靳三针与关节松动术治疗肩关节周围炎的临床对比研究
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摘要
研究目的：
采用随机对照的研究方法和循证医学研究的原则,以靳三针组、关节松动术组作为对照组,通过靳三针结合关节松动术治疗肩关节周围炎的临床观察,探讨靳三针、关节松动术这两种疗法的临床疗效、治疗机理、可行性及其存在的问题,以期对此作出系统、客观、科学的疗效评价,为该病寻找一种疗效可靠的综合疗法。
研究方法：
病例来源于2011年11月至2013年2月台湾永泰中医诊所病人,共收集符合本研究标准的患者95例,按1：1：1的比例随机分配至靳三针结合关节松动术组、靳三针组、关节松动术组,其中靳三针结合关节松动术组32例,靳三针组为32例,关节松动术组为31例。肩周炎西医参照全国第二届肩周炎学术讨论会(1991·湖北)制定的肩关节周围炎诊断标准；中诊断标准参照《中华针灸临床诊疗规范》中的“肩痹”诊断标准。靳三针、关节松动术隔天治疗一次,10次为1疗程,共2个疗程。疗效指标为简化McGill疼痛量表、肩功能Constant—Murley评定法、日常生活活动能力(ASES肩关节功能评价表)、肩关节前屈、外展、指耳间距、指椎间距。中医证候疗效标准参照国家中医药管理局《中医病症诊断与疗效标准》之肩周炎中医证候疗效标准。肩周炎整体疗效标准根据《中药新药临床研究指导原则》(卫生部制定发行,1997年第三辑)有关“肩周炎”的疗效标准。用SPSS17.0软件进行统计分析。计量资料用均数±标准差(x±S)表示,计数资料用构成比(%)表示。
结果：
一、治疗前一般资料比较：本研究共纳入95例,其中男性42例,女性53例。分为靳三针结合关节松动术组、靳三针组、关节松动术组。三组肩关节周围炎患者在年龄、病程、性别、中医辨证分型等基线因素分析比较,差异均无统计学意义(P>0.05),表明组间基线条件一致,具有可比性。
二、疗效比较
(一)肩部疼痛评定(McGill疼痛量表)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后McGill疼痛量表总分与治疗前相比明显减少,差异有显著统计学意义(P<0.01)；靳三针组患者治疗前后的McGill疼痛量表总分差异也明显减少；关节松动术组患者McGill疼痛量表总分与治疗前相比有所减少,差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,McGill疼痛量表总分评定方面,靳三针结合关节松动术组疼痛总分情况与靳三针、关节松动术组相比得分减少,三组经方差分析检验,差异有统计学意义(P<0.05)。提示：对于改善肩周炎患者疼痛分级指数、患病情感(软弱无力、厌烦、害怕等)、视觉模拟定级、现有疼痛强度等,三种疗法均有不同程度的疗效,可以减少肩周炎患者肩部疼痛评定(McGill疼痛量表)得分。但相比之下,以靳三针结合关节松动术疗法尤佳,尤其以改善肩周炎患者的PRI感觉分、视觉模拟定级评定(VAS)、PPI改善最为明显。
(二)肩功能运动功能评定(肩功能Constant—-Murley评定法)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后肩关节功能运动功能评定(肩功能Constant—Murley评定法)总分与治疗前相比明显改善,差异有显著统计学意义(P<0.01)；靳三针组患者治疗前后的肩关节功能Constant—Murl ey评定总分差异也有所提高；关节松动术组患者肩关节功能Constant—Murley评定总分与治疗前相比改善差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,肩关节功能运动功能评定(肩功能Constant—Murley评定法)总分评定方面,靳三针结合关节松动术组肩关节运动功能总分情况与靳三针、关节松动术组相比得分减少,三组经方差分析检验,差异有统计学意义(P<0.05)。提示：对于改善肩周炎患者肩关节功能活动方面,靳三针结合关节松动术可以较好地缓解局部疼痛症状,改善肩关节活动情况,增强肩关节前屈、后伸、外展、内收、上举、外旋等活动幅度,提高患者上肢肌力,有利于肩周炎患者日常生活活动能力的恢复。其两种联合疗法的协同作用比单一疗法更为明显。而关节松动术在改善肩周炎患者关节活动度方面具有较好优势,但整体肩关节功能活动不如靳三针结合关节松动术效果好。
