively relieve pain degree in shoulder joint,and improve shoulder joint function,microcirculation status of local blood,activities of daily living and quality of life.