中医正骨手法治疗肩关节周围炎的临床研究

Clinical Study of Chinese Bone-setting Manipulation for Treatment of Shoulder Periarthritis

目的研究评估中医正骨手法治疗肩关节周围炎(肩周炎)的临床疗效。方法选取60例符合肩周炎诊断标准的患者为研究对象,年龄45~60岁。按照随机数字表法分为对照组和试验组,各30例。对照组口服塞来昔布3天,就诊当日及3天后,肩部红光照射理疗20 min;试验组在对照组治疗基础上分别于就诊当日及3天后施以中医正骨手法。治疗及随访期间进行自主功能锻炼。对比组间与组内治疗前后Constant-Murley肩关节功能评分、视觉模拟评分(visual analogue scale,VAS)、肩关节活动度(内旋、外旋、前屈、后伸、外展、内收)、肩关节外展肌力。结果首次治疗后即刻、第2次治疗后即刻、随访1月时两组Constant-Murley评分、肩关节内旋活动度、肩关节外展活动度较治疗前均明显升高(P均<0.05),且试验组均明显高于对照组(P均<0.05)。首次治疗后即刻、第2次治疗后即刻、随访1月时试验组肩关节外旋活动度、肩关节外展肌力明显升高(P均<0.05);对照组第2次治疗后即刻、随访1月时肩关节外旋活动度与外展肌力较治疗前均明显升高(P均<0.05),且试验组均明显高于对照组(P均<0.05)。两组首次治疗后即刻、第2次治疗后即刻、随访1月时肩关节前屈活动度、肩关节内收活动度较治疗前均明显升高(P均<0.05),首次治疗后即刻试验组肩关节前屈与内收活动度高于对照组(P<0.05)。对照组首次治疗后即刻VAS较治疗前升高(P<0.05),第2次治疗后即刻、随访1月时VAS较治疗前均明显降低(P均<0.05);试验组首次治疗后即刻、第2次治疗后即刻、随访1月时VAS较治疗前均明显降低(P均<0.05),且试验组均明显低于对照组(P均<0.05)。对照组首次治疗后即刻、第2次治疗后即刻、随访1月时肩关节后伸活动度较治疗前均降低(P均<0.05);试验组第2次治疗后即刻、随访1月时肩关节后伸活动度较治疗前均升高(P均<0.05)。结论在口服消炎止痛药物、红光照射理疗和功能锻炼等常规疗法基础上加用中医正骨手法,在减轻肩周炎疼痛、提升肩关节活动度与外展肌力、改善肩关节功能方面显著优于单用常规疗法,值得临床应用与推广。

Objective To study and evaluate the clinical effect of Chinese bone-setting manipulation on treating shoulder periarthritis.Methods A total of 60 patients aged between 45 and 60 years old,who met the diagnostic criteria for shoulder periarthritis were selected and divided into control group and experimental group with 30 cases in each according to random number table method.The control group received celecoxib orally for 3 days and red light therapy for 20 minutes on the day and 3 days after receiving celecoxib orally;on the basis of the treatment in the control group,the experimental group was treated additionally with Chinese bone-setting manipulation on the day and 3 days after treatment.Autonomic exercise was performed during the treatment and follow-up period.Changes in the Constant-Murley score,visual analogue scale(VAS),range of motion of shoulder joint(internal rotation,external rotation,forward flexion,back extension,abduction and adduction)and muscle strength of shoulder abduction were compared before and after treatment.Results The Constant-Murley score,range of motion of shoulder internal rotation and abduction of the two groups immediately after the first and second treatment and at 1 month of follow-up were significantly higher than those before treatment(all P<0.05),and the experimental group was significantly higher than the control group(all P<0.05).The range of motion of shoulder external rotation and muscle strength of shoulder abduction of the experimental group immediately after the first and second treatment and at 1 month of follow-up significantly increased(all P<0.05).In the control group,the range of motion of shoulder external rotation and muscle strength of shoulder abduction was significantly higher immediately after the second treatment and at 1 month of follow-up than before treatment(all P<0.05),and the experimental groups were significantly higher than those in the control group(all P<0.05).The range of motion of shoulder forward flexion and abduction of the two groups immediately after the first and second treatment and at 1 month of follow-up significantly increased(all P<0.05).Immediately after the first treatment,the range of motion of shoulder forward flexion and abduction in the experimental group was higher than that in the control group(P<0.05).In the control group,the VAS immediately after the first treatment was higher than that before treatment(P<0.05),and the VAS immediately after the second treatment and at 1 month of follow-up was significantly lower than that before treatment(all P<0.05);the VAS of the experimental group were significantly lower than those before treatment immediately after the first treatment,immediately after the second treatment and at 1 month of follow-up(all P<0.05),and the experimental group was significantly lower than that of the control group(all P<0.05).In the control group,the range of motion of shoulder back extension immediately after the first treatment,immediately after the second treatment and at 1 month of follow-up were lower than those before treatment(all P<0.05);the range of motion of shoulder back extension of the experimental group increased immediately after the second treatment and at 1 month of follow-up compared with that before treatment(all P<0.05).Conclusion On the basis of conventional therapy such as oral anti-inflammatory and analgesic drug,red light irradiation and functional exercise,traditional Chinese bone-setting manipulation showed better efficacy than conventional therapy alone in reducing the pain of shoulder periarthritis,improving the range of motion of shoulder joint and muscle strength of shoulder abduction,and improving the function of shoulder joint,which is worthy of clinical application and promotion.