(三)日常生活活动能力(ASES肩关节功能评价表)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后日常生活活动能力(ASES肩关节功能评价表)评分与治疗前相比有明显提高,治疗前后差异显著(P<0.01)；靳三针组患者治疗后的日常生活活动能力评分比治疗前也有改善,经配对样本t检验,有统计学意义(P<0.05)；关节松动术组患者日常生活活动能力与治疗前相比改善差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,日常生活活动能力(ASES肩关节功能评价表)评分方面,靳三针结合关节松动术组日常生活活动能力(ASES肩关节功能评价表)评分总分情况比关节松动术组相比得分明显提高,两组组间差异有统计学意义(P<0.05)。但与靳三针组相比差异不明显(P>0.05)。提示：对于改善肩周炎患者日常生活活动能力(ASES肩关节功能评价表)评分方面,靳三针结合关节松动术能明显改善肩周炎患者的日常生活能力,如穿衣、梳头、上厕所、举物等,从而有效地提高患者的生活质量。相比之下,靳三针组也有一定疗效,但关节松动术组的改善情况不甚明显,结合之前的研究,关节松动术对于肩周炎的关节活动度有较好的疗效,但是镇痛效果不如结合针灸疗效明显,可能在一定程度上影响了肩周炎患者的生活活动能力。
(四)肩关节活动功能比较
经过两个疗程的治疗后,靳三针结合关节松动术组肩关节前屈、外展、指耳间距、指椎间距比治疗前均有明显改善,差异有显著统计学意义(P<0.01)。治疗后靳三针结合关节松动术组肩周炎患者肩关节前屈、外展、指耳间距改善情况比靳三针组提高明显,差异有统计学意义(P<0.05)。靳三针结合关节松动术组与关节松动术组肩关节活动功能情况组间差异不明显(P<0.05)。
(五)中医证候疗效比较
靳三针结合关节松动术组、靳三针组及关节松动术组治疗后经秩和检验,H=4.28,P=0.065,三组中医证候疗效差异有统计学意义(P<0.05),其中,靳三针结合关节松动术组为临床痊愈18.8%,显效为43.7%,有效为25.0%,无效为12.5%,总有效率为87.5%；靳三针组临床痊愈为12.9%,显效为32.3%,有效为16.1%,无效为38.7%,总有效率为61.3%；关节松动术组临床痊愈为9.7%,显效为38.7%,有效为19.3%,无效为32.5%,总有效率为67.7%。提示：靳三针结合关节松动术组治疗肩周炎患者与靳三针组及关节松动术组相比较,对于改善患者的肩周炎患者中医临床症状、体征等方面效果较显著,临床疗效较佳。
(六)肩周炎临床疗效比较
靳三针结合关节松动术组、靳三针组及关节松动术组治疗后经秩和检验,H=11.34,P=0.021,三组肩周炎整体疗效差异有统计学意义(P<0.05),其中,靳三针结合关节松动术组治愈为18.8%,显效为46.9%,有效为25.0%,无效为9.4%,总有效率为90.6%；靳三针组临床痊愈为16.1%,显效为29.1%,有效为16.1%,无效为38.7%,总有效率为61.3%；关节松动术组临床痊愈为12.9%,显效为35.5%,有效为22.6%,无效为29.0%,总有效率为70.9%。提示：在改善肩周炎患者的临床疗效整体比较方面,靳三针结合关节松动术组与靳三针组、关节松动术组相比较,能明显缓解肩部疼痛症状,促进肩关节活动范围恢复正常,提高肩周炎患者的生活质量。
结论：
肩周炎是临床常见病、多发病,严重影响了患者的工作和生活。疼痛和活动障碍是肩周炎患者就诊的主要原因和生活质量的最大影响因素。如何更好地提高肩周炎患者的疗效,减轻其病痛,对我们传统医学是一个挑战。
本课题研究结果初步提示,靳三针结合关节松动术治疗肩周炎有良好的临床效果。此疗法可将针刺镇痛消炎、腧穴刺激和经络传导,与关节松动术促进肩关节功能恢复、松解粘连有机结合,通过改善血液循环、促进炎性物质转运和降解、缓解炎性水肿及改善组织营养障碍等起作用的。靳三针结合关节松动术方法简便、安全,具有中医特色,是一种安全、行之有效无毒副作用的疗法。
Objective
A randomized controlled research methods and evidence-based medical research principle, Jin three-needle group, joint mobilization group as a control group, Jin three needles combined with joint mobilization techniques in the treatment of periarthritis of clinical observation, to explore Jin three-needle and joint mobilization both the clinical efficacy of the therapy, therapeutic mechanism, the feasibility and the problems in order to make this system, objective and scientific evaluation of the efficacy, combination therapy for the disease to find an effective and reliable.
