温针配合推拿治疗急性期肩周炎临床
摘要
研究目的：
本课题采用电脑随机分配软件,将病人随机分配成温针组、推拿组、温针与推拿合用组。通过观察温针,推拿,温针结合推拿治疗肩周炎的临床结局及对其结果的的分析,来探讨温针和(或)推拿治疗肩周炎的临床疗效,优化温针、推拿及两者同时治疗肩周炎的疗效,提高肩周炎患者生活质量,为温针、推拿在肩周炎的治疗方面提供实践依据。如能证明该法能够有效治疗肩周炎,则既节省了时间,又减轻了病人的负担,具有一定的卫生经济学效益及应用价值。
研究方法：
1.病例来源
本研究共收集患者80例,采集时间为2012年1月至2013年3月。所有病例均为台湾大同中医诊所门诊肩周炎患者。
2.诊断标准
本研究采用国家中医药管理局1994年发布的《中医病证诊断疗效标准》中“肩周炎”的诊断标准,同时制定严格的纳入、排除、剔除、脱落标准。
3.分期标准
参考范振华主编《骨科康复医学》对肩周炎的分期标准.
4.分组方法
随机分组法：根据上述诊断标准、纳入标准和排除标准,确定合格受试者后,采用电脑随机分配软件,将病人就诊的顺序1-80号随机分配到温针组,推拿组,温针配合推拿治疗组。
5.治疗方法
5.1温针治疗：
根据肩部压痛部位,采取局部取穴与循经取穴相结合的方法。取患侧肩髑、肩髂、肩前、肩贞、阿是穴、条口、阳陵泉；随证配穴：上臂痛加臂孺、曲池,肩胛痛加曲垣、天宗。患者取健侧卧位,医师用2寸毫针待局部皮肤常规消毒后对准穴位直刺,针刺得气后施以泻法,留针,取肩部3-4穴位,将艾条(长度以1～1.5cm为宜)套在针柄上,艾条下端距皮肤4cm左右。从其上端点燃,待其烧尽自灭除去灰烬后将针取出。为防止表皮意外烫伤,可用中间有圆孔的硬纸板穿过针柄放在皮肤上。每日针灸1次,留针30min。治疗10次为1个疗程,中间间隔2-3d后开始第2疗程。
5.2推拿治疗
顺次行以下手法：①揉捏法：患者端坐,双手下垂,自然放松,宽衣露出患肩。术者站在患者患侧,用掌心或指腹贴于患者肩部的皮肤上,轻轻揉动3-5min。再用拇指点按肩髂、肩髑、天宗、肩井等穴各lmin。随后用拇、食、中三指对握三角肌束和肩部痛筋进行捏法,以解除肩部的胀麻和疼痛。②展筋旋转法：术者一手掌按压患肩,另一手握患肢作缓慢的反复外展牵拉、后伸、内旋、内收等上举动作。然后术者站于患者前面,一手按压患肩,一手托住患肢肘部,将患肢作耸肩动作5次。接着抬患臂至与肩齐平,作肩关节旋转活动。③抖动法：术者站于患者患侧,两手掌紧握患者鱼际,使其患肢处于外展姿势,然后轻轻抖动患肢1min左右。1次/d,10d为1疗程,中间间隔2-3d后,开始第2疗程。
5.3温针结合推拿治疗
温针配合推拿治疗组在温针治疗后按推拿方法进行推拿治疗。
6.治疗疗程
温针、推拿及两者结合治疗,完成2个疗程后随访,随访时间为治疗后1周。
7.疗效评价指标
两组分别在筛选期治疗前、每次治疗后及随访期对各项疗效指标进行观察,疗效评价包括局部症状病情程度评定、疼痛视觉模拟评分法(VAS)、疼痛时间及性质和Constant Murley肩关节评分。
研究结果：
最终全部完成研究者70例,其中温针治疗组22例,推拿组27例,温针结合推拿组21例。患者年龄为43-62岁,平均发病期1.3个月。三组患者的资料在性别、年龄、病程、局部症状病情程度评定、疼痛时间和性质经统计学检验,无显著性差异(P>0.05),基线具有可比性。三组于治疗前后局部症状病情程度评定,VAS评分,疼痛时间、性质评分结果,Constant Murley肩关节评分比较,国家标准疗效评定比较均有显著性差异(p<0.05),提示温针、推拿及两者结合治疗均对急性期肩周炎患者有很好的治疗作用。三组之间治疗效果比较,疼痛视觉模拟评分法(VAS)结果提示随治疗次数增加,温针结合推拿治疗组的止痛效果优于单纯的温针或者推拿。随访期三组之间比较有显著性差异。疼痛时间、性质评分在随访期结果显示温针结合推拿的治疗效果优于两者单独治疗组。但Constant Murley肩关节评分随访期结果显示温针结合推拿及温针的效果(P>0.05)优于单纯的推拿治疗(P<0.05)。国家标准疗效评定在随访期的结果认为三者在这方面的疗效相当。
结论：
(1)温针、推拿及温针结合推拿治疗肩周炎,均能改善肩周炎的局部症状,减轻疼痛,改善活动能力、增加关节活动度和肌力,而且容易实施,安全可靠。
(2)温针结合推拿比温针、推拿单独应用在疗程结束后能更有效减少肩关节疼痛,提高治愈率。建议临床上治疗肩周炎时,医者可于治疗后期应用温针配合推拿治疗,用以提高治愈率和减低患者的疼痛。
Objective
Computer-generated random allocation software were used to assign the patients into three groups:warm needling group, massage group, and the warm needle and massage combined group. Base on the clinical result to explore the warm needle (or) Massage for Treating frozen shoulder and to optimize the warm needle, massage and the two together efficacy of the treatment of frozen shoulder, quality of life of frozen shoulder patients. Propose to prove that which can be an effective treatment of frozen shoulder, once got it, time will save, and reduce the burden on the patients, that means a big effectiveness and value of health economics.
