透灸配合针刺治疗肩凝症的临床对照观察

Clinical trial of treatment of frozen shoulder by intensive moxibustion plus acupuncture

目的:比较透灸配合针刺与单纯针刺治疗肩凝症的临床疗效,分析透灸配合针刺对肩凝症的治疗效果。方法:将60例肩凝症患者随机分为透灸针刺组与单纯针刺组,每组30例。穴取肩髃、肩贞、肩髎、阳陵泉、条口透承山、阿是穴,透灸针刺组用透灸配合针刺治疗,单纯针刺组仅用针刺治疗,每次40～50min,每天1次,每周5次为1个疗程。比较治疗前和治疗2个疗程后患者的视觉模拟量尺(VAS)评分、肩关节功能(Constant-Murley)总积分及各项积分。结果:两组患者治疗后VAS评分均较治疗前降低(P<0.05);两组患者治疗后的Constant-Murley各项积分(日常功能活动、关节活动度、疼痛积分、肌力)、Constant-Murley总积分均较治疗前升高(P<0.05)。治疗后组间比较,透灸针刺组总有效率高于单纯针刺组(P<0.05);透灸针刺组VAS评分低于单纯针刺组(P<0.05),Constant-Murley总积分以及日常功能活动、关节活动度、疼痛积分高于单纯针刺组(P<0.05)。结论:透灸配合针刺治疗肩凝症的综合疗效优于单纯针刺,透灸针刺组通过改善肩凝症患者日常功能活动、关节活动度,减轻患者疼痛而提高治疗效果。

Objective To compare the clinical therapeutic effect of intensive moxibustion plus acupuncture and simple acupuncture therapy in the treatment of frozen shoulder so as to provide a reference for clinical practice.Methods A total of60 patients with frozen shoulder were randomly divided into intensive moxibustion plus acupuncture group and simple acupuncture group(n=30 per group).Acupoints Jianyu(LI15),Jianzhen(SI9),Jianliao(TE14),Tiaokou(ST38),Chengshan(BL57)and Ashi points(Extra)were punctured with filiform needles which were manipulated till the patients experienced feelings of soreness and distension in the local region,followed by retaining the needles for 40 min.For patients of the moxibustion plus acupuncture group,after acupuncture,an ignited moxa-stick segment was applied to the affected shoulder for 40-50 min.After the treatment,all patients were ordered to make a shoulder exercise(anteflexion,rear protraction,abduction and upthrow movements,etc.).The visual analogue scale(VAS)was used to assess the pain severity,and the Constant-Murley shoulder assessment scale(the total score is 100 points,including 15 points in pain severity and 20 points in daily living activities,40 points in joint motion range,and25 points in myodynamia)used to assess the functional state of the shoulder,and the'Standards for Diagnosis and Therapeutic Effect Evaluation of Diseases of Traditional Chinese Medicine'(1994)were employed to evaluate the therapeutic effect.Results Following the treatment,intra-group comparison showed that the VAS score was significantly reduced in both groups in comparison with their own pre-treatment(P<0.05),and the total scores of Constant-Murley scale,the scores of activities of daily living and active motion range,as well as the scores of pain integration and myodynamia,were all considerably increased in the two groups in comparison with their own pre-treatment(all P<0.05).The therapeutic effect of the moxibustion plus acupuncture was significantly superior to that of the simple acupuncture in reducing VAS score and increasing total score of Constant-Murley scale,and scores of activities of daily living and active motion range,as well as the scores of pain integration(P<0.05).Of the two 29 cases in the moxibustion plus acupuncture and simple acupuncture groups,19(65.52%)and 10(34.48%)were cured,8(27.58%)and 12(41.38%)experienced improvement,2(6.90%)and 7(24.14%)were failed,with the effective rate being 93.10%and 75.86%,respectively.The therapeutic effective rate of the moxibustion plus acupuncture was evidently higher than that of the simple acupuncture(P<0.05).Conclusion The therapeutic effect of intensive moxibustion plus acupuncture is superior to that of simple acupuncture in improving symptoms of frozen shoulder in patients.