芒针针刺结合刺络拔罐治疗急性期粘连性肩关节囊炎
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摘要
目的:探讨芒针针刺结合刺络拔罐治疗急性期粘连性肩关节囊炎的临床疗效。方法:将纳入研究的100例急性期粘连性肩关节囊炎患者随机分为芒针组和常规组,每组50例。芒针组采用芒针针刺结合刺络拔罐治疗,用芒针依次深刺肩前穴透极泉穴、深刺肩髃穴透臂臑穴、深刺臑俞穴、平刺臑会穴、深刺肩髃穴透极泉穴,产生针感即拔针;芒针治疗结束后,在肩前、肩髃、臑俞、臑会穴上点刺放血,并将火罐吸附在点刺的穴位上,留罐约6 min。常规组采用常规针刺结合拔罐治疗,用毫针直刺肩前、肩髃、肩贞、臑俞、臑会等穴,留针30 min,留针的同时红外线灯照射患肩,拔针后将火罐吸附在穴位上,留罐约6 min。2组患者均每日治疗1次,1周为1个疗程,共治疗1个疗程。分别在治疗前和治疗结束后,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价患肩疼痛情况,采用Melle肩关节功能评分标准评价患肩功能。结果:治疗前,2组患者患肩疼痛VAS评分、患肩功能Melle评分的组间比较,差异均无统计学意义[(7. 61±1. 05)分,(6. 90±1. 51)分,t=2. 730,P=0. 051;(9. 92±1. 84)分,(9. 46±2. 08)分,t=1. 170,P=0. 052]。治疗结束后,2组患者患肩疼痛VAS评分、患肩功能Melle评分均较治疗前降低[芒针组:(1. 02±0. 98)分,(7. 61±1. 05)分,t=32. 440,P=0. 001;(2. 08±1. 02)分,(9. 92±1. 84)分,t=-26. 080,P=0. 001;常规组:(2. 99±1. 56)分,(6. 90±1. 51)分,t=12. 730,P=0. 001;(4. 16±1. 61)分,(9. 46±2. 08)分,t=-14. 250,P=0. 001],芒针组两项评分均低于常规组[(1. 02±0. 98)分,(2. 99±1. 56)分,t=-7. 561,P=0. 001;(2. 08±1. 02)分,(4. 16±1. 61)分,t=-7. 718,P=0. 001],芒针组评分降低较常规组更明显[(6. 56±1. 01)分,(3. 93±1. 11)分,t=12. 392,P=0. 001;(7. 80±1. 11)分,(5. 32±1. 51)分,t=9. 358,P=0. 001]。结论:对于急性粘连性肩关节囊炎患者,采用芒针针刺结合刺络拔罐治疗和常规针刺结合拔罐治疗均可缓解患肩疼痛、改善患肩功能,且前者疗效优于后者。
Objective: To explore the clinical curative effects of elongated needle acupuncture therapy combined with pricking and cupping therapy for treatment of acute-phase adhesive shoulder capsulitis. Methods: One hundred patients with acute-phase adhesive shoulder capsulitis were enrolled in the study and were randomly divided into elongated needle therapy group and conventional therapy group,50 cases in each group. The patients in elongated needle therapy group were treated with elongated needle acupuncture combined with pricking and cupping. Firstly,the elongated needle was deeply inserted into point Jiquan (HT1) through point Jianqian. Secondly,the elongated needle was deeply inserted into point Binao (LI14) through point Jianyu (LI15). Thirdly,the elongated needle was deeply inserted into point Naoshu (SI10) and horizontally inserted into point Naohui (TE13). Lastly,the elongated needle was deeply inserted into point Jiquan (HT1)through point Jianyu (LI15). The needles were removed when the doctor got the needling sensation. After the end of elongated needle treatment,pricking needling were performed on patients at point Jianqian,Jianyu (LI15),Naoshu (SI10) and Naohui (TE13) for bloodletting,and the cupping jars were adsorbed on the acupuncture points and were retained for 6 minutes. The patients in conventional therapy group were treated with conventional acupuncture combined with cupping. The filliform needles were perpendicularly inserted into point Jianqian,Jianyu (LI15),Jianzhen (SI9),Naoshu (SI10) and Naohui (TE13) and the needles were retained for 30 minutes. Meanwhile,the affacted shoulder was irradiated with infrared lamps. The cupping jars were adsorbed on the acupuncture points for 6 minutes after the needles were removed.All patients in the 2 groups were treated once a day for one course of treatment,7 days for each course. The affected shoulder pain and function were evaluated by using pain visual analogue scale (VAS) score and Melle shoulder function scoring standard respectively before the treatment and after the end of the treatment. Results: There was no statistical difference in pain VAS scores and Melle function scores of affected shoulder between the 2 groups before the treatment (7. 