METHODS
1. Subjects source
In this study,80patients were collected from January2012to March2013from Taiwan DA-TONG Chinese medicine clinic
2. Diagnosis stander
The diagnosis standard of frozen shoulder was selected to the State Administration of Traditional Chinese Medicine in1994"TCM Syndrome Diagnostic efficacy of the standard" in the frozen shoulder diagnostic criteria formulated strict inclusion, exclusion and removed off.
3. Randomization and treatment method
Reference the Orthopaedic Rehabilitation Medicine "frozen shoulder staging criteria" edited by Fan Zhenhua.
4. Groups
Randomized method:According to the diagnostic criteria, inclusion criteria and exclusion criteria to determine eligible subjects, using computer-generated random allocation software, the patient in the order of1to80, were randomly assigned to warm needle group, the massage group, and the moxa needle combined with massage therapy group.
5. Treatment
5.1Moxa acupuncture: According to the point that press hurt in the shoulder, depend on local acupoints and acupoints along meridians. Take ipsilateral shoulder skull, shoulder iliac, shoulder, A shi xue, Tiao kou; Yangling quan; Distribution Points according the symptom:With the card on the arm pain plus arm Ru Qu pool and the scapular pain plus Qu Yuan, Tian zong. Alignment points after patients take the contralateral decubitus physician with a2-inch needle to be routine disinfection of local skin piercing, acupuncture gas impose reducing method, needle retention, take the shoulder3-4acupuncture points, moxa (length2.5-3cm appropriate) sets the needle handle on the lower end of the moxa from the skin about4cm. Allowed to burn out self-destruction, lit from the upper end, remove the ashes after the needle removed. To prevent epidermal accidental burns that can be used the cardboard round hole in the middle through the needle handle on the skin. Daily acupuncture needle retention30min. Treatment of10times for a course, the middle interval2-3d after the second course.
