摘要
肩周炎Periarthritis(全称肩关节周围炎)是发生于肩关节周围软组织(肩关节囊、肩关节周围韧带、肌腱及滑囊)的退行性变和慢性无菌性炎症。俗称冻结肩(frozen shoulder)、喙突炎、漏肩风、五十肩,是常见和多发性疾病,多为单侧发病,左侧较右侧多见,少数可双侧同时发病。多发于中老年人,女性稍高于男性。这类患者常常感到肩部疼痛、肩关节活动受限等而影响正常的日常生活。中年以后突发性的肩关节疼痛及关节挛缩症。其临床表现主要是肩部疼痛以及伴有不同程度的肩关节运动功能障碍。针灸与推拿治疗本病有良好的疗效。本论文对有关肩周炎起源、病因病机及其临床应用等方法,从文献综述进行了探讨。并从临床上以针灸法,推拿归位手法等综合运用治疗本病,针对本病主症疼痛和关节挛缩进行对症治疗,取得了较好的疗效。
1.文献综述
本文对中西医关于肩周炎的概念、流行病学特点进行了探讨。总结了近十多年来中西医对本病的分期、病因病理、诊断的认识,临床常用治疗应用方法等。中医对肩周炎的认识源远流长。常有“肩胛周痹”、“肩痛”、“漏肩风”、“锁肩风”等不同的称谓。中医认为肩周炎的发病有内因和外因两方面的因素:内因包括肝肾亏损、气血虚衰,外因包括六淫、劳伤和外伤等。
现今对肩周炎的中医治疗方法很多,除中药治疗外,针灸推拿治疗方法也多种多样,尤其是推拿治疗对肩周炎有活血化瘀、通络、理筋、止痛,恢复韧带的弹性、松弛肩关节周围软组织,剥离、松解粘连、滑利关节,恢复关节功能的作用。针刺的治疗方法也很多,如毫针刺法中就有许多特殊针法,巨刺法、动刺法、阻力刺法、平衡刺法、齐刺法、透刺法、傍刺法、滞针法等,以及耳针、腕踝针延长法、眼针法等。特殊针法中有:针刀疗法、新九针、火针、芒针、皮内针、小宽针、挑针法、蜂针法、指针法等。艾灸治疗中有用直接灸、温针灸、太乙神针灸等。其他还有穴位注射、穴位中药贴敷、电针、激光、电磁波穴位照射等,也是治疗肩周炎的常用方法,据报导均有良好的效果。
虽然中医对肩周炎的治疗方法诸多,但其中以单一方法治疗的报道较少,以2-3种以上的综合疗法治疗肩周炎的报道则较为常见,临床疗效未见明显的差别,有高有低。大多数观点认为多种疗法效果优于单一疗法。针灸推拿疗法是中医学的宝贵遗产。在治疗许多疾病上,针灸推拿疗法都以其独到之处博得了广大患者的欢迎。推拿疗法为无创痛的疗法,常用于配合其他疗法治疗,若单独使用能将疾病治好更深受广大患者的欢迎。
2.临床研究
本文对采用针灸加推拿歸位手法治疗肩周炎进行了临床对照分组观察。用区组随机方法将120例肩周炎患者分为针刺加推拿歸位手法组和针灸组、歸位法推拿组和常规推拿手法组各30名。
临床结论:
(1)四组病例初诊时疼痛程度评分比较结果显示初诊时四组病人的肩关节功能评定的差异无显著性(P＞0.05),说明不同疼痛程度的病例在四组中得以均衡分布,组间具有可比性。
(2)针刺与推拿歸位手法治疗肩周炎疗效显著。治疗后肩关节总体指标比较可见,治疗3次后针灸加归位法推拿组有效率和肩功能均有好转,而其他三组无明显好转,说明针灸加归位法推拿组疗效优于其他三组。治疗6次后四组治疗方法均有疗效,且疗效相当。治疗10次后针灸加归位法推拿组疗效优于单纯针灸和单纯推拿组。而针灸组与推拿组间比较无显著性差异,说明针灸组与推拿组疗效相当。有效率均达100%,但显效率针灸加归位法推拿组疗效优于其他三组,也说明针灸推拿结合治疗本病比单一治疗方法疗效更好。
(3)针刺与推拿歸位手法治疗肩周炎有明显的镇痛效应。治疗后肩关节疼痛指标比较:四种治疗方法均有良好的镇痛效果,但单纯推拿对本病的疼痛治疗效果较其他两种治疗方法起效时间较慢。且常规推拿组起效时间更长。说明本手法优于常规推拿手法。
(4)针刺与推拿歸位手法治疗肩周炎能明显改善肩关切的活动功能。治疗后肩关节活动度指标比较:四种治疗方法均有良好的改善肩关节活动度效果,但单纯针灸、常规推拿组对本病的关节活动度改善效果较其他两种治疗方法起效时间较慢。
(5)治疗后肩关节肌力:四组治疗方法对肌力无明显影响
(6)年龄、病程、病情的有效治疗次数比较:患者年龄、病情对本病的治疗无明显影响。患者病程对本病的治疗有明显影响。病程越短治疗起效时间也越快。
推拿歸位手法是我在长期的临床治疗中总结出来,自创的治疗肩周炎的一种推拿手法,歸位是为了让肩关节恢复原来的状态,恢复原来的正常功能。肩周炎的病患,其肌腱.轫带或關節處及其肩胛骨皆可能稍微移位或張力改變,若我们将其移位處歸位,張力改變歸位回到正常,其疼痛及活動度将可後原。这一手法配合针灸治疗既可缓解肩周炎患者的疼痛,又能提高及恢复患者的的受限功能。手法具有舒筋活血,通经止痛,滑利关节,拨离粘连的良好作用。研究证明针灸与推拿歸位手法治疗肩周炎有良好的效果。
