发散式与聚焦式冲击波治疗肩周炎合并糖尿病的疗效比较

Effects comparison of divergent and focused shock waves in treatment of shoulder periarthritis combined with diabetes mellitus

目的:比较发散式冲击波与聚焦式冲击波结合康复锻炼治疗糖尿病患者的肩周炎的临床疗效。方法:前瞻性收集2018年7月至2019年11月于石家庄市第二医院骨科门诊就诊的糖尿病合并肩周炎的患者62例。所有患者具有2年以上的糖尿病史且主要症状包括肩关节周围疼痛及肩部活动障碍,排除其他疾病引起的肩部疼痛。随机数字表法将其分为发散式冲击波治疗组和聚焦式冲击波治疗组两组,发散组采用发散式冲击波结合康复锻炼治疗31例,聚焦组采用聚焦式冲击波结合康复锻炼治疗31例。于治疗前和治疗后1、3、6、12个月随访并临床评价,评价指标包括疼痛视觉模拟评分(VAS)、肩关节功能Constant-Murley(CM)评分和前屈、外展、后伸、外旋等肩关节主动活动范围(AROM)。治疗前两组间的比较采用独立样本t检验。VAS评分、CM评分以及AROM的总体差异分析采用重复测量设计的单变量方差分析,并经Mauchly球形度检验。结果:发散式冲击波治疗后1、3、6和12个月的肩关节疼痛VAS评分(F=3.03),肩关节AROM(前屈:F=7.22、后伸:F=15.85、外展:F=6.64、外旋:F=11.31)和Constant-Murley评分(F=3.26)均优于聚焦式冲击波,差异均有统计学意义(均为P<0.05)。结论:相对于聚焦式冲击波结合康复锻炼,发散式冲击波结合康复锻炼治疗糖尿病合并肩周炎具有更好的疗效,安全可靠。

Objective To evaluate the clinical efficiency of divergent shock wave and focused shock wave combined with rehabilitation exercise in the treatment of shoulder periarthritis in diabetes mellitus patients.Methods A total of 62 patients with diabetes mellitus complicated by periarthritis of shoulder who were treated in the Shijiazhuang Second Hospital from July,2018 to November,2019 were enrolled in the study.All the patients had a history of diabetes for more than two years,and the main symptoms included pain around the shoulder and shoulder movement disorders.The patients with shoulder pain caused by other diseases were exclude.The patients were divided into two gourps by random number table,31 in each.One group were treated by divergent shock wave,the other group were treated by focused shock wave.After treatment the patients in both groups were followed up for 12 months.The pain,the range of motion,the status of shoulder joint function were evaluated according to the visual analogue scale(VAS)score of shoulder joint pain,the range of motion of shoulder joint(flexion,abduction,extension,external rotation)and Constant-Murley(CM)score before treatment,at one,three,six,and 12 months after the treatment.The parameters of the two groups were compared by Student t test.Overall differences in VAS score of shoulder joint pain,the range of motion of shoulder joint(flexion,abduction,extension,external rotation)and CM score were analyzed by variance for repeated measurement data,and the data were tested by Mauchfy test of sphelicity.Results In one,three,six and 12 months after the treatment with divergent shock wave,the VAS score of shoulder pain(F=3.03),the range of motion of shoulder(flexion:F=7.22,abduction:F=15.85,extension-F=6.64,external rotation:F=11.31),and CM score(F=3.26)were better than that of focused shock wave,and the difference was statistically significant(all P<0.05).Conclusion Compared with focused shock wave combined with rehabilitation exercise,divergent shock wave combined with rehabilitation exercise has better curative effect and is safe and reliable.