5.2Massage therapy:
Steps:①kneading method:the patient is sitting, hands drooping naturally relax, take off their clothes to expose the suffering shoulder. The surgeon stood ipsilateral affixed to the skin of the patient's shoulder with the palm or pulp, gently knead3-5min. Then thumb point shoulder iliac shoulder skull, day cases, shoulder well points1min. Then, with the thumb, index middle, three fingers pinch method to relieve grip the deltoid beam and shoulder pain tendon the shoulder swelling numbness and pain.②The Show tendons rotation method:a hand surgeon pressed suffering from shoulder, the other hand limb traction slowly repeated outreach, extension, internal rotation, adduction, etc. on the move to make. The surgeon then stood in front of the patient, one hand pressed suffering from shoulder, hand and lift the limb elbow limb for the shrug action five times. Then lift the affected arm to flush with the shoulder for shoulder joint rotation.③The jitter method:patients who stand in the ipsilateral and two the palms clasped patients thenar, its limbs in outreach posture, then gently shake the limb1min.1times/d,10d courses of treatment, the middle of the interval after the2-3d to start the second course.
5.3Moxa acupuncture combined with massage
Moxa Acupuncture first and then follow the massage therapy group.
6. Treatment regimens
After treated by Moxa Acupuncture, massage or combination therapy, a research will be going on follow-up period of1week after treatment.
7. Result Assessment
Evaluation of the severity of local symptoms, pain visual analog scale (VAS), pain time and nature, and Constant Murley shoulder joint score will be studied before middle or after treatment.
The results
There were70subjects completed the research including moxa acupuncture group (22cases), massage therapy group27cases, moxa acupuncture combined with massage therapy group21cases. The age range of Patients is43-62years old, the mean onset period is1.3months. There was no statically significant difference between the three groups at baseline in terms of gender, age, onset time, local severity, pain duration and nature, VAS and Constant Murley shoulder score. Local severity was improved after each treatment session and a follow visit after the course completed for both group(p<0.05). There was no statically significant difference between the treatment group and the control group from the baseline to the end of treatment and the followvisit(p>0.05). This indicates the therapeutic effect of three groups is fairy equal. VAS scores of the three groups before and after treatment showed significant improvement, compared with before treatment there were very significant differences (P<0.01); follow-up period VAS between the three groups have a significant difference (P<0.05), suggesting increased with the number of treatments, moxa analgesic effect of acupuncture combined with massage therapy group than pure moxa needle or massage. There were highly significant differences (P<0.01)between Three groups treatment after compared with before treatment; Compared among the3groups, the results had no significant difference (P>0.05) moxa needle, massage, and a combination of both treatment of frozen shoulder after a certain period of time, can effectively reduce the patient's pain duration, to reduce the burning sensation, the efficacy of the three groups in this respect quite. The follow-up period pain time, the nature of scoring showed moxa acupuncture combined with massage treatment is better than the two separate treatment groups. The Constant Murley shoulder score of the three groups before and after treatment showed significant improvement, but between the three groups showed no significant difference, moxa acupuncture, massage can effectively improve the patient's Constant Murley shoulder score (including degree of joint pain, level of activities of daily living, range of motion, and joint muscle strength), but the follow-up of results show that the combination of massage and moxibustion moxa needle needle effect better than a simple massage therapy. Three considerable efficacy in this regard. Each observation point, three groups in treatment efficacy evaluation in accordance with the evaluation country standard showed no significant difference, prompted the efficacy of the two groups is considerable.
Conelusion
(1) The methods of moxa acupuncture, massage and moax acupuncture combined with massage to treat frozen shoulder could improve the shoulder local symptoms, reduce pain, and improve mobility, increasing range of motion and muscle strength. They are easy to implement, and also safe and reliable.
(2) The date after the end of treatment indicated that the combination of massage and moxa acupuncture is better than moxa acupuncture or massage used alone to treat the frozen shoulder. For it can be more effective to reduce shoulder pain, improve the cure rate. That means it will be a better way in clinical treatment of frozen shoulder, especially in the later stage of the treatment moxa acupuncture and massage use together will improve the cure rate and reduce the patient's pain.
