水针刀靶向三点松解注射技术在冻结肩治疗中的应用
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摘要
目的:观察水针刀靶向三点松解注射微创技术治疗冻结肩的临床效果。方法:自2017年3月至2018年11月,将140例冻结肩患者分为观察组与对照组。观察组70例,男30例,女40例;年龄(59.2±11.5)岁;病程(6.76±4.14)个月;采用水针刀靶向三点松解注射治疗。对照组70例,男29例,女41例;年龄(58.9±11.8)岁;病程(6.65±3.98)个月;采用小针刀治疗。在治疗前和疗程结束1个月后分别采用简化麦吉尔疼痛问卷表对两组患者的疼痛程度进行评估,采用Constant-Murley肩关节评分系统对两组患者的肩关节功能进行评估,并比较治疗后两组临床疗效,最后采用疼痛程度的改善率来评定患者的治疗效果。结果:疗程结束1个月后,两组冻结肩患者SF-MPQ中的分类疼痛评估指数、视觉模拟评分、现时疼痛强度及总的疼痛评分均较治疗前下降(P<0.01),观察组的疼痛程度评分低于对照组(P<0.01);两组肩关节疼痛、功能活动、肌力评分、活动度及Constant-Murley总评分均较治疗前提高(P<0.01),观察组的肩关节疼痛、功能活动、活动度及Constant-Murley总评分优于对照组(P<0.01),但肌力评分与对照组相比差异无统计学意义(P>0.05);观察组疼痛程度改善愈显率为70.0%,优于对照组(45.7%),P=0.003;观察组疼痛程度改善总有效率为97.1%,优于对照组(84.3%),P=0.009。结论:采用水针刀靶向三点松解注射技术治疗冻结肩疗效确切,操作简单,患者痛苦小,安全性高,是一种较好的微创治疗方法。
Objective:To observe the clinical efficacy of minimally invasive acupotomy injection technique with targeted three point in the treatment of frozen shoulder. Methods:From March 2017 to November 2018,a total of 140 patients with frozen shoulder were randomly divided into observation group and control group. The observation group was made up of 70 patients,including 30 males and 40 females;the mean age was(59.2±11.5) years old;the mean duration of disease was(6.76±4.14) months; the observed patients were treated with acupotomy injection technique with targeted three point. There were also 70 patients in the control group,made up of 29 males and 41 females;the mean age was(58.9±11.8) years old;the mean duration of disease was(6.65±3.98) months;the control group was treated with the small needle knife therapy. Before treatment and one month after the treatment,the pain levels of both groups were assessed using the short form McGill pain questionnaire,and the shoulder function was evaluated using the Constant-Murley Shoulder Outcome Scoring. The clinical efficacy of between groups was compared after treatment,and finally,the improvement rate of pain degree was used to evaluate the therapeutic effect of the patients. Results:The PRI,VAS,PPI and total pain scores of frozen shoulder patients in both groups decreased significantly one month after the treatment compared with those before treatment(P<0.01). Compared with the control group,the observation group exhibited a more significant decrease in pain scores(P <0.01). Furthermore,the shoulder pain,muscle strength,ADL,ROM and total function scores of frozen shoulder patients in the two groups were significantly improved one month after the treatment compared with those before treatment(P<0.01). The inter group comparison indicated that the pain,ADL,ROM and total function scores were improved obviously in the observation group when compared to those in the control group(P<0.01),but no remarkable difference was found between muscle strength score and the control group(P>0.05). In addition,the markedly effective rate of pain improvement was 70.0% and 45.7% in the observation group and the control group,respectively,meanwhile,the corresponding total effective rate was 97.1% and 84.3%,respectively. Conclusion:The application of acupotomy injection technique with targeted three point in the treatment of frozen shoulder shows definite efficacy,easy operation,little pain and high safety. Therefore,it is an ideal method for minimally invasive treatment.
