物理疗法、手法和针灸治疗肩周炎优选方案的正交设计研究
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摘要
目的运用正交设计研究物理疗法、手法和针灸的不同组合方案对肩周炎的治疗效果,探讨其最佳的治疗方案。方法选择西安交通大学附属红会医院中医骨科二病区和运动损伤肩肘病区门诊及住院部2016年1月～2017年12月符合纳入标准的肩周炎患者80例,采用区组随机方法按照L_8(2～7)的正交设计表分成八组,每组10例,采用A(物理疗法)、B(手法治疗)、C(针灸治疗)3个因素及相应的2水平(红外线和体外冲击波、关节松动术和推拿手法、普通针刺和温针透刺)进行治疗,采用直观分析和方差分析观察分析不同组合方案对肩周炎患者肩关节疼痛和功能的疗效。结果与治疗前比较,物理疗法、手法、针灸三类治疗的不同组合均能降低肩周炎患者的视觉模拟评分法(VAS)评分,提高肩关节功能评分,差异有统计学意义(P<0.05)。肩关节疼痛VAS评分及功能评分改善的直观分析和方差分析结果显示,物理疗法、手法、针灸治疗是改善患者肩关节疼痛及功能的显著因素(P<0.05),且物理疗法改善最大,手法治疗其次,针灸治疗最小(R_A>R_B>R_C,r_A>r_B>r_C);在同因素不同水平的对比观察中,体外冲击波改善比红外线更明显(K_2>K_1,k_2>k_1),关节松动术改善比推拿手法更明显(K_1>K_2,k_1>k_2),温针透刺改善比普通针刺更明显(K_2>K_1,k_2>k_1);体外冲击波+关节松动术+温针透刺是最佳治疗方案。结论体外冲击波结合关节松动术和温针透刺是肩周炎患者疼痛、功能障碍有效治疗的最佳组合方案,有临床推广价值。
Province,Xi′an 710003,China[Abstract]Objective To study the effect of different combinations of physical therapy,manipulation and acupuncture on patients with periarthritis of shoulder,and to explore the optimal treatment protocol by using orthogonal design.Methods A total of 80 patients with scapulohumeral periarthritis who met the inclusion criteria were selected from Outpatient and Inpatient Department in Ward Two of Department of TCM Orthopedics and Ward of Sports Injury Shoulder Elbow,Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2016 to December 2017.They were divided into eight groups according to the orthogonal design of L_8(2~7)tables with 10 cases in each group by random block method.Three factors including A(physical therapy),B(manipulation therapy),C(acupuncture therapy)and the corresponding 2 levels(infrared ray therapy and extracorporeal shock wave therapy,joint mobilization therapy and manipulation therapy,ordinary acupuncture therapy and warm needle penetration therapy)were used for treatment,shoulder joint pain and function were observed by intuitive analysis and variance analysis.Results Compared with before treatment,different combinations of physical therapy,manipulation therapy and acupuncture therapy all reduced the visual analogue scale(VAS)score and improved the shoulder joint function score of patients with scapulohumeral periarthritis,and the differences were statistically significant(P<0.05).Physical therapy,manipulation and acupuncture therapy were the significant factors to improve shoulder joint pain and function through visual analysis and vari-apy was the least(R_A>R_B>R_C,r_A>r_B>r_C).Compared with different levels of the same factors,the extracorporeal shock wave therapy was better than infrared ray therapy(K_2>K_1,k_2>k_1),joint mobilization therapy was better than manipulation therapy(K_1>K_2,k_1>k_2),and warm needle penetration therapy was better than ordinary acupuncture therapy(K_2>K_1,k_2>k_1).Extracorporeal shock wave therapy combined with joint mobilization therapy and warm needle penetration joint mobilization therapy was the best treatment for patients with scapulohumeral periarthritis.Conclusion The combination of extracorporeal shock wave therapy,joint mobilization therapy and warm needle penetration therapy is the best optimized protocol for the treatment of pain and dysfunction in patients with scapulohumeral periarthritis,which is worthy being popularized.