Methods
The patients were selected from Taiwan Yongtai clinic during November2011to February2013. A total of95patients meet the study criteria, the ratio of1:1:1randomly assigned to Jin three needles and joint mobilization group, Jin three-needle group, joint mobilization group, which Jin acupuncture combined with joint mobilization group32cases, Jin three-needle group of32cases, joint mobilization group31cases. Frozen shoulder periarthritis Western developed with reference to the Second National the frozen shoulder Symposium (1991· Hubei) diagnostic criteria; reference to the Chinese acupuncture clinical diagnostic and treatment practices in the shoulder paralysis diagnostic criteria in the diagnostic criteria. Jin three needles, joint mobilization surgery the next day treatment time,10times as a course of two courses. Efficacy endpoint was to simplify the McGill Pain Questionnaire, shoulder function Constant-Murley evaluation method, activities of daily living (ASES shoulder function evaluation form), shoulder flexion, outreach, ear spacing refers to the vertebral spacing. The TCM syndromes standard reference to the State Administration of Traditional Chinese disease diagnosis and efficacy standards "frozen shoulder TCM syndromes standard. Frozen shoulder the overall efficacy of the standard of Chinese medicine clinical research guiding principles (Ministry of Health issued in1997, the third series)"frozen shoulder" effect of the standard. SPSS17.0software for statistical analysis. Measurement data with the mean±standard deviation (x±s), count data used in forming the ratio (%).
Results
1The general information before treatment:This study included95cases, including42males,53females. Divided into Jin acupuncture combined with joint mobilization group, Jin three-needle group, joint mobilization group. Three groups of patients with periarthritis analysis and comparison of baseline factors of age, disease duration, gender, TCM typing, the difference was not statistically significant (P>0.05), indicating that the set of baseline conditions consistent, comparable.
2The comparison of curative efficacy
2.1The comparison of shoulder pain assessment (McGill Pain Questionnaire)
By statistical analysis, Jin three-pin binding joint surgery in patients with frozen shoulder loose McGill Pain treatment significantly reduced compared to the total score and treatment, the difference was statistically significant (P<0.01); Jin-pin patientsMcGill pain Questionnaire total score difference of before and after treatment also significantly reduced; joint mobilization surgery patients McGill Pain decreased compared to the total score before treatment, the difference was statistically significant (P<0.05). Between the two groups, after two courses of treatment, McGill pain total score assessment, Jin three-needle combination of joint mobilization surgery pain out of Jin-pin, joint mobilization group score be reduced compared to the three groups by analysis of variance, the difference was statistically significant (P<0.05). Tip:improving the patients with frozen shoulder pain rating index, the prevalence of emotional (weak, tired, fear, etc.), visual analog grading existing pain intensity, three therapies varying degrees of efficacy, can reduce shoulder Zhou Yan patients with shoulder pain assessment score (McGill pain Questionnaire). But in comparison、Jin three-pin and joint mobilization therapy is preferred, especially to improve the PRI of patients with frozen shoulder feel points, visual analog grading assessment (VAS), PPI improve the most obvious.
2.2The comparison of shoulder function motor function assessment (shoulder function Constant-Murley assessment method)
The statistical analysis, Jin three-pin binding joint loose surgery in patients with frozen shoulder treatment shoulder function motor function assessment (shoulder function Constant-Murley evaluation method) Total before treatment significantly improved, the difference was statistically significant (P<0.01); Jin needle group of patients before and after treatment of shoulder function Constant-Murley assessment score difference also increased; joint mobilization surgery shoulder function in patients with Constant-Murley rating score before treatment compared improve differencestatistically significant (P<0.05). Between the two groups, after two courses of treatment, the function of the shoulder motor function assessment (shoulder function Constant-Murley evaluation method) and branch assessment, Jin pin in conjunction with joint mobilization surgery group shoulder motor function score Jin pin, joint mobilization group compared to score to reduce the three groups by analysis of variance test, the difference was statistically significant (P<0.05). Tip:improve frozen shoulder shoulder function in patients with activities Jin three-pin combined with joint mobilization can be used to relieve local pain and improve shoulder mobility, enhanced shoulder flexion, extension, abduction, adduction, on the move, external rotation range of activities to improve the patient's upper limbs, is conducive to the recovery of activities of daily living in patients with frozen shoulder. Of two synergistic effect of the combination therapy was significantly more than monotherapy. Joint mobilization to improve the patients with frozen shoulder range of motion has a good advantage, but the overall function of the shoulder as Jin effect of acupuncture combined with joint mobilization activities.
