肩痛导引下中药海桐皮汤熏蒸联合体外冲击波、关节松动治疗肩关节周围炎的疗效及安全性

Efficacy and safety of haitongpi decoction fumigation combined with external shock wave and joint mobilization in the treatment of scapulohumeral periarthritis under the guidance of shoulder pain

目的观察肩痛导引下中药海桐皮汤熏蒸联合体外冲击波、关节松动治疗肩关节周围炎(肩周炎)患者的疗效及安全性。方法本研究为前瞻性随机对照研究。收集义乌市中心医院骨伤科2020年4月1日至2022年10月30日收治的肩周炎患者50例,年龄40~68岁,按照随机数字表法将其随机分为普通治疗组和肩痛导引组,每组25例。普通治疗组根据生物反馈的肩痛点和硬结点用海桐皮汤熏蒸联合体外冲击波进行干预,肩痛导引组在上述治疗的基础上,根据肩关节各方向活动时出现的新痛点和僵硬点,用体外冲击波行阶梯式和分时段的逐级推进关节松动治疗。于治疗前和治疗5、14、28d后,应用视觉模拟评分(VAS)进行肩部疼痛评定。采用肩关节活动度(ROM)和日本骨科协会(JOA)评分评定治疗前和治疗28d后的肩关节功能情况。同时,记录两组患者不良反应发生情况。结果两组间VAS评分差异无统计学意义(Wald X^(2)=0.39,P=0.534);不同时点VAS评分差异有统计学意义(Wald X^(2)=1339.14,P<0.001);与治疗前比较,两组治疗后各时点VAS评分均降低(P均<0.001)。治疗28d后,两组ROM各分项及JOA评分均较治疗前改善(P均<0.05),且肩痛导引组较普通治疗组改善更明显(P均<0.05)。治疗28d后,肩痛导引组愈良率高于普通治疗组[72%(18/25例)比40%(10/25例),X^(2)=5.20,P=0.045]。两组患者均未见严重不良反应。结论肩痛导引下中药海桐皮汤熏蒸联合体外冲击波、关节松动治疗肩周炎疗效显著。

Objective To observe the efficacy and safety of haitongpi decoction fumigation combined with external shock wave and joint mobilization in the treatment of scapulohumeral periarthritis under the guidance of shoulder pain.Methods A prospective randomized controlled study was conducted.Fifty patients with scapulohumeral periarthritis,aged 40 to 68 years old,in the Department of Orthopaedics and Traumatology,Yiwu Central Hospital from April 1,2020 to October 30,2022,were randomly divided into two groups by the random number table:common treatment group and shoulder pain guidance group,25 cases in each group.The common treatment group was treated by haitongpi decoction fumigation combined with extracorporeal shock wave based on biofeedback of shoulder pain points and hard nodes.The shoulder pain guidance group,on the basis of the above treatment,was treated further by extracorporeal shock wave for step-by-step and time-segmented progressive joint mobilization treatment according to the new pain points and stiff points of shoulder joint movement in all directions.Shoulder pain was assessed by visual analogue scale(VAS)before the treatment and at 5,14 and 28 days after the treatment,and shoulder joint function were evaluated by the shoulder joint range of motion(ROM)and the Japanese orthopedic association(JOA)score before the treatment and at 28 days after the treatment.The adverse reactions were recorded in both groups.Results There was no significant difference in VAS between the two groups(Wald×=0.39,P=0.534),but there was significant difference in VAS at different time points(Wald X=1339.14,P<0.001),and VAS decreased at each time point after the treatment in two groups(all P<0.001).After 28 days of treatment,ROM and JOA were improved in both groups(all P<0.05),and the shoulder pain guidance group were better than the common treatment group(all P<0.05).The cure and effective rate was higher in the shoulder pain guidance group than that in the common treatment group at 28 days after the treatment[72%(18/25 cases)vs.40%(10/25 cases),X'=5.20,P=0.045].No serious adverse reactions were found in both groups.Conclusion Under the guidance of shoulder pain,haitongpi decoction fumigation combined with external shock wave and joint mobilization can effectively treat the patients with scapulohumeral periarthritis.