Objective:To observe the clinical efficacy of minimally invasive acupotomy injection technique with targeted three point in the treatment of frozen shoulder. Methods:From March 2017 to November 2018,a total of 140 patients with frozen shoulder were randomly divided into observation group and control group. The observation group was made up of 70 patients,including 30 males and 40 females;the mean age was(59.2±11.5) years old;the mean duration of disease was(6.76±4.14) months; the observed patients were treated with acupotomy injection technique with targeted three point. There were also 70 patients in the control group,made up of 29 males and 41 females;the mean age was(58.9±11.8) years old;the mean duration of disease was(6.65±3.98) months;the control group was treated with the small needle knife therapy. Before treatment and one month after the treatment,the pain levels of both groups were assessed using the short form McGill pain questionnaire,and the shoulder function was evaluated using the Constant-Murley Shoulder Outcome Scoring. The clinical efficacy of between groups was compared after treatment,and finally,the improvement rate of pain degree was used to evaluate the therapeutic effect of the patients. Results:The PRI,VAS,PPI and total pain scores of frozen shoulder patients in both groups decreased significantly one month after the treatment compared with those before treatment(P<0.01). Compared with the control group,the observation group exhibited a more significant decrease in pain scores(P <0.01). Furthermore,the shoulder pain,muscle strength,ADL,ROM and total function scores of frozen shoulder patients in the two groups were significantly improved one month after the treatment compared with those before treatment(P<0.01). The inter group comparison indicated that the pain,ADL,ROM and total function scores were improved obviously in the observation group when compared to those in the control group(P<0.01),but no remarkable difference was found between muscle strength score and the control group(P>0.05). In addition,the markedly effective rate of pain improvement was 70.0% and 45.7% in the observation group and the control group,respectively,meanwhile,the corresponding total effective rate was 97.1% and 84.3%,respectively. Conclusion:The application of acupotomy injection technique with targeted three point in the treatment of frozen shoulder shows definite efficacy,easy operation,little pain and high safety. Therefore,it is an ideal method for minimally invasive treatment.
引文
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[10]Manson NA,Mckeon MD,Abraham EP.Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation:a retrospective case series[J].Can J Surg,2013,56(2):89-96.
[11]Buchbinder R,Hoving JL,Green S,et al.Short course prednisolone for adhesive capsulitis(frozen shoulder or stiff painful shoulder):a randomised,double blind,placebo controlled trial[J].Ann Rhe um Dis,2004,63(11):1460-1469.
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[13]Plancher KD,Johnston JC,Peterson RK,et al.The dimensions of the rotator interval[J].J Shoulder Elbow Surg,2005,14(6):620-625.
[14]Jost B,Koch PP,Gerber C.Anatomy and functional aspects of the rotator interval[J].J Shoulder Elbow Surg,2000,9(4):336-341.
[15]Chen J,Chen S,Li Y,et al.Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder[J].Arthros copy,2010,26(4):529-535.
[16]Caplan A,Fett N,Rosenbach M,et al.Prevention and management of glucocorticoid induced side effects:a comprehensive review:a review of glucocorticoid pharmacology and bone health[J].J Am Acad Dermatol,2017,76(1):1-9.
[17]李金牛,乔晋琳,郭长青,等.针刀干预对L3横突综合征模型大鼠骨骼肌NOS及NO的影响[J].中国骨伤,2009,22(11):844-847.LI JN,QIAO JL,GUO CQ,et al.Nitric oxide synthase(NOS)expression and nitric oxide(NO)content in the skeletal muscles in transverse process syndrome of the 3rd lumbar vertebra of model rats treated with acupotomology therapy[J].Zhongguo Gu Shang/China J Orthop Trauma,2009,22(11):844-847.Chinese with abstract in English.