Province,Xi′an 710003,China[Abstract]Objective To study the effect of different combinations of physical therapy,manipulation and acupuncture on patients with periarthritis of shoulder,and to explore the optimal treatment protocol by using orthogonal design.Methods A total of 80 patients with scapulohumeral periarthritis who met the inclusion criteria were selected from Outpatient and Inpatient Department in Ward Two of Department of TCM Orthopedics and Ward of Sports Injury Shoulder Elbow,Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2016 to December 2017.They were divided into eight groups according to the orthogonal design of L_8(2~7)tables with 10 cases in each group by random block method.Three factors including A(physical therapy),B(manipulation therapy),C(acupuncture therapy)and the corresponding 2 levels(infrared ray therapy and extracorporeal shock wave therapy,joint mobilization therapy and manipulation therapy,ordinary acupuncture therapy and warm needle penetration therapy)were used for treatment,shoulder joint pain and function were observed by intuitive analysis and variance analysis.Results Compared with before treatment,different combinations of physical therapy,manipulation therapy and acupuncture therapy all reduced the visual analogue scale(VAS)score and improved the shoulder joint function score of patients with scapulohumeral periarthritis,and the differences were statistically significant(P<0.05).Physical therapy,manipulation and acupuncture therapy were the significant factors to improve shoulder joint pain and function through visual analysis and vari-apy was the least(R_A>R_B>R_C,r_A>r_B>r_C).Compared with different levels of the same factors,the extracorporeal shock wave therapy was better than infrared ray therapy(K_2>K_1,k_2>k_1),joint mobilization therapy was better than manipulation therapy(K_1>K_2,k_1>k_2),and warm needle penetration therapy was better than ordinary acupuncture therapy(K_2>K_1,k_2>k_1).Extracorporeal shock wave therapy combined with joint mobilization therapy and warm needle penetration joint mobilization therapy was the best treatment for patients with scapulohumeral periarthritis.Conclusion The combination of extracorporeal shock wave therapy,joint mobilization therapy and warm needle penetration therapy is the best optimized protocol for the treatment of pain and dysfunction in patients with scapulohumeral periarthritis,which is worthy being popularized.
引文
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[14]黄宙锋.红外线治疗仪联合关节腔透明质酸钠注射治疗肩周炎的疗效观察[J].中国医疗器械信息,2017,23(14):60-61.
[15]祝鹏宇,武丹,郭文海,等.循经远取动法结合体外冲击波治疗肩关节周围炎的临床疗效观察[J].针灸临床杂志,2018,34(5):26-29.
[16]陈勇,彭轩,汤智伟,等.关节松动术结合体外冲击波治疗肩周炎的疗效观察[J].中国康复,2014,29(3):192-194.
[17]刘步云,胡松,史梦龙.关节松动技术治疗肩周炎的临床疗效观察[J].临床检验杂志:电子版,2018,7(1):60-62.
[18]史军锋.推拿手法配合超声波治疗肩周炎临床疗效观察[J].湖北中医杂志,2014,36(10):66-67.
[19]冯军平,王承祥.小针刀配合推拿手法治疗肩周炎的临床疗效分析[J].中国中医骨伤科杂志,2015,23(2):42-43.
[20]陈慕远,蒲沁沁,刘申易,等.不同刺激方法治疗肩周炎疗效比较[J].中国针灸,2013,33(2):109-112.
[21]王欣.透刺疗法治疗肩周炎临床研究进展[J].湖南中医杂志,2014,30(9):180-181.
[22]Hawk C,Minkalis AL,Khorsan R,et al.Systematic Review of Nondrug,Nonsurgical Treatment of Shoulder Conditions[J].J Manipulative Physiol Ther,2017,40(5):293-319.