本课题采用电脑随机分配软件,将病人随机分配成温针组、推拿组、温针与推拿合用组。通过观察温针,推拿,温针结合推拿治疗肩周炎的临床结局及对其结果的的分析,来探讨温针和(或)推拿治疗肩周炎的临床疗效,优化温针、推拿及两者同时治疗肩周炎的疗效,提高肩周炎患者生活质量,为温针、推拿在肩周炎的治疗方面提供实践依据。如能证明该法能够有效治疗肩周炎,则既节省了时间,又减轻了病人的负担,具有一定的卫生经济学效益及应用价值。
研究方法：
1.病例来源
本研究共收集患者80例,采集时间为2012年1月至2013年3月。所有病例均为台湾大同中医诊所门诊肩周炎患者。
2.诊断标准
本研究采用国家中医药管理局1994年发布的《中医病证诊断疗效标准》中“肩周炎”的诊断标准,同时制定严格的纳入、排除、剔除、脱落标准。
3.分期标准
参考范振华主编《骨科康复医学》对肩周炎的分期标准.
4.分组方法
随机分组法：根据上述诊断标准、纳入标准和排除标准,确定合格受试者后,采用电脑随机分配软件,将病人就诊的顺序1-80号随机分配到温针组,推拿组,温针配合推拿治疗组。
5.治疗方法
5.1温针治疗：
根据肩部压痛部位,采取局部取穴与循经取穴相结合的方法。取患侧肩髑、肩髂、肩前、肩贞、阿是穴、条口、阳陵泉；随证配穴：上臂痛加臂孺、曲池,肩胛痛加曲垣、天宗。患者取健侧卧位,医师用2寸毫针待局部皮肤常规消毒后对准穴位直刺,针刺得气后施以泻法,留针,取肩部3-4穴位,将艾条(长度以1～1.5cm为宜)套在针柄上,艾条下端距皮肤4cm左右。从其上端点燃,待其烧尽自灭除去灰烬后将针取出。为防止表皮意外烫伤,可用中间有圆孔的硬纸板穿过针柄放在皮肤上。每日针灸1次,留针30min。治疗10次为1个疗程,中间间隔2-3d后开始第2疗程。
5.2推拿治疗
顺次行以下手法：①揉捏法：患者端坐,双手下垂,自然放松,宽衣露出患肩。术者站在患者患侧,用掌心或指腹贴于患者肩部的皮肤上,轻轻揉动3-5min。再用拇指点按肩髂、肩髑、天宗、肩井等穴各lmin。随后用拇、食、中三指对握三角肌束和肩部痛筋进行捏法,以解除肩部的胀麻和疼痛。②展筋旋转法：术者一手掌按压患肩,另一手握患肢作缓慢的反复外展牵拉、后伸、内旋、内收等上举动作。然后术者站于患者前面,一手按压患肩,一手托住患肢肘部,将患肢作耸肩动作5次。接着抬患臂至与肩齐平,作肩关节旋转活动。③抖动法：术者站于患者患侧,两手掌紧握患者鱼际,使其患肢处于外展姿势,然后轻轻抖动患肢1min左右。1次/d,10d为1疗程,中间间隔2-3d后,开始第2疗程。
5.3温针结合推拿治疗
温针配合推拿治疗组在温针治疗后按推拿方法进行推拿治疗。
6.治疗疗程
温针、推拿及两者结合治疗,完成2个疗程后随访,随访时间为治疗后1周。
7.疗效评价指标
两组分别在筛选期治疗前、每次治疗后及随访期对各项疗效指标进行观察,疗效评价包括局部症状病情程度评定、疼痛视觉模拟评分法(VAS)、疼痛时间及性质和Constant Murley肩关节评分。
研究结果：
最终全部完成研究者70例,其中温针治疗组22例,推拿组27例,温针结合推拿组21例。患者年龄为43-62岁,平均发病期1.3个月。三组患者的资料在性别、年龄、病程、局部症状病情程度评定、疼痛时间和性质经统计学检验,无显著性差异(P>0.05),基线具有可比性。三组于治疗前后局部症状病情程度评定,VAS评分,疼痛时间、性质评分结果,Constant Murley肩关节评分比较,国家标准疗效评定比较均有显著性差异(p<0.05),提示温针、推拿及两者结合治疗均对急性期肩周炎患者有很好的治疗作用。三组之间治疗效果比较,疼痛视觉模拟评分法(VAS)结果提示随治疗次数增加,温针结合推拿治疗组的止痛效果优于单纯的温针或者推拿。随访期三组之间比较有显著性差异。疼痛时间、性质评分在随访期结果显示温针结合推拿的治疗效果优于两者单独治疗组。但Constant Murley肩关节评分随访期结果显示温针结合推拿及温针的效果(P>0.05)优于单纯的推拿治疗(P<0.05)。国家标准疗效评定在随访期的结果认为三者在这方面的疗效相当。
结论：
(1)温针、推拿及温针结合推拿治疗肩周炎,均能改善肩周炎的局部症状,减轻疼痛,改善活动能力、增加关节活动度和肌力,而且容易实施,安全可靠。
(2)温针结合推拿比温针、推拿单独应用在疗程结束后能更有效减少肩关节疼痛,提高治愈率。建议临床上治疗肩周炎时,医者可于治疗后期应用温针配合推拿治疗,用以提高治愈率和减低患者的疼痛。
Objective
Computer-generated random allocation software were used to assign the patients into three groups:warm needling group, massage group, and the warm needle and massage combined group. Base on the clinical result to explore the warm needle (or) Massage for Treating frozen shoulder and to optimize the warm needle, massage and the two together efficacy of the treatment of frozen shoulder, quality of life of frozen shoulder patients. Propose to prove that which can be an effective treatment of frozen shoulder, once got it, time will save, and reduce the burden on the patients, that means a big effectiveness and value of health economics.
