瘀滞型肩关节周围炎中医优化方案筛选研究

Screening study on optimization scheme of TCM clinical treatment of periarthritis of shoulder with the pattern of blood stasis and qi stagnation

目的基于随机对照试验进行中医临床治疗优化方案的筛选研究,明确中医治疗瘀滞型肩关节周围炎的最佳临床方案。方法选取2020年6月-2021年12月在长春中医药大学附属医院门诊就诊的瘀滞型肩关节周围炎患者99例,随机分为A、B、C组,3组常规进行推拿及功能锻炼治疗,在此基础上A组联合药物疗法,B组联合针灸疗法,C组联合药物疗法及针灸疗法,疗程2周,于治疗后1周、2周及3个月对患者进行随访。以视觉模拟标尺评分(visual analogue scale,VAS评分)、Constant-Murley肩关节评分量表、肩关节活动范围、红细胞沉降率(erythrocyte sedimentation rate,ESR)及生化指标评价疗效和安全性。结果共92例患者完成研究。相较于本组治疗前,3组在治疗后1周、2周及3个月VAS评分、Constant-Murley肩关节评分、肩关节活动范围有显著改善(P<0.05),完成治疗后ESR有显著改善(P<0.05),肝肾生化指标无统计学意义(P>0.05)。3组组间比较,治疗后1周疗效无统计学意义(P>0.05),C组2周后及3个月效果明显优于A、B组(P<0.05)。完成治疗后的ESR及肝肾生化指标水平无统计学意义(P>0.05)。3组均未发现严重不良事件,不良反应发生率3组比较,差异无统计学意义(P>0.05)。结论针刺、中药内服及外用等疗法对于瘀滞型肩关节周围炎患者的疼痛和活动受限具有显著疗效,能明显地提高患者的生活质量,综合应用中医治疗手段2周后的中远期疗效明显优于单一手段。

Objective To screen and optimize TCM clinical treatment schemes based on randomized controlled trials,and clarify the optimal clinical scheme for TCM treatment of shoulder periarthritis with the pattern of blood stasis and qi stagnation.Methods From June 2020 to December 2021,99 patients of shoulder periarthritis with the pattern of blood stasis and qi stagnation treated in the outpatient department of the Affiliated Hospital of ChangchunUniversity of Chinese Medicine were randomly divided into three groups A,B and C.The three groups were routinelytreated with massage and a functional exercise.On this basis,group A was given a drug therapy,while group B wasadded with an acupuncture and moxibustion therapy,and group C was treated with a drug therapy and an acupunctureand moxibustion therapy,all for two weeks.They were followed up at one week,two weeks and three months aftertreatment.Their efficacy and safety were evaluated by the visual analogue scale(VAS)score,Constant-Murley shoulderscore,shoulder range of motion,erythrocyte sedimentation rate(ESR)and biochemical indexes.Results A total of 92patients completed the study.Compared with before treatment,the VAS score,Constant-Murley shoulder score andshoulder range of motion were significantly improved in the three groups at one week,two weeks and three monthsafter treatment(P<0.05),and ESR was significantly improved after treatment(P<0.05),while there was no significantdifference in the liver and kidney biochemical indexes(P>0.05).There was no significant difference among the threegroups after 1 week of treatment(P>0.05),while the efficacy of group C was significantly better than that of groupsA and B after 2 weeks and 3 months(P<0.05).The levels of ESR and liver and kidney biochemical indicators aftertreatment were not statistically significant among the three groups(P>0.05).No serious adverse events were found inall the three groups,and there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Acupuncture,oral administration of herbs and their external application have significant effectson pain and activity limitation of patients of shoulder periarthritis with the pattern of blood stasis and qi stagnation,which can significantly improve the quality of life of patients.The long-term efficacy of a comprehensive application oftraditional Chinese medicine is significantly better than that of single means after 2 weeks.