2.3The comparison of activities of daily living (ASES shoulder function evaluation form)
Jin acupuncture combined with statistical analysis, joint mobilization after surgery in patients with frozen shoulder treatment activities of daily living (ASES shoulder function evaluation form) score significantly improved compared with before treatment, after treatment difference was significant (P<0.01); activities of daily living score Jin pin patients after treatment than before treatment also improved by paired samples t-test was statistically significant (P<0.05); joint mobilization surgery group of patients with activities of daily living before treatment compared toimprove the difference was statistically significant (P<0.05). Between the two groups, after two courses of treatment, activities of daily living (ASES shoulder function evaluation form) score, Jin three-pin combination of joint mobilization surgery group activities of daily living (ASES shoulder function evaluation form) total score than joint mobilization group score significantly improved compared to the difference between the two groups was statistically significant (P<0.05). Jin three-needle group was not significantly different (P>0.05). Tip:For improving frozen shoulder patients with activities of daily living (ASES shoulder function evaluation form) score, Jin three-pin binding joint mobilization techniques can significantly improve frozen shoulder patients with activities of daily living such as dressing, hair on the toilet, lifting, etc., thereby effectively improving the quality of life of patients. In contrast, Jin three-needle group also have some effect, but the improvement was not significant joint mobilization group, combined with previous studies, joint mobilization for frozen shoulder range of motion has a good effect, but the analgesic as effective as combined efficacy of acupuncture may to a certain extent affected the living ability of patients with frozen shoulder.
2.4The comparison of shoulder joint function
After two courses of treatment, Jin three-pin combination loose joint surgery of shoulder flexion, abduction, refers to the ear spacing vertebral spacing than before treatment showed significant improvement, the difference was statistically significant (P<0.01). Jin three-pin combination treatment loose joint surgery group patients with frozen shoulder shoulder flexion, abduction, ear spacing to improve the situation Jin three-pin group improved significantly, and the difference was statistically significant (P<0.05). Jin acupuncture combined with loose joint mobilization group and joint surgery of shoulder joint functional situation between the two groups was not significantly different (P>0.05).
2.5The comparison of TCM syndrome
Jin acupuncture combined with joint mobilization group, Jin three-needle group and joint mobilization group after treatment, the rank-sum test, H=4.28, P=0.065the three groups TCM syndromes difference was statistically significant (P<0.05), Jin acupuncture combined with joint mobilization group for clinical recovery of18.8%, markedly by43.7%,25.0%effective, ineffective12.5%, total effective rate was87.5%; Jin three-pin clinical cure was12.9%, effective32.3%effective for16.1%,38.7%invalid, the total effective rate was61.3%; joint mobilization surgery clinical cure was9.7%, markedly to38.7%,19.3%effective, ineffective for32.5%, total effective rate was67.7%. Tip:Jin acupuncture combined with joint mobilization treatment of patients with frozen shoulder surgery group Jin three-needle group and joint mobilization group compared improve the performance of patients with frozen shoulder methods in patients with clinical symptoms, signs, etc. more significant clinical effect than good.
2.6The comparison of clinical efficacy of frozen shoulder
Jin acupuncture combined with joint mobilization group, Jin three-needle group and joint mobilization treatment after rank-sum test, H=11.34, P=0.021, the three groups frozen shoulder the overall efficacy difference was statistically significant (P<0.05), where Jin acupuncture combined with joint mobilization group were cured,18.8%, effective in46.9%,25.0%effective, ineffective to9.4%, the total effective rate was90.6%; Jin three-needle group clinical recovery was16.1%, markedly29.1%effective for16.1%,38.7%invalid, the total effective rate was61.3%; the joint mobilization clinical recovery was12.9%, markedly to35.5%,22.6%effective for invalid for29.0%, total effective rate was70.9%. Tip:to improve the clinical efficacy of the overall comparison of patients with frozen shoulder, Jin three-pin combination of joint mobilization group and Jin three-needle group, can relieve symptoms of shoulder pain, joint mobilization group compared to promote the recovery of shoulder mobility range normal, to improve the quality of life of patients with frozen shoulder.
Conclusion
Frozen shoulder is a common disease, frequently-occurring disease, a serious impact on the work and life of the patient. Pain and movement disorder is the main reason for treatment and quality of life in patients with frozen shoulder most influential factor in. How to better improve the efficacy in patients with frozen shoulder, to alleviate their pain, is a challenge to our traditional medicine.
The results of this research are initially prompted Jin acupuncture combined with joint mobilization treatment of frozen shoulder with good clinical results. This therapy can be the acupuncture analgesic anti-inflammatory, stimulation of acupoints and meridians conduction, and joint mobilization to promote recovery of shoulder function, the organic integration of the lysis of adhesions, improve blood circulation, promote the transport and degradation of inflammatory substances, relieve inflammatory edema and improve tissue nutrition disorders play a role. Jin acupuncture combined with joint mobilization surgery method is simple, safe, and with Chinese characteristics, is a safe and effective non-toxic side effects of therapy.