61 +/-1. 05 vs 6. 90 +/-1. 51 points,t = 2. 730,P = 0. 051; 9. 92 +/-1. 84 vs9. 46 +/-2. 08 points,t = 1. 170,P = 0. 052). The pain VAS scores and Melle function scores of affected shoulder decreased in the 2 groups after the end of the treatment compared to pretreatment (elongated needle therapy group: 1. 02 +/-0. 98 vs 7. 61 +/-1. 05 points,t =32. 440,P = 0. 001; 2. 08 +/-1. 02 vs 9. 92 +/-1. 84 points,t =-26. 080,P = 0. 001; conventional therapy group: 2. 99 +/-1. 56 vs6. 90 +/-1. 51 points,t = 12. 730,P = 0. 001; 4. 16 +/-1. 61 vs 9. 46 +/-2. 08 points,t =-14. 250,P = 0. 001),and the pain VAS scores and Melle function scores were lower in elongated needle therapy group compared to conventional therapy group (1. 02 +/-0. 98 vs2. 99 +/-1. 56 points,t =-7. 561,P = 0. 001; 2. 08 +/-1. 02 vs 4. 16 +/-1. 61 points,t =-7. 718,P = 0. 001),and the scores decreased more obviously in elongated needle therapy group compared to conventional therapy group (6. 56 +/-1. 01 vs 3. 93 +/-1. 11 points,t =12. 392,P = 0. 001; 7. 80 +/-1. 11 vs 5. 32 +/-1. 51 points,t = 9. 358,P = 0. 001). Conclusion: For patients with acute-phase adhesive shoulder capsulitis,both combination therapy of elongated needle acupuncture and pricking and cupping and combination therapy of conventional acupuncture and cupping can relieve shoulder pain and improve shoulder function,moreover,the former surpasses the latter in clinical curative effects.
Objective: To explore the clinical curative effects of elongated needle acupuncture therapy combined with pricking and cupping therapy for treatment of acute-phase adhesive shoulder capsulitis. Methods: One hundred patients with acute-phase adhesive shoulder capsulitis were enrolled in the study and were randomly divided into elongated needle therapy group and conventional therapy group,50 cases in each group. The patients in elongated needle therapy group were treated with elongated needle acupuncture combined with pricking and cupping. Firstly,the elongated needle was deeply inserted into point Jiquan (HT1) through point Jianqian. Secondly,the elongated needle was deeply inserted into point Binao (LI14) through point Jianyu (LI15). Thirdly,the elongated needle was deeply inserted into point Naoshu (SI10) and horizontally inserted into point Naohui (TE13). Lastly,the elongated needle was deeply inserted into point Jiquan (HT1)through point Jianyu (LI15). The needles were removed when the doctor got the needling sensation. After the end of elongated needle treatment,pricking needling were performed on patients at point Jianqian,Jianyu (LI15),Naoshu (SI10) and Naohui (TE13) for bloodletting,and the cupping jars were adsorbed on the acupuncture points and were retained for 6 minutes. The patients in conventional therapy group were treated with conventional acupuncture