基于肌骨超声技术循经远取动法结合扬刺治疗肱二头肌长头腱鞘炎
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摘要
目的观察采用肌骨超声技术评价循经远取动法结合扬刺法治疗肱二头肌长头腱鞘炎的临床疗效。方法78例符合纳入标准的患者随机分为治疗组(循经远取动法结合扬刺)和对照组(单纯扬刺法),采用VAS视觉模拟评分评价治疗前、治疗1次及治疗后患者肩关节疼痛程度变化,采用CMS肩关节评分评价治疗前、治疗1次及治疗后患者肩关节综合评分变化,采用肌骨超声技术评价治疗前、治疗后患者肩关节结节间沟处肱二头肌长头腱肌腱厚度、腱鞘厚度及积液情况的变化。结果治疗组和对照组均可显著改善肱二头肌长头腱鞘炎患者局部疼痛VAS评分及CMS评分,差异具有统计学意义(P<0.01);其中治疗组在治疗1次时VAS评分及CMS评分均较疗前有显著改善,差异具有统计学意义(P<0.05);治疗组和对照组均可明显减少患者肱二头肌长头肌腱厚度、腱鞘厚度及积液,与治疗前相比,差异具有统计学意义(P<0.05)。结论循经远取动法结合扬刺治疗肱二头肌长头腱鞘炎在快速改善疼痛及活动受限症状方面具有显著优势。
Objective To evaluate the clinical therapeutic effects on the long head biceps tenosynovitis by kinetic acupuncture on the distal points of the affected meridians with yang thorn therapy. Methods 78 patients who met the inclusion criteria were randomly divided into two groups: treatment group(combined with acupuncture along meridian and distal meridian) and control group(simple acupuncture). VAS visual analogue score was used to evaluate the pain degree of shoulder joint before treatment once and after treatment. CMS's shoulder score was used to evaluate the changes of shoulder joint comprehensive score before and after treatment, and the thickness of long head tendon of biceps brachii muscle was evaluated before and after treatment by the technique of musculoskeletal ultrasound, and the thickness of tendon of long head of biceps brachii muscle was evaluated before and after treatment. Changes of thickness of tendon sheath and accumulation of fluid. Results The VAS score and CMS score of local pain in patients with long head tenosynovitis of biceps brachii muscle were significantly improved in treatment group and control group(P < 0.01), and the VAS score and CMS score in treatment group were significantly improved compared with those before treatment. The difference was statistically significant(P < 0.05), the thickness of tendon, tendon sheath and hydrops of the biceps brachii longhead were significantly decreased in both the treatment group and the control group, and the difference was statistically significant compared with that before treatment(P < 0.05). Conclusion The treatment of long head tenosynovitis of biceps brachii with the method of meridian distal removal combined with acupuncture has a significant advantage in improving the symptoms of pain and limited movement.
Objective To evaluate the clinical therapeutic effects on the long head biceps tenosynovitis by kinetic acupuncture on the distal points of the affected meridians with yang thorn therapy. Methods 78 patients who met the inclusion criteria were randomly divided into two groups: treatment group(combined with acupuncture along meridian and distal meridian) and control group(simple acupuncture). VAS visual analogue score was used to evaluate the pain degree of shoulder joint before treatment once and after treatment. CMS's shoulder score was used to evaluate the changes of shoulder joint comprehensive score before and after treatment, and the thickness of long head tendon of biceps brachii muscle was evaluated before and after treatment by the technique of musculoskeletal ultrasound, and the thickness of tendon of long head of biceps brachii muscle was evaluated before and after treatment. Changes of thickness of tendon sheath and accumulation of fluid. Results The VAS score and CMS score of local pain in patients with long head tenosynovitis of biceps brachii muscle were significantly improved in treatment group and control group(P < 0.01), and the VAS score and CMS score in treatment group were significantly improved compared with those before treatment. The difference was statistically significant(P < 0.05), the thickness of tendon, tendon sheath and hydrops of the biceps brachii longhead were significantly decreased in both the treatment group and the control group, and the difference was statistically significant compared with that before treatment(P < 0.05). Conclusion The treatment of long head tenosynovitis of biceps brachii with the method of meridian distal removal combined with acupuncture has a significant advantage in improving the symptoms of pain and limited movement.
