超声引导下肩袖间隙注射联合“肩三针”温针灸治疗冈上肌腱炎的临床研究及其作用机制分析  

Mechanism of ultrasound-guided gap injection for rotator cuff repair together with"shoulder three needles"warm acupuncture in the treatment of supraspinatus tendonitis

作　　者：曹霄 黄凯 练剑锋 蔡丽霞 陆云云 CAO Xiao;HUANG Kai;LIAN Jianfeng;CAI Lixia;LU Yunyun(Department of Acupuncture,Haian Hospital of Traditional Chinese Medicine,Hai'an,Jiangsu 226600)

机构地区：[1]江苏省海安市中医院针灸科,江苏海安226600

出　　处：《河北中医》2024年第7期1154-1158,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：南通市中医医疗联盟科研项目(编号:TZYK202120)。

摘　　要：目的观察超声引导下肩袖间隙注射联合“肩三针”温针灸治疗冈上肌腱炎的临床疗效及作用机制分析。方法选取2022年1月至2022年9月收治的64例冈上肌腱炎患者作为研究对象,随机分为2组。对照组32例予以“肩三针”温针灸治疗,治疗组32例予超声引导下肩袖间隙注射联合“肩三针”温针灸治疗。2组均治疗3周后统计疗效,比较2组治疗前及治疗1、3周肩关节外展肌力和活动度变化情况,比较2组治疗前及治疗1、3周疼痛视觉模拟评分法(VAS)评分、功能独立性评定量表(FIM)评分及Constant-Murley肩关节功能评分量表(CMS)评分变化情况,比较2组治疗前及治疗1、3周核苷酸结合寡聚化结构域样受体家族3(NLRP3)炎症小体相关蛋白NLRP3、半胱天冬酶-1(Caspase-1)、凋亡相关斑点样蛋白(ASC)mRNA相对表达水平变化情况,观察2组治疗期间不良反应发生情况。结果治疗组总有效率93.75%(30/32),对照组总有效率68.75%(23/32),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,2组治疗1、3周肩关节外展肌力及活动度水平均增加(P<0.05),且治疗组治疗1、3周肩关节外展肌力及活动度水平均大于对照组同期(P<0.05)。与本组治疗前比较,2组治疗1、3周疼痛VAS评分均降低(P<0.05),FIM评分及CMS评分均升高(P<0.05),且治疗组治疗1、3周疼痛VAS评分低于对照组同期(P<0.05),FIM评分及CMS评分均高于对照组同期(P<0.05)。与本组治疗前比较,2组治疗1、3周NLRP3炎症小体相关NLRP3、Caspase-1及ASC mRNA相对表达水平均降低(P<0.05),且治疗组治疗1、3周NLRP3、Caspase-1及ASC mRNA相对表达水平均低于对照组同期(P<0.05)。治疗组不良反应总发生率21.88%(7/32),对照组不良反应总发生率15.63%(5/32),2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论超声引导下肩袖间隙注射联合“肩三针”温针灸治疗冈上肌腱炎疗效确切,可有效改善患者肩关Objective To investigate the mechanism of ultrasound-guided gap injection for rotator cuff repair together with"shoulder three needles"warm acupuncture in the treatment of supraspinatus tendonitis(ST).Methods Sixty-four ST patients treated in our hospital from January 2022 to September 2022 were selected as study subjects and randomly divided into two groups of 32 patients each.All patients were given“shoulder three needles”warm acupuncture,those in the observation group were additionally given ultrasound-guided gap injection for rotator cuff repair.A 3-week treatment was performed,aiming to compare the clinical efficacy,shoulder abductor strength(SAS)and shoulder range of motion(ROM),visual analog scale(VAS)score,functional independence measure(FIM)score,Constant-Murley scale(CMS),and the expression levels of NLRP3,cysteinyl aspartate specific proteinase-1(caspase-1)and apoptosis-associated speckle-like protein(ASC)mRNA before treatment and at weeks 1 and 3 of treatment between groups.The incidence of adverse effects was assessed.Results The total clinical treatment efficiency of the observation group was significantly higher than that of the control group(93.75%[30/32]vs 68.75%[23/32],P<0.05).At weeks 1 and 3 of treatment,the score of SAS and ROM,FIM,and CMS in the both group were significantly higher than those before treatment,but the VAS score was significantly lower(all P<0.05).The improvements were more pronounced in the observation group relative to the control group(all P<0.05).The expression levels of NLRP3,Caspase-1 and ASC mRNA were significantly lower in the both group than those before treatment(P<0.05).The observation group was superior to the control group for the expression levels of NLRP3,Caspase-1 and ASC mRNA(P<0.05).The incidence of adverse reactions in the observation group was comparable to the control group(21.88%[7/32]vs 15.63%[5/32],P>0.05).Conclusion The ultrasound-guided gap injection for rotator cuff repair together with"shoulder three needles"warm acupuncture can improve shoulder

关 键 词：冈上肌腱炎 超声检查 温针灸 

分 类 号：R246.223[医药卫生—针灸推拿学]