combined with cupping. The filliform needles were perpendicularly inserted into point Jianqian,Jianyu (LI15),Jianzhen (SI9),Naoshu (SI10) and Naohui (TE13) and the needles were retained for 30 minutes. Meanwhile,the affacted shoulder was irradiated with infrared lamps. The cupping jars were adsorbed on the acupuncture points for 6 minutes after the needles were removed.All patients in the 2 groups were treated once a day for one course of treatment,7 days for each course. The affected shoulder pain and function were evaluated by using pain visual analogue scale (VAS) score and Melle shoulder function scoring standard respectively before the treatment and after the end of the treatment. Results: There was no statistical difference in pain VAS scores and Melle function scores of affected shoulder between the 2 groups before the treatment (7. 61 +/-1. 05 vs 6. 90 +/-1. 51 points,t = 2. 730,P = 0. 051; 9. 92 +/-1. 84 vs9. 46 +/-2. 08 points,t = 1. 170,P = 0. 052). The pain VAS scores and Melle function scores of affected shoulder decreased in the 2 groups after the end of the treatment compared to pretreatment (elongated needle therapy group: 1. 02 +/-0. 98 vs 7. 61 +/-1. 05 points,t =32. 440,P = 0. 001; 2. 08 +/-1. 02 vs 9. 92 +/-1. 84 points,t =-26. 080,P = 0. 001; conventional therapy group: 2. 99 +/-1. 56 vs6. 90 +/-1. 51 points,t = 12. 730,P = 0. 001; 4. 16 +/-1. 61 vs 9. 46 +/-2. 08 points,t =-14. 250,P = 0. 001),and the pain VAS scores and Melle function scores were lower in elongated needle therapy group compared to conventional therapy group (1. 02 +/-0. 98 vs2. 99 +/-1. 56 points,t =-7. 561,P = 0. 001; 2. 08 +/-1. 02 vs 4. 16 +/-1. 61 points,t =-7. 718,P = 0. 001),and the scores decreased more obviously in elongated needle therapy group compared to conventional therapy group (6. 56 +/-1. 01 vs 3. 93 +/-1. 11 points,t =12. 392,P = 0. 001; 7. 80 +/-1. 11 vs 5. 32 +/-1. 51 points,t = 9. 358,P = 0. 001). Conclusion: For patients with acute-phase adhesive shoulder capsulitis,both combination therapy of elongated needle acupuncture and pricking and cupping and combination therapy of conventional acupuncture and cupping can relieve shoulder pain and improve shoulder function,moreover,the former surpasses the latter in clinical curative effects.
引文
[1]赵宏,赵婷,刘保延,等.条口穴不同刺法对肩周炎疗效差异的观察[J].中国针灸,2006,26(10):729-731.
[2]尹平,苏肇家,徐世芬.苏肇家针灸治疗肩周炎经验辑要[J].中医药导报,2017,23(14):55.
[3]ZREIK N H,MALIK R A,CHARALAMBOUS C P.Adhesive capsulitis of the shoulder and diabetes:a meta-analysis of prevalence[J].Muscles Ligaments Tendons J,2016,6(1):26-34.
[4]周亚锋,殷建权,严伟.肩三针温针灸治疗肩周炎87例分析[J].中华全科医学,2017,15(5):868-870.
[5]张万海,艾志国,张海军.“肩三针”温灸联合理疗、手法松解治疗慢性期肩周炎临床疗效综合评价[J].河北医药,2016,38(13):1979-1982.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:186-187.
[7]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[8]何继永.外科疾病诊断标准[M].北京:北京科学技术出版社,2001:57.
[9]李正祥,王海梁,易文静,等.松解三法联合功能锻炼治疗黏连期肩周炎的临床研究[J].中医正骨,2017,29(6):35-38.
[10]孙华堂,万欢,张录杰,等.减压放血针加电针治疗急性期肩周炎临床疗效观察[J].中国针灸,2016,36(9):933-937.
[11]何勇,熊建义,崔家鸣,等.肩周炎肩关节活动受限的分子生物学研究[J].国际骨科学杂志,2016,37(3):187-189.
[12]钱洪,赵建宁,包倪荣.冻结肩的治疗进展[J].颈腰痛杂志,2017,38(1):69-72.
