推拿联合针刺治疗肩关节周围炎气滞血瘀证
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摘要
目的:探讨推拿联合针刺治疗肩关节周围炎气滞血瘀证的疗效及对患者血清中白细胞介素(interleukin,IL)-10和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的影响。方法:选取118例肩关节周围炎患者作为研究对象,参照数字表法随机分为对照组和观察组,每组59例。两组患者均予肩部功能康复锻炼。对照组予肩关节腔内注射玻璃酸钠,每次2 m L,每周1次;观察组在对照组基础上予推拿联合针刺治疗。两组均治疗4周。比较两组患者肩关节功能、疼痛程度及临床疗效。检测患者血清中IL-10和TNF-α水平。结果:治疗后,观察组患者关节活动度、疼痛、日常生活活动评分显著高于对照组(P <0. 01)。观察组治疗后疼痛评级指数(pain rating index,PRI)、疼痛视觉模拟评分(visual analogue scale,VAS)、疼痛状况(present pain intensity,PPI)评分明显少于对照组(P <0. 01)。观察组有效率为96. 61%,显著高于对照组83. 05%(P <0. 05)。观察组治疗后血清中IL-10水平明显高于对照组,TNF-α明显低于对照组(P <0. 01)。结论:推拿联合针刺治疗肩关节周围炎气滞血瘀证疗效显著,其作用机制可能是通过调节炎性因子水平来实现。
Objective: To explore the effect of combined acupuncture and massage on qi stagnation and blood stasis syndrome in periarthritis of shoulder and the effects of serum interleukin( IL)-10 and tumor necrosis factor( TNF)-α levels. Methods: A total of 118 patients with periarthritis of shoulder were selected as the study subjects. They were randomly divided into the control group and the observation group by reference to the digital table method,with 59 cases in each group. Both groups of patients were given rehabilitation exercises for shoulder function. The control group was injected with sodium hyaluronate into the shoulder joint,2 m L each time,once a week. The observation group was treated with massage combined with acupuncture on the basis of the control group. Both groups were treated for 4 weeks. The shoulder function,pain level and clinical efficacy were compared between the two groups. The levels of IL-10 and TNF-α in the serum of the patients were measured. Results: After treatment,the joint activity,pain,and activities of daily living were significantly higher in the observation group than those in the control group( P < 0. 01). Pain rating index( PRI),visual analogue scale( VAS),and present pain intensity( PPI) in the observation group were significantly lower than those in the control group( P < 0. 01). The effective rate of the observation group was 96. 61%,which was significantly higher than 83. 05% of the control group( P < 0. 05). The serum IL-10 level in the observation group was significantly higher than that in the control group,and TNF-α was significantly lower than the control( P < 0. 01). Conclusion: Massage combined with acupuncture in the treatment of periarthritis of shoulder of qi stagnation and blood stasis syndrome is effective,and its mechanism may be achieved by regulating the level of inflammatory factors.
Objective: To explore the effect of combined acupuncture and massage on qi stagnation and blood stasis syndrome in periarthritis of shoulder and the effects of serum interleukin( IL)-10 and tumor necrosis factor( TNF)-α levels. Methods: A total of 118 patients with periarthritis of shoulder were selected as the study subjects. They were randomly divided into the control group and the observation group by reference to the digital table method,with 59 cases in each group. Both groups of patients were given rehabilitation exercises for shoulder function. The control group was injected with sodium hyaluronate into the shoulder joint,2 m L each time,once a week. The observation group was treated with massage combined with acupuncture on the basis of the control group. Both groups were treated for 4 weeks. The shoulder function,pain level and clinical efficacy were compared between the two groups. The levels of IL-10 and TNF-α in the serum of the patients were measured. Results: After treatment,the joint activity,pain,and activities of daily living were significantly higher in the observation group than those in the control group( P < 0. 01). Pain rating index( PRI),visual analogue scale( VAS),and present pain intensity( PPI) in the observation group were significantly lower than those in the control group( P < 0. 01). The effective rate of the observation group was 96. 61%,which was significantly higher than 83. 05% of the control group( P < 0. 05). The serum IL-10 level in the observation group was significantly higher than that in the control group,and TNF-α was significantly lower than the control( P < 0. 01). Conclusion: Massage combined with acupuncture in the treatment of periarthritis of shoulder of qi stagnation and blood stasis syndrome is effective,and its mechanism may be achieved by regulating the level of inflammatory factors.
引文
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[12]苏周伟,王杰.加味桂枝芍药知母汤联合推拿治疗气滞血瘀型椎动脉型颈椎病疗效观察[J].四川中医,2016,34(4):162-164.
[13]徐俊,陈立峰,杜毅,等.肩关节腔扩张联合扳动手法治疗老年肩周炎的临床疗效[J].中国老年学杂志,2017,37(8):1982-1984.
[14]邓明,刘玉峰.针刺治疗对肩周炎患者血清TNF-α和IL-6的影响[J].中医药导报,2012,18(2):68-69.
[15]罗浩,袁义,杨超.玻璃酸钠联合糖皮质激素治疗肩周炎的疗效观察[J].中国生化药物杂志,2017,37(5):77-79.
[2]张万海,张海军.手法松解、理疗联合“肩三针”治疗肩关节周围炎198例[J].河南中医,2015,35(12):3002-3004.
[3]张玉兴,王振强,吴红.中医综合疗法治疗肩关节周围炎42例[J].中国实验方剂学杂志,2014,20(14):206-210.
[4]陈爱萍,肖林,王娴默,等.肩周炎的中西医治疗进展[J].中医学报,2013,28(7):1076-1078.
[5]周秀美.透穴手法按摩配合针灸治疗肩关节周围炎临床研究[J].中医学报,2014,29(8):1236-1237.
[6]中华中医药学会.肩关节周围炎[J].风湿病与关节,2013,2(2):73-75.
[7]CONSTANT C R,MURLEY A G. A clinical method of functional assessment of the shoulder[J]. Clin Orthopaedics Related Research,1987,214:160.
[8]李君,冯艺,韩济生,等.中文版简版Mc Gill疼痛问卷-2的制定与多中心验证[J].中国疼痛医学杂志,2013,19(1):42-46.
[9]中国中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:199-201.
[10]吴栩,韦伟标.中医药治疗肩关节周围炎研究进展[J].河南中医,2014,34(10):1959-1960.
[11]沈龙,仇琳,赵侃如,等.压痛点强刺激推拿配合药物注射治疗肩周炎的疗效[J].上海医学,2015,38(6):493-496.
[12]苏周伟,王杰.加味桂枝芍药知母汤联合推拿治疗气滞血瘀型椎动脉型颈椎病疗效观察[J].四川中医,2016,34(4):162-164.
[13]徐俊,陈立峰,杜毅,等.肩关节腔扩张联合扳动手法治疗老年肩周炎的临床疗效[J].中国老年学杂志,2017,37(8):1982-1984.
[14]邓明,刘玉峰.针刺治疗对肩周炎患者血清TNF-α和IL-6的影响[J].中医药导报,2012,18(2):68-69.
[15]罗浩,袁义,杨超.玻璃酸钠联合糖皮质激素治疗肩周炎的疗效观察[J].中国生化药物杂志,2017,37(5):77-79.