采用随机对照的研究方法和循证医学研究的原则,以靳三针组、关节松动术组作为对照组,通过靳三针结合关节松动术治疗肩关节周围炎的临床观察,探讨靳三针、关节松动术这两种疗法的临床疗效、治疗机理、可行性及其存在的问题,以期对此作出系统、客观、科学的疗效评价,为该病寻找一种疗效可靠的综合疗法。
研究方法：
病例来源于2011年11月至2013年2月台湾永泰中医诊所病人,共收集符合本研究标准的患者95例,按1：1：1的比例随机分配至靳三针结合关节松动术组、靳三针组、关节松动术组,其中靳三针结合关节松动术组32例,靳三针组为32例,关节松动术组为31例。肩周炎西医参照全国第二届肩周炎学术讨论会(1991·湖北)制定的肩关节周围炎诊断标准；中诊断标准参照《中华针灸临床诊疗规范》中的“肩痹”诊断标准。靳三针、关节松动术隔天治疗一次,10次为1疗程,共2个疗程。疗效指标为简化McGill疼痛量表、肩功能Constant—Murley评定法、日常生活活动能力(ASES肩关节功能评价表)、肩关节前屈、外展、指耳间距、指椎间距。中医证候疗效标准参照国家中医药管理局《中医病症诊断与疗效标准》之肩周炎中医证候疗效标准。肩周炎整体疗效标准根据《中药新药临床研究指导原则》(卫生部制定发行,1997年第三辑)有关“肩周炎”的疗效标准。用SPSS17.0软件进行统计分析。计量资料用均数±标准差(x±S)表示,计数资料用构成比(%)表示。
结果：
一、治疗前一般资料比较：本研究共纳入95例,其中男性42例,女性53例。分为靳三针结合关节松动术组、靳三针组、关节松动术组。三组肩关节周围炎患者在年龄、病程、性别、中医辨证分型等基线因素分析比较,差异均无统计学意义(P>0.05),表明组间基线条件一致,具有可比性。
二、疗效比较
(一)肩部疼痛评定(McGill疼痛量表)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后McGill疼痛量表总分与治疗前相比明显减少,差异有显著统计学意义(P<0.01)；靳三针组患者治疗前后的McGill疼痛量表总分差异也明显减少；关节松动术组患者McGill疼痛量表总分与治疗前相比有所减少,差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,McGill疼痛量表总分评定方面,靳三针结合关节松动术组疼痛总分情况与靳三针、关节松动术组相比得分减少,三组经方差分析检验,差异有统计学意义(P<0.05)。提示：对于改善肩周炎患者疼痛分级指数、患病情感(软弱无力、厌烦、害怕等)、视觉模拟定级、现有疼痛强度等,三种疗法均有不同程度的疗效,可以减少肩周炎患者肩部疼痛评定(McGill疼痛量表)得分。但相比之下,以靳三针结合关节松动术疗法尤佳,尤其以改善肩周炎患者的PRI感觉分、视觉模拟定级评定(VAS)、PPI改善最为明显。
(二)肩功能运动功能评定(肩功能Constant—-Murley评定法)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后肩关节功能运动功能评定(肩功能Constant—Murley评定法)总分与治疗前相比明显改善,差异有显著统计学意义(P<0.01)；靳三针组患者治疗前后的肩关节功能Constant—Murl ey评定总分差异也有所提高；关节松动术组患者肩关节功能Constant—Murley评定总分与治疗前相比改善差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,肩关节功能运动功能评定(肩功能Constant—Murley评定法)总分评定方面,靳三针结合关节松动术组肩关节运动功能总分情况与靳三针、关节松动术组相比得分减少,三组经方差分析检验,差异有统计学意义(P<0.05)。提示：对于改善肩周炎患者肩关节功能活动方面,靳三针结合关节松动术可以较好地缓解局部疼痛症状,改善肩关节活动情况,增强肩关节前屈、后伸、外展、内收、上举、外旋等活动幅度,提高患者上肢肌力,有利于肩周炎患者日常生活活动能力的恢复。其两种联合疗法的协同作用比单一疗法更为明显。而关节松动术在改善肩周炎患者关节活动度方面具有较好优势,但整体肩关节功能活动不如靳三针结合关节松动术效果好。
(三)日常生活活动能力(ASES肩关节功能评价表)比较
