张氏姜枝活血汤加减联合五步整肩手法治疗肩袖损伤的效果

Effect of the modified Zhang′s Jiangzhi decoction for promoting blood circulation combined with five-step shoulder consolidation manipulation in the treatment of rotator cuff injury

目的研究张氏姜枝活血汤加减联合五步整肩手法治疗肩袖损伤的效果。方法选择2022年1月至2023年12月浙江省杭州市富阳中医骨伤医院纳入的90例肩袖损伤患者为研究对象,按随机数字表法分为治疗组(44例,采取张氏姜枝活血汤加减联合五步整肩手法)和对照组(46例,采取五步整肩手法)。比较2组临床资料、炎性因子、肩关节活动度、视觉模拟评分(VAS)及简明健康状况调查问卷(SF?鄄36)评分。结果治疗后2组C反应蛋白(CRP)、白细胞介素?鄄6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于治疗前,治疗组更低于对照组[(16.4±2.2)mg/L与(20.8±3.0)mg/L,(13.4±2.1)mg/L与(19.6±3.2)mg/L,(15.3±2.4)mg/L与(21.4±2.9)mg/L,t=8.003,10.727,11.078,P<0.05]。治疗后各组前屈、外展、外旋活动度均高于治疗前,治疗组高于对照组[(104±12)°与(94±11)°,(73±8)°与(69±7)°,(58±6)°与(51±6)°,t=3.891,2.291,5.682,P<0.05]。治疗后各组日间活动时、夜间静息时VAS均低于治疗前,治疗组较对照组低(2.1±0.7)分与(3.7±1.1)分,(1.9±0.5)分与(2.4±0.7)分,t=8.260,4.216,P<0.05。治疗后除社会功能、情感职能之外,2组SF-36评分均高于治疗前,治疗组较对照组升高(71.4±3.2)分与(66.8±4.1)分,(84.4±2.6)分与(80.2±3.0)分,(73.4±6.4)分与(69.5±6.8)分,(83.2±3.4)分与(79.8±4.6)分,(81.0±3.5)分与(75.2±4.4)分,(84.2±2.7)分与(77.4±3.6)分,t=5.931,6.921,2.817,3.868,6.987,10.109,P<0.05]。结论张氏姜枝活血汤加减联合五步整肩手法较单用五步整肩手法的效果更为显著,能够促进患者肩关节功能恢复,减轻炎性反应,有效减轻日间活动及夜间静息时的疼痛程度,对生活质量产生积极影响。

Objective To study the effect of the modified Zhang′s Jiangzhi decoction for promoting blood circulation combined with five-step shoulder consolidation manipulation in the treatment of rotator cuff injury.Methods A total of 90 patients with rotator cuff injury admitted to Fuyang Traditional Chinese Medicine Ortho-pedics and Traumatology Hospital from January 2022 to December 2023 were selected as the research subjects,and were divided into treatment group(n=44,treated with modified Zhang′s Jiangzhi decoction for promoting blood circulation combined with five-step shoulder consolidation manipulation)and control group(n=46,treated with five-step shoulder consolidation manipulation)according to the random number table method.The clinical data,inflammatory factors,range of motion of shoulder joint,visual analogue scale(VAS)and the MOS 36-item short-form health survey(SF-36)were compared between the two groups.Results After treatment,the levels of C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)in each group were lower than those before treatment,and those in the treatment group were lower than those in the control group(16.4±2.2)mg/L vs(20.8±3.0)mg/L,(13.4±2.1)mg/L vs(19.6±3.2)mg/L,(15.3±2.4)mg/L vs(21.4±2.9)mg/L,t=8.003,10.727,11.078,P<0.05.After treatment,the range of motion of forward flexion,abduction and external rotation in each group were higher than those before treatment,and those in the treatment group were higher than those in the con-trol group(104±12)°vs(94±11)°,(73±8)°vs(69±7)°,(58±6)°vs(51±6)°,t=3.891,2.291,5.682,P<0.05).After treatment,the VAS scores during daytime activities and at rest at night in each group were lower than those before treatment,and the VAS scores in the treatment group were lower than those in the control group(2.1±0.7)vs(3.7±1.1),(1.9±0.5)vs(2.4±0.7),t=8.260,4.216,P<0.05.After treatment,except for social function and emotional function,SF-36 scores of each group were higher than those before treatment,and the treatment group was signifi-cantly higher than the control group(71.4±3.2)vs(66.8±4.1),(84.4±2.6)vs(80.2±3.0),(73.4±6.4)vs(69.5±66.8),(83.2±3.4)vs(79.8±4.6),(81.0±3.5)vs(75.2±4.4),(84.2±2.7)vs(77.4±3.6),t=5.931,6.921,2.817,3.868,6.987,10.109,P<0.05.Conclusion The effect of modified Zhang′s Jiangzhi decoction for promoting blood circulation combined with five-step shoulder consolidation manipulation is more significant,which can not only promote patients with shoulder joint function recovery,but also reduce inflammatory reaction,effectively relieve daytime activities and level of pain when resting at night,have a positive impact on the quality of life as well.