METHODS
1. Subjects source
In this study,80patients were collected from January2012to March2013from Taiwan DA-TONG Chinese medicine clinic
2. Diagnosis stander
The diagnosis standard of frozen shoulder was selected to the State Administration of Traditional Chinese Medicine in1994"TCM Syndrome Diagnostic efficacy of the standard" in the frozen shoulder diagnostic criteria formulated strict inclusion, exclusion and removed off.
3. Randomization and treatment method
Reference the Orthopaedic Rehabilitation Medicine "frozen shoulder staging criteria" edited by Fan Zhenhua.
4. Groups
Randomized method:According to the diagnostic criteria, inclusion criteria and exclusion criteria to determine eligible subjects, using computer-generated random allocation software, the patient in the order of1to80, were randomly assigned to warm needle group, the massage group, and the moxa needle combined with massage therapy group.
5. Treatment
5.1Moxa acupuncture: According to the point that press hurt in the shoulder, depend on local acupoints and acupoints along meridians. Take ipsilateral shoulder skull, shoulder iliac, shoulder, A shi xue, Tiao kou; Yangling quan; Distribution Points according the symptom:With the card on the arm pain plus arm Ru Qu pool and the scapular pain plus Qu Yuan, Tian zong. Alignment points after patients take the contralateral decubitus physician with a2-inch needle to be routine disinfection of local skin piercing, acupuncture gas impose reducing method, needle retention, take the shoulder3-4acupuncture points, moxa (length2.5-3cm appropriate) sets the needle handle on the lower end of the moxa from the skin about4cm. Allowed to burn out self-destruction, lit from the upper end, remove the ashes after the needle removed. To prevent epidermal accidental burns that can be used the cardboard round hole in the middle through the needle handle on the skin. Daily acupuncture needle retention30min. Treatment of10times for a course, the middle interval2-3d after the second course.