经统计学分析,靳三针结合关节松动术组肩周炎患者治疗后日常生活活动能力(ASES肩关节功能评价表)评分与治疗前相比有明显提高,治疗前后差异显著(P<0.01)；靳三针组患者治疗后的日常生活活动能力评分比治疗前也有改善,经配对样本t检验,有统计学意义(P<0.05)；关节松动术组患者日常生活活动能力与治疗前相比改善差异有统计学意义(P<0.05)。组间比较方面,经过两个疗程的治疗,日常生活活动能力(ASES肩关节功能评价表)评分方面,靳三针结合关节松动术组日常生活活动能力(ASES肩关节功能评价表)评分总分情况比关节松动术组相比得分明显提高,两组组间差异有统计学意义(P<0.05)。但与靳三针组相比差异不明显(P>0.05)。提示：对于改善肩周炎患者日常生活活动能力(ASES肩关节功能评价表)评分方面,靳三针结合关节松动术能明显改善肩周炎患者的日常生活能力,如穿衣、梳头、上厕所、举物等,从而有效地提高患者的生活质量。相比之下,靳三针组也有一定疗效,但关节松动术组的改善情况不甚明显,结合之前的研究,关节松动术对于肩周炎的关节活动度有较好的疗效,但是镇痛效果不如结合针灸疗效明显,可能在一定程度上影响了肩周炎患者的生活活动能力。
(四)肩关节活动功能比较
经过两个疗程的治疗后,靳三针结合关节松动术组肩关节前屈、外展、指耳间距、指椎间距比治疗前均有明显改善,差异有显著统计学意义(P<0.01)。治疗后靳三针结合关节松动术组肩周炎患者肩关节前屈、外展、指耳间距改善情况比靳三针组提高明显,差异有统计学意义(P<0.05)。靳三针结合关节松动术组与关节松动术组肩关节活动功能情况组间差异不明显(P<0.05)。
(五)中医证候疗效比较
靳三针结合关节松动术组、靳三针组及关节松动术组治疗后经秩和检验,H=4.28,P=0.065,三组中医证候疗效差异有统计学意义(P<0.05),其中,靳三针结合关节松动术组为临床痊愈18.8%,显效为43.7%,有效为25.0%,无效为12.5%,总有效率为87.5%；靳三针组临床痊愈为12.9%,显效为32.3%,有效为16.1%,无效为38.7%,总有效率为61.3%；关节松动术组临床痊愈为9.7%,显效为38.7%,有效为19.3%,无效为32.5%,总有效率为67.7%。提示：靳三针结合关节松动术组治疗肩周炎患者与靳三针组及关节松动术组相比较,对于改善患者的肩周炎患者中医临床症状、体征等方面效果较显著,临床疗效较佳。
(六)肩周炎临床疗效比较
靳三针结合关节松动术组、靳三针组及关节松动术组治疗后经秩和检验,H=11.34,P=0.021,三组肩周炎整体疗效差异有统计学意义(P<0.05),其中,靳三针结合关节松动术组治愈为18.8%,显效为46.9%,有效为25.0%,无效为9.4%,总有效率为90.6%；靳三针组临床痊愈为16.1%,显效为29.1%,有效为16.1%,无效为38.7%,总有效率为61.3%；关节松动术组临床痊愈为12.9%,显效为35.5%,有效为22.6%,无效为29.0%,总有效率为70.9%。提示：在改善肩周炎患者的临床疗效整体比较方面,靳三针结合关节松动术组与靳三针组、关节松动术组相比较,能明显缓解肩部疼痛症状,促进肩关节活动范围恢复正常,提高肩周炎患者的生活质量。
结论：
肩周炎是临床常见病、多发病,严重影响了患者的工作和生活。疼痛和活动障碍是肩周炎患者就诊的主要原因和生活质量的最大影响因素。如何更好地提高肩周炎患者的疗效,减轻其病痛,对我们传统医学是一个挑战。
本课题研究结果初步提示,靳三针结合关节松动术治疗肩周炎有良好的临床效果。此疗法可将针刺镇痛消炎、腧穴刺激和经络传导,与关节松动术促进肩关节功能恢复、松解粘连有机结合,通过改善血液循环、促进炎性物质转运和降解、缓解炎性水肿及改善组织营养障碍等起作用的。靳三针结合关节松动术方法简便、安全,具有中医特色,是一种安全、行之有效无毒副作用的疗法。
Objective
A randomized controlled research methods and evidence-based medical research principle, Jin three-needle group, joint mobilization group as a control group, Jin three needles combined with joint mobilization techniques in the treatment of periarthritis of clinical observation, to explore Jin three-needle and joint mobilization both the clinical efficacy of the therapy, therapeutic mechanism, the feasibility and the problems in order to make this system, objective and scientific evaluation of the efficacy, combination therapy for the disease to find an effective and reliable.
