棍点理筋正骨手法治疗肩周炎患者30例的随机对照试验  

Stick-point Sinew-soothing and Bone-setting Manipulation for Scapulohumeral Periarthritis:a Randomised Controlled Trial

作　　者：蒋海军[1] 卜献忠 钟远鸣 黄剑峰[1] 尹保和 岑定善 JIANG Haijun;BU Xianzhong;ZHONG Yuanming;HUANG Jianfeng;YIN Baohe;CEN Dingshan(Hezhou Hospital of Traditional Chinese Medicine Affiliated to Guangxi University of Chinese Medicine,Hezhou,542899;The First Affiliated Hospital of Henan University of Chinese Medicine;The First Affiliated Hospital of Guangxi University of Chinese Medicine)

机构地区：[1]广西中医药大学附属贺州医院,广西壮族自治区542899 [2]河南中医药大学第一附属医院 [3]广西中医药大学第一附属医院

出　　处：《中医杂志》2024年第3期292-298,共7页Journal of Traditional Chinese Medicine

基　　金：广西科技计划项目(桂科AB20159018);广西壮族自治区中医药管理局自筹经费科研课题(GZZC2020345)。

摘　　要：目的观察棍点理筋正骨手法治疗肩周炎的临床效果和安全性。方法采用前瞻性随机对照试验方法,收集肩周炎患者60例,随机分为对照组和研究组各30例。两组患者均口服用塞来昔布,对照组在此基础上应用传统正骨推拿疗法治疗,隔日1次,14天为1个疗程;研究组在此基础上采用棍点理筋正骨手法治疗,3~5天治疗1次,14天为1个疗程。两组均治疗2个疗程。主要观察指标为疼痛视觉模拟量表(VAS)评分和肩关节疼痛与功能障碍指数(SPADI),于治疗前及治疗2周、4周时各评价1次。次要疗效指标包括美国加州大学肩关节量表(UCLA)评分、中医证候评分(包括关节疼痛、痛有定处、活动受限、局部僵硬症状评分),检测患者治疗前后血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平,判定临床疗效,记录诊疗过程中发生的不良反应情况。结果与本组治疗前比较,两组患者治疗2周、4周时疼痛VAS评分、SPADI及关节疼痛、痛有定处、活动受限、局部僵硬评分均降低,UCLA评分升高,治疗4周时血清IL-6、TNF-α水平均降低(P<0.05)。两组治疗2周、4周时组间比较,研究组疼痛VAS评分、SPADI及中医各症状评分均低于对照组,UCLA评分高于对照组(P<0.01),治疗4周时血清IL-6、TNF-α水平低于对照组(P<0.01)。研究组临床疗效显效率为66.67%,显著高于对照组的40.00%(P=0.038)。研究过程中两组患者均未见不良反应。结论与传统推拿手法相比,棍点理筋正骨手法治疗肩周炎在缓解疼痛症状,减轻炎症反应,促进肩关节功能恢复方面更具优势。Objective To explore the clinical effectiveness and safety of stick-point sinew-soothing and bonesetting manipulation for scapulohumeral periarthritis.Methods Using prospective randomised controlled trial method,60 cases of patients with scapulohumeral periarthritis were collected and randomly divided into 30 cases each in control group and trial group.Both groups of patients were orally treated with celecoxib,on the basis of which the control group was treated with traditional bonesetting manipulation once every other day for 14 days,while the trial group was treated with stick-point sinew-soothing and bone-setting manipulation once every 3~5 days for 14 days.Both groups were treated for 2 courses.The main observation indexes were pain visual analogue scale(VAS)score and shoulder pain and dysfunction index(SPADI),which were evaluated once before treatment and after 2 and 4 weeks of treat⁃ment.The secondary effectiveness indicators included the university of California at Los Angeles shoulder rating scale(UCLA),traditional Chinese medicine syndrome score(including symptom scores as joint pain,pain in a fixed place,activity limitation,local stiffness),and serum interleukin(IL-6)and tumour necrosis factorα(TNF-α)levels before and after the treatment,in order to evaluate the clinical effectiveness,and to record the adverse reactions that occurred in the process of diagnosis and treatment.Results Compared with the groups before treatment,the pain VAS score,SPADI and scores of joint pain,pain with a fixed place,activity limitation and local stiffness were lower,UCLA score was higher,and serum IL-6 and TNF-αlevels were lower at 4 weeks of treatment in the two groups(P<0.05).When comparing the two groups between the groups at 2 and 4 weeks of treatment,the pain VAS score,SPADI and TCM scores of each symptom in the study group were lower than those in the control group,the UCLA score was higher than those in the control group(P<0.01),and the serum IL-6 and TNF-αlevels were lower than those in the control group at 4

关 键 词：肩周炎 推拿 疼痛 炎症因子 棍点理筋正骨手法 

分 类 号：R244.1[医药卫生—针灸推拿学]