5.2Massage therapy:
Steps:①kneading method:the patient is sitting, hands drooping naturally relax, take off their clothes to expose the suffering shoulder. The surgeon stood ipsilateral affixed to the skin of the patient's shoulder with the palm or pulp, gently knead3-5min. Then thumb point shoulder iliac shoulder skull, day cases, shoulder well points1min. Then, with the thumb, index middle, three fingers pinch method to relieve grip the deltoid beam and shoulder pain tendon the shoulder swelling numbness and pain.②The Show tendons rotation method:a hand surgeon pressed suffering from shoulder, the other hand limb traction slowly repeated outreach, extension, internal rotation, adduction, etc. on the move to make. The surgeon then stood in front of the patient, one hand pressed suffering from shoulder, hand and lift the limb elbow limb for the shrug action five times. Then lift the affected arm to flush with the shoulder for shoulder joint rotation.③The jitter method:patients who stand in the ipsilateral and two the palms clasped patients thenar, its limbs in outreach posture, then gently shake the limb1min.1times/d,10d courses of treatment, the middle of the interval after the2-3d to start the second course.
5.3Moxa acupuncture combined with massage
Moxa Acupuncture first and then follow the massage therapy group.
6. Treatment regimens
After treated by Moxa Acupuncture, massage or combination therapy, a research will be going on follow-up period of1week after treatment.
7. Result Assessment
Evaluation of the severity of local symptoms, pain visual analog scale (VAS), pain time and nature, and Constant Murley shoulder joint score will be studied before middle or after treatment.
The results
There were70subjects completed the research including moxa acupuncture group (22cases), massage therapy group27cases, moxa acupuncture combined with massage therapy group21cases. The age range of Patients is43-62years old, the mean onset period is1.3months. There was no statically significant difference between the three groups at baseline in terms of gender, age, onset time, local severity, pain duration and nature, VAS and Constant Murley shoulder score. Local severity was improved after each treatment session and a follow visit after the course completed for both group(p<0.05). There was no statically significant difference between the treatment group and the control group from the baseline to the end of treatment and the followvisit(p>0.05). This indicates the therapeutic effect of three groups is fairy equal. VAS scores of the three groups before and after treatment showed significant improvement, compared with before treatment there were very significant differences (P<0.01); follow-up period VAS between the three groups have a significant difference (P<0.05), suggesting increased with the number of treatments, moxa analgesic effect of acupuncture combined with massage therapy group than pure moxa needle or massage. There were highly significant differences (P<0.01)between Three groups treatment after compared with before treatment; Compared among the3groups, the results had no significant difference (P>0.05) moxa needle, massage, and a combination of both treatment of frozen shoulder after a certain period of time, can effectively reduce the patient's pain duration, to reduce the burning sensation, the efficacy of the three groups in this respect quite. The follow-up period pain time, the nature of scoring showed moxa acupuncture combined with massage treatment is better than the two separate treatment groups. The Constant Murley shoulder score of the three groups before and after treatment showed significant improvement, but between the three groups showed no significant difference, moxa acupuncture, massage can effectively improve the patient's Constant Murley shoulder score (including degree of joint pain, level of activities of daily living, range of motion, and joint muscle strength), but the follow-up of results show that the combination of massage and moxibustion moxa needle needle effect better than a simple massage therapy. Three considerable efficacy in this regard. Each observation point, three groups in treatment efficacy evaluation in accordance with the evaluation country standard showed no significant difference, prompted the efficacy of the two groups is considerable.
Conelusion
(1) The methods of moxa acupuncture, massage and moax acupuncture combined with massage to treat frozen shoulder could improve the shoulder local symptoms, reduce pain, and improve mobility, increasing range of motion and muscle strength. They are easy to implement, and also safe and reliable.
(2) The date after the end of treatment indicated that the combination of massage and moxa acupuncture is better than moxa acupuncture or massage used alone to treat the frozen shoulder. For it can be more effective to reduce shoulder pain, improve the cure rate. That means it will be a better way in clinical treatment of frozen shoulder, especially in the later stage of the treatment moxa acupuncture and massage use together will improve the cure rate and reduce the patient's pain.
引文
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