Methods
The patients were selected from Taiwan Yongtai clinic during November2011to February2013. A total of95patients meet the study criteria, the ratio of1:1:1randomly assigned to Jin three needles and joint mobilization group, Jin three-needle group, joint mobilization group, which Jin acupuncture combined with joint mobilization group32cases, Jin three-needle group of32cases, joint mobilization group31cases. Frozen shoulder periarthritis Western developed with reference to the Second National the frozen shoulder Symposium (1991· Hubei) diagnostic criteria; reference to the Chinese acupuncture clinical diagnostic and treatment practices in the shoulder paralysis diagnostic criteria in the diagnostic criteria. Jin three needles, joint mobilization surgery the next day treatment time,10times as a course of two courses. Efficacy endpoint was to simplify the McGill Pain Questionnaire, shoulder function Constant-Murley evaluation method, activities of daily living (ASES shoulder function evaluation form), shoulder flexion, outreach, ear spacing refers to the vertebral spacing. The TCM syndromes standard reference to the State Administration of Traditional Chinese disease diagnosis and efficacy standards "frozen shoulder TCM syndromes standard. Frozen shoulder the overall efficacy of the standard of Chinese medicine clinical research guiding principles (Ministry of Health issued in1997, the third series)"frozen shoulder" effect of the standard. SPSS17.0software for statistical analysis. Measurement data with the mean±standard deviation (x±s), count data used in forming the ratio (%).
Results
1The general information before treatment:This study included95cases, including42males,53females. Divided into Jin acupuncture combined with joint mobilization group, Jin three-needle group, joint mobilization group. Three groups of patients with periarthritis analysis and comparison of baseline factors of age, disease duration, gender, TCM typing, the difference was not statistically significant (P>0.05), indicating that the set of baseline conditions consistent, comparable.
2The comparison of curative efficacy
2.1The comparison of shoulder pain assessment (McGill Pain Questionnaire)
By statistical analysis, Jin three-pin binding joint surgery in patients with frozen shoulder loose McGill Pain treatment significantly reduced compared to the total score and treatment, the difference was statistically significant (P<0.01); Jin-pin patientsMcGill pain Questionnaire total score difference of before and after treatment also significantly reduced; joint mobilization surgery patients McGill Pain decreased compared to the total score before treatment, the difference was statistically significant (P<0.05). Between the two groups, after two courses of treatment, McGill pain total score assessment, Jin three-needle combination of joint mobilization surgery pain out of Jin-pin, joint mobilization group score be reduced compared to the three groups by analysis of variance, the difference was statistically significant (P<0.05). Tip:improving the patients with frozen shoulder pain rating index, the prevalence of emotional (weak, tired, fear, etc.), visual analog grading existing pain intensity, three therapies varying degrees of efficacy, can reduce shoulder Zhou Yan patients with shoulder pain assessment score (McGill pain Questionnaire). But in comparison、Jin three-pin and joint mobilization therapy is preferred, especially to improve the PRI of patients with frozen shoulder feel points, visual analog grading assessment (VAS), PPI improve the most obvious.
2.2The comparison of shoulder function motor function assessment (shoulder function Constant-Murley assessment method)
The statistical analysis, Jin three-pin binding joint loose surgery in patients with frozen shoulder treatment shoulder function motor function assessment (shoulder function Constant-Murley evaluation method) Total before treatment significantly improved, the difference was statistically significant (P<0.01); Jin needle group of patients before and after treatment of shoulder function Constant-Murley assessment score difference also increased; joint mobilization surgery shoulder function in patients with Constant-Murley rating score before treatment compared improve differencestatistically significant (P<0.05). Between the two groups, after two courses of treatment, the function of the shoulder motor function assessment (shoulder function Constant-Murley evaluation method) and branch assessment, Jin pin in conjunction with joint mobilization surgery group shoulder motor function score Jin pin, joint mobilization group compared to score to reduce the three groups by analysis of variance test, the difference was statistically significant (P<0.05). Tip:improve frozen shoulder shoulder function in patients with activities Jin three-pin combined with joint mobilization can be used to relieve local pain and improve shoulder mobility, enhanced shoulder flexion, extension, abduction, adduction, on the move, external rotation range of activities to improve the patient's upper limbs, is conducive to the recovery of activities of daily living in patients with frozen shoulder. Of two synergistic effect of the combination therapy was significantly more than monotherapy. Joint mobilization to improve the patients with frozen shoulder range of motion has a good advantage, but the overall function of the shoulder as Jin effect of acupuncture combined with joint mobilization activities.
