整肩三步九法治疗冻结期肩周炎随机对照试验  

Three-Step Nine-Method Shoulder Treatment for Frozen Shoulder:A Randomized Controlled Trial

作　　者：方仪德 莫文[1,2] 许金海 叶洁[1] 施杞[1,2] FANG Yi-de;MO Wen;XU Jin-hai;YE Jie;SHI Qi(Department of Orthopedics,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200032;Institute of Spinal Diseases,Shanghai Academy of Traditional Chinese Medicine,Shanghai,200032)

机构地区：[1]上海中医药大学附属龙华医院骨伤科,上海200032 [2]上海中医药研究院脊柱病研究所,上海200032

出　　处：《中国中西医结合杂志》2024年第12期1450-1456,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药管理局中医药特色技术筛选评价和传承应用项目(No.GZY-KJS-2020-083);国家中医药管理局高水平中医药重点学科建设项目(No.ZYYZDXK-2023059);上海市浦东新区中医药传承创新发展示范试点项目建设项目(No.YC-2023-0901)。

摘　　要：目的 观察整肩三步九法治疗冻结期肩周炎的疗效。方法 筛选冻结期肩周炎患者118例,其中108例符合纳入标准。按随机数字表法分为两组,试验组进行整肩三步九法治疗,对照组进行温热式中低频理疗仪治疗,3次/周,治疗2周,两组均配合功能锻炼。比较治疗前、治疗后2周、随访4、12周的肩关节疼痛和功能障碍指数(SPADI)、肩关节功能(Constant-Murley评分)、关节活动度、视觉模拟评分(VAS),并对整肩三步九法的临床疗效进行Logistic分析。结果 两组各脱落2例,104例患者完成全部治疗及随访,两组各52例,试验组总有效率为85.19%(46/54),对照组总有效率为66.67%(36/54),试验组总体疗效优于对照组(χ^(2)=6.132,P<0.05)。与治疗前比较,两组治疗2周后、随访4、12周,SPADI、VAS下降(P<0.05),Constant-Murley评分、被动上举角度、被动外展角度增加,且随着时间延长,持续改善症状。治疗2周后及随访中,试验组的SPADI、VAS、Constant-Murley评分均优于对照组(P<0.05)。Logistic分析显示基线水平的SPADI对疗效有独立影响[OR=1.033,95%CI(1.003,1.062),P=0.028]。结论 整肩三步九法治疗冻结期肩周炎的总体疗效优于温热式中低频理疗,安全性良好,并能提高冻结期肩周炎患者的生活质量。Objective To evaluate the clinical efficacy of Three-Step Nine-Method Shoulder Treatment for patients with frozen shoulder periarthritis.Methods Totally 118 patients with frozen shoulder periarthritis were screened and 108 met the inclusion criteria.They were assigned to two groups according to random digit table.Patients in the treatment group received Three-Step Nine-Method Shoulder Treatment,while those in the control group received warm-type medium-low frequency therapy,three times per week for two successive weeks,along with functional exercises.The evaluation metrics used included the Shoulder Pain and Disability Index(SPADI),Constant-Murley score,range of motion,and Visual Analogue Scale(VAS),which were assessed at baseline,at week 2 after treatment,and at week 4 and 12after follow-ups.Logistic analysis was conducted to assess clinical effectiveness.Results Two cases dropped out from each group.The rest 104 patients completed the treatment and follow-ups,52 in each group.The total effective rate was 85.19%(46/54 cases)in the treatment group and 66.67%(36/54 cases)in the control group,demonstrating a statistically significant advantage for the treatment group(χ^(2)=6.132,P<0.05).Both groups showed significant improvements in SPADI,VAS(P<0.05),and Constant-Murley scores between at baseline and at week 2 after treatment/at week 4 and 12 after follow-ups.Besides,passive elevation angles and passive abduction angles showed obvious increase.Along with time went on,symptoms were consistently improved.SPADI,VAS,and Constant-Murley scores were superior in the treatment group to those in the control group at week 2 after treatment and during follow-ups(P<0.05).Logistic regression analysis indicated that baseline SPADI independently influenced the treatment efficacy[OR=1.033,95%CI(1.003,1.062),P=0.028].Conclusions Three-Step Nine-Method Shoulder Treatment demonstrated superior overall efficacy compared to warm low-frequency physical therapy for treating frozen shoulder periarthritis.Three-Step Nine-Method Treatment

关 键 词：冻结肩 肩周炎 整肩三步九法 随机对照试验 中西医结合 

分 类 号：R274.9[医药卫生—中西医结合]