不同针法治疗慢性肩关节周围炎的疗效及复发率的对比研究

Comparative study on curative effect and recurrence rate of chronic scapulohumeral periarthritis treated with different acupuncture techniques

目的:观察毫针局部苍龟探穴针刺、电针和温针灸3种针刺治疗方式对慢性肩关节周围炎患者肩关节疼痛、功能、生活质量、炎性指标及复发率的影响,探讨慢性肩关节周围炎患者各类突出症状的最优针刺方法。方法:将108例慢性肩关节周围炎患者随机分为手针组(36例,脱落1例)、电针组(36例,脱落1例)和温针组(36例,脱落3例)。3组取穴均为患侧肩前、肩髃、肩贞、阿是穴及阳陵泉,手针组采用苍龟探穴针刺治疗,温针组采用温针灸治疗,电针组采用电针治疗,每次30 min,隔日治疗1次,3次/周,治疗4周。比较治疗前后3组患者肩关节Neer评分;采用视觉模拟量尺(VAS)评分法评定肩关节疼痛程度;日常生活活动能力量表(ADL)评价日常生活活动能力;酶联免疫吸附法测定血清前列腺素E2(PGE2)含量。评价临床疗效并计算有效率,统计复发率,记录不良反应发生情况。结果:与治疗前比较,治疗后3组患者Neer评分的疼痛、功能、关节活动度和总分均升高(P<0.05);VAS评分、ADL评分及血清PGE2含量均降低(P<0.05)。治疗后,电针组和温针组Neer疼痛评分高于手针组(P<0.05),手针组和温针组Neer功能评分高于电针组(P<0.05),手针组Neer关节活动度评分高于电针组、温针组(P<0.05),但3组的Neer评分总分差异无统计学意义;电针组VAS评分低于温针组、手针组(P<0.05);手针组ADL评分低于温针组(P<0.05);温针组、手针组PGE2含量低于电针组(P<0.05)。手针组治疗后总有效率为85.71%(30/35),电针组为91.43%(32/35),温针组为90.91%(30/33),组间比较差异无统计学意义。治疗后6个月月末随访,3组复发率差异无统计学意义。3组均未出现严重不良反应。结论:在慢性肩关节周围炎患者治疗中,电针、温针和手针治疗的短期疗效相当,但电针治疗镇痛效果更佳,手针和温针治疗的消炎作用更佳,而手针苍龟探穴针法在松解粘连、恢复肩关节活动度方面效果更佳。

Objective To observe the effects of the local stimulation with 3 acupuncture techniques,i.e.Canggui Tanxue(needle insertion method like dark tortoise detecting point)technique,electroacupuncture(EA)and warm needling(WN)with filiform needles on shoulder pain,shoulder joint function,quality of life,inflammatory indica⁃tors and recurrence rate in the patients with chronic scapulohumeral periarthritis(CSP),so as to explore the opti⁃mal needling method of acupuncture for the predominant symptoms of CSP during the attack stage in the patients.Methods A total of 108 patients with CSP were randomly divided into a manual acupuncture(MA)group(36 cases,one case dropped off),a WN group(36 cases,3 cases dropped off)and an EA group(36 cases,1 case dropped off).In the three groups,Jianqian(EX-UE12),Jianyu(LI15),Jianzhen(SI9),Ashi(Extra)and Yanglingquan(GB34)on the affected side were selected.Canggui Tanxue needling technique,WN technique and EA were delivered in the MA group,the WN group and the EA group,respectively,30 min each time,3 times weekly for 4 weeks.The Neer test scores were compared;the visual analogue scale(VAS)was used to assess the degree of shoulder joint pain;the daily life activity abilities was evaluated using the activities of daily living(ADL)scale;the serum prostaglandin E2(PGE2)content was measured using ELISA before and after treatment.The effectiveness rate and recurrence rate were calculated,and the occurrences of adverse reactions were recorded.Results Compared with the scores before treatment,the scores of pain,joint function,and range of motion as well as the total score of Neer test were all in⁃creased after treatment in the three groups(P<0.05);the VAS score,ADL score and the content of serum PGE2 were decreased(P<0.05).After treatment,the pain score of Neer test in the EA group and the WN group were higher than those of the MA group(P<0.05),the joint function score of Neer test in the MA group and the WN group were higher than that of the EA group(P<0.05),and the range of motion score of Neer test in the MA group was higher when com⁃pared with the EA and WN groups(P<0.05).There was no statistical difference in the total score of Neer score among the three groups.VAS score in the EA group was lower than that of either the WN group or the MA group(P<0.05).ADL score in the MA group was lower compared with that of the WN group(P<0.05).PGE2 levels in both the WN group and the MA group were lower than that of the EA group(P<0.05).The total effective rate was 85.71%(30/35)in the MA group,91.43%(32/35)in the EA group and 90.91%(30/33)in the WN group,there was no statistical differences among the three groups.At the end of the 6-month follow-up visit after treatment,there was no significant difference in the recurrence rate among three groups.No serious adverse reaction was found.Conclusion In the treatment of CSP,the short-term effect is equivalent among EA,WN and MA.But,the analgesic effect is the best in the EA group,the treatment for anti-inflammation is the most effective in the MA and WN groups,and the needling technique of Cang⁃gui Tanxue in the MA group obtains the most favorable effect of releasing adhesion and recovering the range of motion in the shoulder joint.