钙化性肩袖肌腱炎的针刺封闭治疗

Close needling for the treatment of calcifying tendinitis

目的 探讨和分析应用闭合针刺封闭疗法治疗钙化性肩袖肌腱炎的疗效。 方法对 17例应用针刺封闭疗法治疗钙化性肩袖肌腱炎的患者进行随访 ,平均随访时间 9 3个月。治疗时采用 18或 16号粗针头对钙化灶进行反复穿刺 ,针刺封闭后第 4、6、8周以及随后每隔 4周随访患者 ,记录症状缓解情况并进行相同体位的X线片投照 ,应用ASES评分、Constant Murley评分、UCLA评分以及简易肩关节测验 (SST)问卷评估对比治疗前后的治疗结果。 结果 17例中 15例在 1～ 3次针刺封闭注射后钙化灶消失 ,平均消失时间为 9 4周 (4～ 2 0周 )。治疗前ASES评分平均为 4 7 7(34～ 5 9) ,肩关节活动度平均为前屈上举 90°(70°～ 10 0°) ,外旋 15°(0°～ 30°) ,内旋L3～ 4 (L1～臀部 ) ;Constant Murley评分平均为 4 4 6 (34～ 5 4 ) ;UCLA评分平均为 11 6 (8～ 15 ) ;SST问卷这回答“是”的问题平均为 3 4个 (2～ 5个 )。经针刺封闭治疗后ASES评分平均为 87 1(72～ 91) ,肩关节活动度平均为前屈上举 14 3 5°(12 0°～ 16 0°) ,外旋 4 0°(30°～ 5 0°) ,内旋T8～T9水平 ;Constant Murley评分平均为 87 8(6 4～ 94 ) ;UCLA评分平均为 2 9 5 (19～ 33) ;SST问卷这回答“是”的问题平均为 9 1个(6～ 12个 )。

Objective To study the effect of close needling in the treatment of calcifying tendonitis. Methods Seventeen patients with calcifying tendonitis who had received close needling treatment were followed-up for 9.3 months on average. An 18-gauge or 16-gauge needle was used during needling. X-ray examnation was given 4, 6, 8 and every 4 weeks after needling. SST (simple shoulder test) questionnaire, ASES(American Shoulder & Elbow Suegeon) score, constant-Murley score and UCLA score were adopted for evaluation before and after treatment. Results Calcium deposition disappeared within 4-20 weeks mean 9.4 weeks in 15 of the 17 patients after needling for 1-3 times. Average ASES score before treatment was 47.7(34-59), forward elevation was 90°(70°-100°), external rotation was 15°(0°-30°), and internal rotation was L3-4(L1-buttock). Average constant-Murley score before treatment was 44.6(34-54), UCLA score was 11.6(8-15), and numbers of questions for “yes” in SST questionnaire was 3.4(2-5). After needling the average ASES score was 87.1 (72-91), forward elevation was 143.5° (120°-160°), external rotation was 40°(30°-50°), internal rotation was T 8-T 9, constant-Murley score was 87.8(64-94), UCLA score was 29.5(19-33), and numbers of questions for “yes” in SST questionnaire was 9.1 (6-12). Significant difference was found between before and after needling (ASES: P < 0.01,forward elevation, external rotation and internal rotation: P < 0.01, constant-Murley: P < 0.01, UCLA: P < 0.01, SST: P < 0.01). Conclusions Close needling is an effective method for the treatment of calcifying tendonitis. Symptoms and disability are greatly relieved non-surgically in most of patients. Care should be taken in differential diagnosis of degenerative calcification in chronic rotator cuff disease.