Periarthritis(whole name Periarthritis of shoulder)(narrow meaning)is the degeneration and chronic aseprtic inflammation around the shoulder joint surrounding soft tissue(capsula articularis humeri, shoulder joint surrounding ligament,tendon and bursa mucosa).It is commonly called frozen shoulder,coarcoiditis,LouJianFeng,Fifty Shoulder.It is a common and a multiple disease.It always happens in one side.Left side is more common than the right side.There is a few happening in both side at the same time.It is more common to the elderly and higher to female than to male.These patients always feel the shoulder pains and the limitation of shoulder activity which influence normal daily life.After the middle age,paroxysmal shoulder pains and arthrogryposis happen.Acupuncture and massage have a better effect to cure the disease.Its clinical situation is mainly the shoulder pains and different degrees of shoulder motor dysfunction.This essay has carried on the discussion about periarthritis of shoulder' s source, etiological factor,pathogenesis and clinical application method on the literature summary.Also in the clinic we use acupuncture massage and so on synthetic to cure this disease,aiming directly to cure the pains and contracture of joints and get a better therapeutic effect.
1.Literature summary
This essay has discussed on the periarthritis of shoulde' s concept, epidemiology feature in Chinese medicine and western medicine.It summarizes more than ten years' cognition of disease stages,etiological factor,pathology,diagnoses and clinical frequently used therapy in TCM.TCM' cognition to periarthritis of shoulde is of ancient origin and long development.It always has different names such as:humeral callus panodynia,shoulder pain,LouJianFeng,SuoJianFeng and so on. TCM think that periarthritis of shoulder morbility has the internal factor and external factor:internal factor includes liver and kidney deficiency,qi and blood deficiency;external factor includes six exopathogens,impairment caused by overstraining,external injury and so on.