引文
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[11]宋毅勤.运用扬刺法治疗肱二头肌长头腱鞘炎[J].上海针灸杂志,1986(3):19-20.
[12]彭江华.扬刺电针法治疗桡肱关节滑囊炎56例临床观察[J].吉林中医药,2005,25(10):42-43.
[13]孙远征,刘铁镌,毛翔.循经远取动法治疗肩关节周围炎对照观察(英文)[J].世界针灸杂志(英文版),2010,20(3):19-22,26.
[14]宗行万之助.疼痛的估价:用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994(4):153.
[15]王伟,毕大卫.肩关节功能评分的研究现状[J].浙江中西医结合杂志,2010,20(5):323-325,327.
[16]贺涓涓,窦祖林,解东风,等.肌骨超声影像分析肩痛患者流行病学及影像学特点[J].中国老年学杂志,2017,37(22):5668-5670.
[2]Castagna A,Mouhsine E,Conti M,et al.Chondral print on humeral head:an indirect sign of long head biceps tendon instability[J].Knee Surgery,Sports Traumatology,Arthroscopy:Official Journal of the ESSKA,2007,15(5):645-648.
[3]Cobaleda aristizabal A F,Sanders E J,Barber F A.Adverse events associated with biodegradable lactide-containing suture anchors[J].Arthroscopy:the Journal of Arthroscopic&Related Surgery:Official Publication of the Arthroscopy A s s o c i a t i o n o f N o r t h A m e r i c a a n d t h e I n t e r n a t i o n a l Arthroscopy Association,2014,30(5):555-560.
[4]CHEN C H,CHEN C H,CHANG C H,et al.Classification and analysis of pathology of the long head of the biceps tendon in complete rotator cuff tears[J].Chang Gung Medical Journal,2012,35(3):263-270.
[5]Armstrong A,Teefey S A,WU T,et al.The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology[J].Journal of Shoulder and Elbow Surgery,2006,15(1):7-11.
[6]尹国军.超声在肱二头肌长头腱断裂诊断中的价值[J].临床超声医学杂志,2015,17(6):431-432.
[7]Drolet P,Martineau A,Lacroix R,et al.Reliability of ultrasound evaluation of the long head of the biceps tendon[J].Journal of Rehabilitation Medicine,2016,48(6):554-558.
[8]Battaglia p J,Welk A B,Kettner N W.Ultrasound appearance and dynamic evaluation of variant long head of the biceps ten do n anatomy w ith M RI cor relation[J].J our nal of Ultrasound,2015,18(2):187-189.
[9]程永.肩周炎的经筋病机实质与治疗探讨[J].天津中医药,2012,29(6):552-555.
[10]李坤,高琳琳,李治罡.手法治疗肱二头肌长头腱腱鞘炎[J].长春中医药大学学报,2007,22(1):46-47.
[11]宋毅勤.运用扬刺法治疗肱二头肌长头腱鞘炎[J].上海针灸杂志,1986(3):19-20.
[12]彭江华.扬刺电针法治疗桡肱关节滑囊炎56例临床观察[J].吉林中医药,2005,25(10):42-43.
[13]孙远征,刘铁镌,毛翔.循经远取动法治疗肩关节周围炎对照观察(英文)[J].世界针灸杂志(英文版),2010,20(3):19-22,26.
[14]宗行万之助.疼痛的估价:用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994(4):153.
[15]王伟,毕大卫.肩关节功能评分的研究现状[J].浙江中西医结合杂志,2010,20(5):323-325,327.
[16]贺涓涓,窦祖林,解东风,等.肌骨超声影像分析肩痛患者流行病学及影像学特点[J].中国老年学杂志,2017,37(22):5668-5670.