[23]Steuri R,Sattelmayer M,Elsig S,et al.Effectiveness of conservative interventions including exercise,manual therapy and medical management in adults with shoulder impingement:a systematic review and meta-analysis of RCTs[J].Br J Sports Med,2017,51(18):1340-1347.
[2]Cleland J,Durall C.Physical therapy for adhesive capsulitis:systematic review[J].Physiotherapy,2002,88(8):450-457.
[3]Zreik NH,Malik RA,Charalambous CP,et al.Adhesive capsulitis of the shoulder and diabetes:a meta-analysis of prevalence[J].Muscles Ligaments Tendons J,2016,6(1):26-34.
[4]Dias R,Cutts S,Massoud S,et al.Frozen shoulder[J].BMJ,2005,331(7530),1453-1456.
[5]中华医学会.临床诊疗指南物理医学与康复分册[M].北京:人民卫生出版社,2005:68.
[6]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:186-187.
[7]陶熔,王静,李海芹,等.丁丙诺啡联合关节松动术治疗肩周炎的疗效观察[J].中华物理医学与康复杂志,2017,39(2):137-141.
[8]谭冠先.疼痛诊疗学[M].2版.北京:人民卫生出版社,2005:7-9.
[9]杨树萱.肩周炎康复体疗功能评定方案[J].中国康复医学杂志,1993(1):8-10.
[10]中华中医药学会.肩关节周围炎[J].风湿病与关节炎,2013,2(2):73-75.
[11]Hagiwara Y,Ando A,Onoda Y,et al.Coexistence of fibrotic and chondrogenic process in the capsule of idiopathic frozen shoulders[J].Osteoarthritis Cartilage,2012,20(3):241-249.
[12]骨肌疾病体外冲击波疗法中国专家共识(第2版)[J].中国医学前沿杂志:电子版,2017,9(2):25-33.
[13]Abed JM,McClure SR,Yaeger MJ,et al.Immunohistochemical evaluation of substance P and calcitonin generelated peptide in skin and periosteum after extracorporeal shock wave therapy and radial pressure wave therapy in sheep[J].Am J Vet Res,2007,68(3):323-328.
[14]黄宙锋.红外线治疗仪联合关节腔透明质酸钠注射治疗肩周炎的疗效观察[J].中国医疗器械信息,2017,23(14):60-61.
[15]祝鹏宇,武丹,郭文海,等.循经远取动法结合体外冲击波治疗肩关节周围炎的临床疗效观察[J].针灸临床杂志,2018,34(5):26-29.
[16]陈勇,彭轩,汤智伟,等.关节松动术结合体外冲击波治疗肩周炎的疗效观察[J].中国康复,2014,29(3):192-194.
[17]刘步云,胡松,史梦龙.关节松动技术治疗肩周炎的临床疗效观察[J].临床检验杂志:电子版,2018,7(1):60-62.
[18]史军锋.推拿手法配合超声波治疗肩周炎临床疗效观察[J].湖北中医杂志,2014,36(10):66-67.
[19]冯军平,王承祥.小针刀配合推拿手法治疗肩周炎的临床疗效分析[J].中国中医骨伤科杂志,2015,23(2):42-43.
[20]陈慕远,蒲沁沁,刘申易,等.不同刺激方法治疗肩周炎疗效比较[J].中国针灸,2013,33(2):109-112.
[21]王欣.透刺疗法治疗肩周炎临床研究进展[J].湖南中医杂志,2014,30(9):180-181.
[22]Hawk C,Minkalis AL,Khorsan R,et al.Systematic Review of Nondrug,Nonsurgical Treatment of Shoulder Conditions[J].J Manipulative Physiol Ther,2017,40(5):293-319.
[23]Steuri R,Sattelmayer M,Elsig S,et al.Effectiveness of conservative interventions including exercise,manual therapy and medical management in adults with shoulder impingement:a systematic review and meta-analysis of RCTs[J].Br J Sports Med,2017,51(18):1340-1347.