复方合谷巨刺局部麻醉运动针法治疗粘连期肩周炎的临床研究

Clinical Study on the Kinetic Needling Treatment of Periarthritis of Shoulder by Local Anaesthesia of Contralateral Meridian Needling LI4

目的:观察复方合谷巨刺局部麻醉运动针法对粘连期肩周炎的临床疗效并探讨其作用机制。方法:将6 0例粘连期肩周炎患者随机分成观察组30例与对照组30例,观察组取大椎、肩髃、肩髎、肩贞、肩前、阿是穴予灸箱灸、烧山火合谷刺法、刺络拔罐放血,并予合谷穴巨刺局部麻醉运动针法;对照组除了不使用合谷穴巨刺局部麻醉运动针法外,其他与观察组相同。隔日1次,治疗10次。观察两组治疗前后患肩各向活动度数和疼痛分级指数(PRI)、视觉模拟评分(VAS),核磁共振检测观察组30例患肩关键肌肉韧带水肿、滑囊积液、关节囊厚度治疗前后的改变;评定外周血白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)、β-内啡肽(β-endorphin,β-EP)表达量的变化及临床疗效。结果:治疗后观察组临床痊愈率93. 33%(28/30),优于对照组的3. 33%(1/30,P <0. 01)。两组患肩各向活动度及疼痛各项评分(PRI、VAS)等均较本组治疗前改善(观察组P <0. 01,对照组P <0. 05),观察组优于对照组(P <0. 01)。观察组患肩关键肌肉韧带的水肿体积、滑囊积液体积、关节囊厚度治疗后减轻(P <0. 05)。观察组IL-6、IL-10、TNF-α表达量低于治疗前(P <0. 01),与对照组比较差异有统计学意义(P <0. 05)。观察组β-EP表达量较首次操作前升高(P <0. 05),与对照组比较差异有统计学意义(P <0. 05)。结论:复方合谷巨刺局部麻醉运动针法是一种治疗粘连期肩周炎有效的方法,能够减轻肩关节关键肌肉韧带水肿、减少滑囊积液、消除关节囊炎症,可能与其降低IL-6、IL-10、TNF-α水平和升高β-EP的表达量有关。

Objective: To observe the clinical efficacy and mechanism of local anaesthesia by dynamic contralateral meridian needling Hegu( LI4) in treating periarthritis of shoulder during adhesion stage. Methods: 60 patiens with periarthritis of shoulder during adhesion stage were randomly divided into the observation group( n =30) and the control group( n = 30). The observation group was treated with moxibustion,mountain burning fire method,and bloodletting puncture with cupping;the points chosen for moxibustion in the observation group were Dazhui( GV14),Jianyu( LI15),Jianliao( TE14),Jianzhen( SI9),Jianqian and Ashi points;LI4 was applied with mountain burning fire method and dynamic contralateral meridian needling method of local anaesthesia. The control group was the same as the observation group except for the dynamic contralateral meridian needling. The two groups were treated once every other day for 10 times. The degree of shoulder movement in each direction,pain rating index( PRI),and visual analogue score( VAS) were observed in the two groups before and after the treatment. MRI test was carried out in the observation group to detect the changes of the edema volume,synovial fluid volume and joint capsule thickness of the key muscle ligament of the shoulder before and after the treatment. The expressions of IL-6,IL-10,TNF-α,and β-EP in peripheral blood,as well as the clinical efficacy were evaluated in the two groups. Results: The clinical recovery rate of the observation group was 93. 33%( 28/30) after the treatment,which was superior to 3. 33%( 1/30) of the control group( P < 0. 01). The degrees of shoulder movements and the pain scores( PRI,VAS) were improved after the treatment compared to those before the treatment in the two groups( P < 0. 01,P < 0. 05);of which,the observation group was better than the control group( P < 0. 01). The edema volume,synovial fluid volume and joint capsule thickness of the key muscle ligament of the shoulder were significantly reduced after the treatment in the observation group( P < 0. 05). The expression levels of IL-6,IL-10 and TNF-α were significantly lower after the treatment than those before the treatment in the observation group( P < 0. 01);there was statistical differences when compared to the control group( P < 0. 05). The expression level of β-EP in the observation group is higher after the treatment than that before the first operation( P < 0. 05);there was statistical differences when compared to the control group( P < 0. 05). Conclusion: The local anaesthesia of dynamic contralateral meridian needling LI4 is an effective way to treat periarthritis of shoulder during adhesion period,which can reduce the edema of muscle and ligament of shoulder joint,reduce synovial fluid accumulation,and eliminate inflammation of joint capsule. It may be related to the reduction of IL-6,IL-10 and TNF-α,as well as be related to the increase of β-EP expression.