2.3The comparison of activities of daily living (ASES shoulder function evaluation form)
Jin acupuncture combined with statistical analysis, joint mobilization after surgery in patients with frozen shoulder treatment activities of daily living (ASES shoulder function evaluation form) score significantly improved compared with before treatment, after treatment difference was significant (P<0.01); activities of daily living score Jin pin patients after treatment than before treatment also improved by paired samples t-test was statistically significant (P<0.05); joint mobilization surgery group of patients with activities of daily living before treatment compared toimprove the difference was statistically significant (P<0.05). Between the two groups, after two courses of treatment, activities of daily living (ASES shoulder function evaluation form) score, Jin three-pin combination of joint mobilization surgery group activities of daily living (ASES shoulder function evaluation form) total score than joint mobilization group score significantly improved compared to the difference between the two groups was statistically significant (P<0.05). Jin three-needle group was not significantly different (P>0.05). Tip:For improving frozen shoulder patients with activities of daily living (ASES shoulder function evaluation form) score, Jin three-pin binding joint mobilization techniques can significantly improve frozen shoulder patients with activities of daily living such as dressing, hair on the toilet, lifting, etc., thereby effectively improving the quality of life of patients. In contrast, Jin three-needle group also have some effect, but the improvement was not significant joint mobilization group, combined with previous studies, joint mobilization for frozen shoulder range of motion has a good effect, but the analgesic as effective as combined efficacy of acupuncture may to a certain extent affected the living ability of patients with frozen shoulder.
2.4The comparison of shoulder joint function
After two courses of treatment, Jin three-pin combination loose joint surgery of shoulder flexion, abduction, refers to the ear spacing vertebral spacing than before treatment showed significant improvement, the difference was statistically significant (P<0.01). Jin three-pin combination treatment loose joint surgery group patients with frozen shoulder shoulder flexion, abduction, ear spacing to improve the situation Jin three-pin group improved significantly, and the difference was statistically significant (P<0.05). Jin acupuncture combined with loose joint mobilization group and joint surgery of shoulder joint functional situation between the two groups was not significantly different (P>0.05).
2.5The comparison of TCM syndrome
Jin acupuncture combined with joint mobilization group, Jin three-needle group and joint mobilization group after treatment, the rank-sum test, H=4.28, P=0.065the three groups TCM syndromes difference was statistically significant (P<0.05), Jin acupuncture combined with joint mobilization group for clinical recovery of18.8%, markedly by43.7%,25.0%effective, ineffective12.5%, total effective rate was87.5%; Jin three-pin clinical cure was12.9%, effective32.3%effective for16.1%,38.7%invalid, the total effective rate was61.3%; joint mobilization surgery clinical cure was9.7%, markedly to38.7%,19.3%effective, ineffective for32.5%, total effective rate was67.7%. Tip:Jin acupuncture combined with joint mobilization treatment of patients with frozen shoulder surgery group Jin three-needle group and joint mobilization group compared improve the performance of patients with frozen shoulder methods in patients with clinical symptoms, signs, etc. more significant clinical effect than good.
2.6The comparison of clinical efficacy of frozen shoulder
Jin acupuncture combined with joint mobilization group, Jin three-needle group and joint mobilization treatment after rank-sum test, H=11.34, P=0.021, the three groups frozen shoulder the overall efficacy difference was statistically significant (P<0.05), where Jin acupuncture combined with joint mobilization group were cured,18.8%, effective in46.9%,25.0%effective, ineffective to9.4%, the total effective rate was90.6%; Jin three-needle group clinical recovery was16.1%, markedly29.1%effective for16.1%,38.7%invalid, the total effective rate was61.3%; the joint mobilization clinical recovery was12.9%, markedly to35.5%,22.6%effective for invalid for29.0%, total effective rate was70.9%. Tip:to improve the clinical efficacy of the overall comparison of patients with frozen shoulder, Jin three-pin combination of joint mobilization group and Jin three-needle group, can relieve symptoms of shoulder pain, joint mobilization group compared to promote the recovery of shoulder mobility range normal, to improve the quality of life of patients with frozen shoulder.
Conclusion
Frozen shoulder is a common disease, frequently-occurring disease, a serious impact on the work and life of the patient. Pain and movement disorder is the main reason for treatment and quality of life in patients with frozen shoulder most influential factor in. How to better improve the efficacy in patients with frozen shoulder, to alleviate their pain, is a challenge to our traditional medicine.
The results of this research are initially prompted Jin acupuncture combined with joint mobilization treatment of frozen shoulder with good clinical results. This therapy can be the acupuncture analgesic anti-inflammatory, stimulation of acupoints and meridians conduction, and joint mobilization to promote recovery of shoulder function, the organic integration of the lysis of adhesions, improve blood circulation, promote the transport and degradation of inflammatory substances, relieve inflammatory edema and improve tissue nutrition disorders play a role. Jin acupuncture combined with joint mobilization surgery method is simple, safe, and with Chinese characteristics, is a safe and effective non-toxic side effects of therapy.
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