[18]段宝霖,冯智英,傅志俭,等.糖皮质激素在疼痛微创介入治疗中的应用-中国专家共识[J].中国疼痛医学杂志,2017,23(6):401-404.DUAN BL,FENG ZY,FU ZJ,et al.Application of glucocorticoids in minimally invasive interventional treatment of pain consensus among Chinese experts[J].Zhongguo Teng Tong Yi Xue Za Zhi,2017,23(6):401-404.Chinese.
[2]Vastam ki H,Kettunen J,Vastam ki M.The natural history of idiopathic frozen shoulder:a 2 to 27 year followup study[J].Clin Orthop Relat Res,2012,470(4):1133-1143.
[3]Maund E,Craig D,Suekarran S,et al.Management of frozen shoulder:a systematic review and cost effectiveness analysis[J].Health Teehnol Assess,2012,16(11):261-264.
[4]Itoi E,Arce G,Bain GI,et al.Shoulder stiffness:current concepts and concerns[J].Arthroscopy,2016,32(7):1402-1414.
[5]Melzack R.The short form McGill pain questionnaire[J].Pain,1987,30(2):191-197.
[6]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop Relat Res,1987,(214):160-164.
[7]Gerber C,Werner CM,Macy JC,et al.Effect of selective Capsulorrhaphy on the passive range of motion of the glenohumeral joint[J].J Bone Joint Surg Am,2003,85(1):48-55.
[8]Hand GC,Athanasou NA,Matthews T,et al.The pathology of frozen shoulder[J].J Bone Joint Surg Br,2007,89(7):928-932.
[9]Uppal HS,Evans JP,Smith C.Frozen shoulder:a systematic review of therapeutic options[J].World J Orthop,2015,6(2):263-268.
[10]Manson NA,Mckeon MD,Abraham EP.Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation:a retrospective case series[J].Can J Surg,2013,56(2):89-96.
[11]Buchbinder R,Hoving JL,Green S,et al.Short course prednisolone for adhesive capsulitis(frozen shoulder or stiff painful shoulder):a randomised,double blind,placebo controlled trial[J].Ann Rhe um Dis,2004,63(11):1460-1469.
[12]Mengiardi B,Pfirrmnn CW,Gerber C,et al.Frozen shoulder:MRarthrographic findings[J].Radiology,2004,233(2):486-492.
[13]Plancher KD,Johnston JC,Peterson RK,et al.The dimensions of the rotator interval[J].J Shoulder Elbow Surg,2005,14(6):620-625.
[14]Jost B,Koch PP,Gerber C.Anatomy and functional aspects of the rotator interval[J].J Shoulder Elbow Surg,2000,9(4):336-341.
[15]Chen J,Chen S,Li Y,et al.Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder[J].Arthros copy,2010,26(4):529-535.
[16]Caplan A,Fett N,Rosenbach M,et al.Prevention and management of glucocorticoid induced side effects:a comprehensive review:a review of glucocorticoid pharmacology and bone health[J].J Am Acad Dermatol,2017,76(1):1-9.
[17]李金牛,乔晋琳,郭长青,等.针刀干预对L3横突综合征模型大鼠骨骼肌NOS及NO的影响[J].中国骨伤,2009,22(11):844-847.LI JN,QIAO JL,GUO CQ,et al.Nitric oxide synthase(NOS)expression and nitric oxide(NO)content in the skeletal muscles in transverse process syndrome of the 3rd lumbar vertebra of model rats treated with acupotomology therapy[J].Zhongguo Gu Shang/China J Orthop Trauma,2009,22(11):844-847.Chinese with abstract in English.
[18]段宝霖,冯智英,傅志俭,等.糖皮质激素在疼痛微创介入治疗中的应用-中国专家共识[J].中国疼痛医学杂志,2017,23(6):401-404.DUAN BL,FENG ZY,FU ZJ,et al.Application of glucocorticoids in minimally invasive interventional treatment of pain consensus among Chinese experts[J].Zhongguo Teng Tong Yi Xue Za Zhi,2017,23(6):401-404.Chinese.