Nowadays TCM has many therapies to periarthritis of shoulder,except Chinese medicine,acupuncture and massage therapy method are also varied, especially massage has the effects to periarthritis of shoulder,like: promoting blood flow and removing blood stasis,soothing tendon, stopping pains,reverting ligament flexibility,loosing shoulder surrounding soft tissue,uncovering and saluting conglutination, lubricating joint,reverting Joint function.Acupuncture has many therapies such as:a great many special needling techniques in acupuncture needling method like:great needling,moving needling,resisting force needling,balancing needling,neatly needling,penetrating needling, lateral needling,sticking needling and auricular needling,wrist and ankle needling,extension needling,eye needling;special needling techniques like:needle and knife therapy,new nine forms of needles, fire needle,awn needle,intradermal imbedding needle,small width needle,teasing needle,bee needle,pointer needle and so on. Moxibustion therapy has direct moxibustion,warmed needle with moxibustion,Taiyi moxacone moxibustion.The others have acupoint injection,acupoint Chinese medicine sticking,electric acupuncture, laser and electromagnetic waves acupoint exposure.These are common methods to periarthritis of shoulder.It is reported that they have better effect.
Although TCM has many therapies to periarthritis of shoulder,there is few reports about using single method.The reports using more than 2-3 kinds of combined therapy to cure periarthritis of shoulder are more common.There are no significant differences between these therapeutic effects.The majority point of views are varied therapy surpass mono-therapy.Acupuncture and massage therapy are the precious heritage of TCM.To cure many diseases,acupuncture and massage therapy earn a lot of patients' welcome because of its specialty.Massage is a therapy with no pains and it always goes with other therapies.If it can cure the disease alone,it surely can earn more patients' welcome.
2.Clinical research
This thesis makes clinical study on acupuncture and massage therapy of scapulohumeral periarthritis.120 patients with scapulohumeral periarthritis were blocking randomized to observation group(acupuncture and Guiwei massage),acupuncture group,Guiwei massage group and general massage group,with 30 cases each.
Clinical conclusion:
(1)In compare with first pain degree of the cases in the four groups, it shows there is not obvious differentia in shoulder joint function among each group(P＞0.05),which indicates the cases of different pain grade in the four groups are equilibrated and they are absolutely compatible.
(2)Overall index comparison on shoulder joint after treated:The effective rate and shoulder function are getting better after cured for three times in the observation group while the other three groups get no significant improvement,so the observation group is more effective than the other three groups.The effects among them are coordinative after cured for six times.After treated for ten times,the observation group is better than the acupuncture group and the general massage group.There is not.obvious differentia betweenthe acupuncture group and the general massage group,so they have coordinative effect.The general effective rate of the group is 100%.Acupuncture and Guiwei massage is more effective to cure scapulohumeral periarthritis than single method for the effective rate of observation group is better.
(3)Pain index comparison on shoulder joint after treated:Four kinds of treatment can ease pain effectively,but the effect on easing pain by single massage for this disease takes longer time than the other two treatments comparatively.In addition to that,the general massage takes more time to get effect,showing that Guiwei massage is better than general massage.
(4)Range of motion index comparison on shoulder joint after treated: Four kinds of treatment can improve the range of motion effectively,but the effect on improving the range of motion by acupuncture and general massage for this disease takes longer time than the other two treatments comparatively.
(5)Muscle power of shoulder joint after treated:Four groups of treatments do not have obvious influence for muscle power.
(6)Comparison on cured times of effective treatment between age, course of diseases and their condition:The age of patient and their course of diseases do not have obvious influence.Patient' s condition has obvious influence for the treatment of this disease.Shorter the condition is,sooner the effect is.
Guiwei massage summarized from my long-term clinical treatment experience,a kind of manipulation maneuver created by myself to cure periarthritis of shoulder.Repositioning is to make the shoulder back to to the original condition and recover original normal function. Periarthritis of shoulder patients' tendon,ligament,joint,and scapula are all possible slightly shift or tension changed.If we make the shifting position back and the tension back to the original state,its pains and range of motion can be recovered.The manipulation matching acupuncture and moxibustion can not only relieve periarthritis patients' pains,but also increase and recover patients' limited function.The manipulation has a better effect in loosing tendon and activing blood circulation, inducing menstruation to stop pain,lubricating joint,dissecting accretion.Research is proved that acupuncture and moxibustion and Guiwei massage have better effect to cure periarthritis of shoulder.
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