经筋推拿联合温针灸治疗寒湿痹阻型急性期肩关节周围炎临床观察  

Clinical effect of tendon massage combined with warm acupuncture for patients with acute scapulohumeral periarthritis of cold-dampness syndrome

作　　者：刘伙生 赵海龙 宣守松 杨一帆 罗永宝[1] LIU Huosheng;ZHAO Hailong;XUAN Shousong;YANG Yifan;LUO Yongbao(Department of Massage,Jiading District Hospital of Traditional Chinese Medicine,Shanghai 201800)

机构地区：[1]上海市嘉定区中医医院推拿科,上海201800

出　　处：《河北中医》2022年第12期2063-2067,2076,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：上海市卫生和计划生育委员会、上海市中医药发展计划办公室进一步加快中医药事业发展三年行动计划(2018—2020年)项目[编号:ZY(2018—2020)-FWTX-4013];上海市嘉定区科学技术委员会自然科学研究课题(编号:JDKW-2020-0028)。

摘　　要：目的观察经筋推拿联合温针灸治疗寒湿痹阻型急性期肩关节周围炎(以下简称肩周炎)的临床疗效。方法将128例寒湿痹阻型急性期肩周炎患者按照随机数字表法分为3组,联合治疗组42例予经筋推拿联合温针灸治疗,经筋推拿组43例予经筋推拿治疗,温针灸组43例予温针灸治疗。3组均每周治疗3次,共治疗18次,疗程结束后6个月随访。比较3组疗效;比较3组治疗前、治疗后、随访时疼痛视觉模拟评分(VAS)变化;比较3组治疗前后及随访时肩关节活动度变化;比较3组治疗前后肿瘤坏死因子α(TNF-α)、前列腺素E_(2)(PGE_(2))水平变化。结果联合治疗组总有效率97.5%(39/40),经筋推拿组总有效率80.0%(32/40),温针灸组总有效率70.0%(28/40),联合治疗组疗效优于经筋推拿组、温针灸组(P<0.05)。3组治疗后疼痛VAS均较本组治疗前降低(P<0.05),联合治疗组、经筋推拿组随访时疼痛VAS均较本组治疗前降低(P<0.05),治疗后、随访时联合治疗组疼痛VAS均低于经筋推拿组、温针灸组(P<0.05)。治疗后、随访时联合治疗组前屈、后伸、外展、内收活动度均较本组治疗前增加(P<0.05),治疗后、随访时经筋推拿组、温针灸组前屈、外展、内收活动度均较本组治疗前增加(P<0.05),治疗后、随访时联合治疗组前屈、后伸、外展、内收活动度均优于经筋推拿组、温针灸组同期(P<0.05),治疗后、随访时经筋推拿组与温针灸组前屈、后伸、外展、内收活动度比较差异均无统计学意义(P>0.05)。3组治疗后TNF-α、PGE_(2)水平均较本组治疗前降低(P<0.05),治疗后联合治疗组TNF-α、PGE_(2)水平均低于经筋推拿组、温针灸组(P<0.05),治疗后经筋推拿组与温针灸组TNF-α、PGE_(2)水平比较差异无统计学意义(P>0.05)。结论经筋推拿联合温针灸治疗寒湿痹阻型急性期肩周炎,能减轻患者疼痛症状,改善肩关节活动度,治疗安全。Objective To observe the clinical effect of tendon massage combined with warm acupuncture for patients with acute scapulohumeral periarthritis(cold-dampness syndrome).Methods Patients(n=128)with acute scapulohumeral periarthritis(cold-dampness syndrome)were as subjects.The treatment continued for 6 weeks(TIW),and the 6-month follow-up was performed in three groups which were comprised of the combined treatment group(tendon massage+warm acupuncture,n=42),tendon massage group(n=43),and warm acupuncture group(n=43).The visual analogue scale(VAS),shoulder range of motion(ROM),tumor necrosis factor alpha(TNF-α),prostaglandin E_(2)(PGE_(2))were included as comparators;the curative effect was assessed.Results The overall effective rate in combined treatment group was superior to that in tendon massage group and warm acupuncture group(97.5%[39/40]vs 80.0%[32/40],70.0%[28/40],[P<0.05],respectively).The post-treatment VAS in the three groups was decreased(P<0.05),the follow-up VAS in the combined treatment group and tendon massage group was decreased(P<0.05),irrespective of post-treatment and follow-up VAS was decreased in the combined treatment group as compared with the other two groups(P<0.05).The post-treatment and follow-up shoulder ROM(anteflexion,posterior extension,abduction,adduction)in the combined treatment group was increased(P<0.05),in comparison of the three groups,but superior in combined treatment group(P<0.05),and with no statistically significant difference between the tendon massage group and warm acupuncture group(P>0.05);while the post-treatment and follow-up shoulder ROM(anteflexion,abduction,adduction)in the tendon massage group and warm acupuncture group were increased(P<0.05).The post-treatment TNF-αand PGE_(2) levels in the three groups were decreased,the combined treatment group was more prevalent(P<0.05);none of the TNF-αand PGE_(2) differed between the tendon massage group and warm acupuncture group(P>0.05).Conclusion For patients with acute scapulohumeral periarthritis(cold-dampness syndrom

关 键 词：关节周围炎 肩关节 推拿 针刺疗法 

分 类 号：R684.73[医药卫生—骨科学] R244.1[医药卫生—外科学] R245[医药卫生—临床医学]