[13]王新昌,郝连升,陈健.放散式体外冲击波联合关节腔注射和功能锻炼治疗肩周炎的临床研究[J].中医正骨,2017,29(8):36-38
[14]徐耀,张昶,刘赵丽,等.冻结肩的中医治疗进展[J].世界中西医结合杂志,2016,11(11):1619-1623.
[15]方汉军,林新晓,陈思,等.肩周炎的中医治疗研究进展[J].现代中医临床,2017,24(1):41-44.
[16]王佩,谢雁鸣,王志飞.肩周炎中医药治疗的文献计量学研究[J].中国中医骨伤科杂志,2016,24(11):41-45.
[17]于俊龙,孙玉明.搜风通络汤对肩周炎关节镜术后肩关节功能状态的干预[J].吉林中医药,2016,36(5):475-477.
[18]韩晓瑞,陈春海,刘春,等.纪青山教授针灸治疗肩周炎急性发作期[J].长春中医药大学学报,2016,32(4):674-676.
[19]罗晓舟,唐纯志,杨雪捷,等.针灸治疗肩周炎有效性Meta分析[J].中国中医基础医学杂志,2017,23(4):586-591.
[20]黄美,安红丽.刮痧拔罐法治疗颈型颈椎病30例临床观察[J].江苏中医药,2016,48(11):56-58.
[2]尹平,苏肇家,徐世芬.苏肇家针灸治疗肩周炎经验辑要[J].中医药导报,2017,23(14):55.
[3]ZREIK N H,MALIK R A,CHARALAMBOUS C P.Adhesive capsulitis of the shoulder and diabetes:a meta-analysis of prevalence[J].Muscles Ligaments Tendons J,2016,6(1):26-34.
[4]周亚锋,殷建权,严伟.肩三针温针灸治疗肩周炎87例分析[J].中华全科医学,2017,15(5):868-870.
[5]张万海,艾志国,张海军.“肩三针”温灸联合理疗、手法松解治疗慢性期肩周炎临床疗效综合评价[J].河北医药,2016,38(13):1979-1982.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:186-187.
[7]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[8]何继永.外科疾病诊断标准[M].北京:北京科学技术出版社,2001:57.
[9]李正祥,王海梁,易文静,等.松解三法联合功能锻炼治疗黏连期肩周炎的临床研究[J].中医正骨,2017,29(6):35-38.
[10]孙华堂,万欢,张录杰,等.减压放血针加电针治疗急性期肩周炎临床疗效观察[J].中国针灸,2016,36(9):933-937.
[11]何勇,熊建义,崔家鸣,等.肩周炎肩关节活动受限的分子生物学研究[J].国际骨科学杂志,2016,37(3):187-189.
[12]钱洪,赵建宁,包倪荣.冻结肩的治疗进展[J].颈腰痛杂志,2017,38(1):69-72.
[13]王新昌,郝连升,陈健.放散式体外冲击波联合关节腔注射和功能锻炼治疗肩周炎的临床研究[J].中医正骨,2017,29(8):36-38
[14]徐耀,张昶,刘赵丽,等.冻结肩的中医治疗进展[J].世界中西医结合杂志,2016,11(11):1619-1623.
[15]方汉军,林新晓,陈思,等.肩周炎的中医治疗研究进展[J].现代中医临床,2017,24(1):41-44.
[16]王佩,谢雁鸣,王志飞.肩周炎中医药治疗的文献计量学研究[J].中国中医骨伤科杂志,2016,24(11):41-45.
[17]于俊龙,孙玉明.搜风通络汤对肩周炎关节镜术后肩关节功能状态的干预[J].吉林中医药,2016,36(5):475-477.
[18]韩晓瑞,陈春海,刘春,等.纪青山教授针灸治疗肩周炎急性发作期[J].长春中医药大学学报,2016,32(4):674-676.
[19]罗晓舟,唐纯志,杨雪捷,等.针灸治疗肩周炎有效性Meta分析[J].中国中医基础医学杂志,2017,23(4):586-591.
[20]黄美,安红丽.刮痧拔罐法治疗颈型颈椎病30例临床观察[J].江苏中医药,2016,48(11):56-58.