拍打手法配合针灸中药治疗废用性肩周炎的临床研究

Clinical study on the treatment of disuse periarthritis of shoulder with tapping manipulation combined with acupuncture and moxibustion and traditional Chinese medicine

目的探讨拍打手法配合针灸中药治疗废用性肩周炎的临床效果。方法采用随机对照实验设计,将符合纳入标准的废用性肩周炎患者60例分为A组、B1组、B2组,每组20例。A组接受肩周局部行轻柔推拿理筋后,进行手掌拍打,再行肩三针,外用艾灸、内服中药;B1组接受肩周推拿理筋,再行帮扶患者肩关节功能锻炼;B2组接受肩周局部推拿、针刺肩三针,外用艾灸、内服中药。比较三组患者的治疗效果,肩关节变化情况。结果治疗15 d,A组的视觉模拟评分法(VAS)评分为(4.2±1.1)分,低于B1组的(5.1±0.9)分及B2组的(5.0±1.2)分;A组的Constant-Murley评分为(75.6±6.3)分,高于B1组的(69.8±7.6)分及B2组的(70.4±8.1)分,差异具有统计学意义(P<0.05)。治疗30 d,A组的VAS评分为(3.7±0.8)分,低于B1组的(4.8±0.7)分及B2组的(4.3±1.0)分;A组的Constant-Murley评分为(82.4±5.2)分,高于B1组的(76.9±6.5)分及B2组的(78.3±7.3)分,差异具有统计学意义(P<0.05)。治疗45 d,A组的VAS评分为(2.9±0.6)分,低于B1组的(4.3±0.6)分及B2组的(3.9±0.8)分;A组的Constant-Murley评分为(89.2±4.8)分,高于B1组的(81.3±6.1)分及B2组的(83.6±6.8)分,差异具有统计学意义(P<0.05)。治疗15、30、45 d,B1组与B2组的VAS评分、Constant-Murley评分比较,差异均无统计学意义(P>0.05)。在肩周肌肉变化方面:A组治疗后逐渐恢复正常状态,B1组和B2组的肩周肌肉变化较为有限。在肩关节功能变化方面:A组的肩关节功能改善显著,例如肩关节活动范围增加、疼痛减轻等,B1组和B2组的肩关节功能改善相对较少。在肩关节位置变化方面:A组的肩关节位置逐渐恢复正常,B1组和B2组的肩关节位置变化较为有限。结论拍打手法配合针灸中药治疗废用性肩周炎能够显著改善肩周肌肉变化、肩关节功能变化以及肩关节位置变化,且治疗效果持续时间较长。因此,该方法可作为废用性肩周炎的一种有效治疗手段。然而,由于本研究样本量有限,仍需要进一步扩大样本量并进行更长时间的随访观察,以验证其长期疗效和安全性。

Objective To explore the clinical effect of tapping manipulation combined with acupuncture and moxibustion and traditional Chinese medicine in the treatment of disuse periarthritis of shoulder.Methods This study used a randomized controlled experimental design and divided 60 patients with disuse periarthritis of shoulder who met the inclusion criteria into group A,group B1 and group B2,with 20 cases in each group.Group A received gentle massage and muscle management around the shoulder area,followed by palm tapping,three shoulder injections,external moxibustion,and internal administration of traditional Chinese medicine.Group B1 received shoulder massage and muscle management,followed by assisting patients with shoulder joint function exercises.Group B2 received local massage around the shoulder,three acupuncture needles on the shoulder,external moxibustion,and internal administration of traditional Chinese medicine.The treatment effect and the changes of shoulder joint were compared among the three groups.Results After 15 d of treatment,the VAS score of group A was(4.2±1.1)points,which was lower than(5.1±0.9)points of group B1 and(5.0±1.2)points of group B2;the Constant-Murley score of group A was(75.6±6.3)points,which was higher than(69.8±7.6)points of group B1 and(70.4±8.1)points of group B2;the difference was statistically significant(P<0.05).After 30 d of treatment,the VAS score of group A was(3.7±0.8)points,which was lower than(4.8±0.7)points of group B1 and(4.3±1.0)points of group B2;the Constant-Murley score of group A was(82.4±5.2)points,which was higher than(76.9±6.5)points of group B1 and(78.3±7.3)points of group B2;the difference was statistically significant(P<0.05).After 45 d of treatment,the VAS score of group A was(2.9±0.6)points,which was lower than(4.3±0.6)points of group B1 and(3.9±0.8)points of group B2;the Constant-Murley score of group A was(89.2±4.8)points,which was higher than(81.3±6.1)points of group B1 and(83.6±6.8)points of group B2;the difference was statistically significant(P<0.05).After 15,30 and 45 d of treatment,there was no significant difference in VAS score and Constant-Murley score between group B1 and group B2(P>0.05).In terms of changes in shoulder muscles:group A gradually returned to normal after treatment,while the changes in shoulder muscles in group B1 and group B2 were relatively limited.In terms of changes in shoulder joint function:group A showed significant improvement in shoulder joint function,such as increased range of motion and reduced pain,while group B1 and group B2 showed relatively less improvement in shoulder joint function.In terms of changes in shoulder joint position:group A gradually returned to normal,while the changes in shoulder joint position in group B1 and group B2 were relatively limited.Conclusion Tapping manipulation combined with acupuncture and moxibustion and traditional Chinese medicine can significantly improve the changes of shoulder muscles,shoulder joint function and shoulder joint position in the treatment of disuse periarthritis of shoulder,and the treatment effect lasts for a long time.Therefore,this method can be an effective treatment for disuse periarthritis of shoulder.However,due to the limited sample size of this study,further expansion of the sample size and longer follow-up observations are needed to verify its long-term efficacy and safety.