CAJ | 학술논문

目的：观察关节腔加压灌注联合局部封闭和手法治疗肩周炎的临床疗效和安全性。方法：将126例肩周炎患者随机分为3组，43例采用关节腔加压灌注＋局部封闭＋手法治疗（A组），42例采用关节腔加压灌注＋手法治疗（B组），41例采用局部封闭＋手法治疗（C组）。分别于治疗前及治疗开始后1 d、7d、14d、21 d、28d采用肩关节周围炎疗效评定量表评定疗效，并观察治疗期间3组患者不良事件的发生情况。结果：①疗效评定结果。治疗前后不同时间之间疗效评分的差异有统计学意义，即存在时间效应（F＝4746．830，P＝0．000）；时间因素和分组因素之间存在交互效应（F＝166．330，P＝0．000）；3组患者疗效评分的组间差异总体上有统计学意义，即存在分组效应（F＝1843．600，P＝0．000）；除治疗前外，其余各时点3组的疗效评分比较，差异均有统计学意义[（44．13±12．79）分，（46．02±10．38）分，（45．63±11．06）分，F＝210．917，P＝0．076；（66．39±12．57）分，（59．16±13．26）分，（47．19±10．23）分，F＝271．000，P＝0．000；（81．12±6．43）分，（69．67±8．25）分，（55．29±9．38）分，F＝633．400，P＝0．000；（91．37±6．62）分，（76．21±8．36）分，（60．62±9．87）分，F＝1584．000，P＝0．000；（95．12±4．28）分，（90．20±7．03）分，（85．65±7．46）分，F＝201．000，P＝0．000；（95．73±3．96）分，（92．57±5．81）分，（91．15±5．72）分，F＝163．000，P＝0．000]；治疗开始后1 d、7 d、14 d、21 d和28 d，A组的评分均大于B组和C组（P＝0．010，P＝0．001；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000）。B组和C组患者的评分均于治疗开始后21 d达到痊愈标准，而A组评分在治疗开始后7d即达到痊愈标准。②安全性评定结果。3组患者治疗期间均未发生药物过敏、晕针、血糖较大幅度波动、医源性骨折、肩关节关节囊破裂等不良事件。结论：关节腔加压灌注联合局部封闭和手法治疗能迅速缓解肩周炎患者的肩部疼痛症状、改善关节功能，与关节腔加压灌注联合手法治疗和局部封闭联合手法治疗相比，起效快、疗效好，而且具有较高的安全性，值得临床推广应用。目的：觀察關節腔加壓灌註聯閤跼部封閉和手法治療肩週炎的臨床療效和安全性。方法：將126例肩週炎患者隨機分為3組，43例採用關節腔加壓灌註＋跼部封閉＋手法治療（A組），42例採用關節腔加壓灌註＋手法治療（B組），41例採用跼部封閉＋手法治療（C組）。分彆于治療前及治療開始後1 d、7d、14d、21 d、28d採用肩關節週圍炎療效評定量錶評定療效，併觀察治療期間3組患者不良事件的髮生情況。結果：①療效評定結果。治療前後不同時間之間療效評分的差異有統計學意義，即存在時間效應（F＝4746．830，P＝0．000）；時間因素和分組因素之間存在交互效應（F＝166．330，P＝0．000）；3組患者療效評分的組間差異總體上有統計學意義，即存在分組效應（F＝1843．600，P＝0．000）；除治療前外，其餘各時點3組的療效評分比較，差異均有統計學意義[（44．13±12．79）分，（46．02±10．38）分，（45．63±11．06）分，F＝210．917，P＝0．076；（66．39±12．57）分，（59．16±13．26）分，（47．19±10．23）分，F＝271．000，P＝0．000；（81．12±6．43）分，（69．67±8．25）分，（55．29±9．38）分，F＝633．400，P＝0．000；（91．37±6．62）分，（76．21±8．36）分，（60．62±9．87）分，F＝1584．000，P＝0．000；（95．12±4．28）分，（90．20±7．03）分，（85．65±7．46）分，F＝201．000，P＝0．000；（95．73±3．96）分，（92．57±5．81）分，（91．15±5．72）分，F＝163．000，P＝0．000]；治療開始後1 d、7 d、14 d、21 d和28 d，A組的評分均大于B組和C組（P＝0．010，P＝0．001；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000）。B組和C組患者的評分均于治療開始後21 d達到痊愈標準，而A組評分在治療開始後7d即達到痊愈標準。②安全性評定結果。3組患者治療期間均未髮生藥物過敏、暈針、血糖較大幅度波動、醫源性骨摺、肩關節關節囊破裂等不良事件。結論：關節腔加壓灌註聯閤跼部封閉和手法治療能迅速緩解肩週炎患者的肩部疼痛癥狀、改善關節功能，與關節腔加壓灌註聯閤手法治療和跼部封閉聯閤手法治療相比，起效快、療效好，而且具有較高的安全性，值得臨床推廣應用。
목적：관찰관절강가압관주연합국부봉폐화수법치료견주염적림상료효화안전성。방법：장126례견주염환자수궤분위3조，43례채용관절강가압관주＋국부봉폐＋수법치료（A조），42례채용관절강가압관주＋수법치료（B조），41례채용국부봉폐＋수법치료（C조）。분별우치료전급치료개시후1 d、7d、14d、21 d、28d채용견관절주위염료효평정량표평정료효，병관찰치료기간3조환자불량사건적발생정황。결과：①료효평정결과。치료전후불동시간지간료효평분적차이유통계학의의，즉존재시간효응（F＝4746．830，P＝0．000）；시간인소화분조인소지간존재교호효응（F＝166．330，P＝0．000）；3조환자료효평분적조간차이총체상유통계학의의，즉존재분조효응（F＝1843．600，P＝0．000）；제치료전외，기여각시점3조적료효평분비교，차이균유통계학의의[（44．13±12．79）분，（46．02±10．38）분，（45．63±11．06）분，F＝210．917，P＝0．076；（66．39±12．57）분，（59．16±13．26）분，（47．19±10．23）분，F＝271．000，P＝0．000；（81．12±6．43）분，（69．67±8．25）분，（55．29±9．38）분，F＝633．400，P＝0．000；（91．37±6．62）분，（76．21±8．36）분，（60．62±9．87）분，F＝1584．000，P＝0．000；（95．12±4．28）분，（90．20±7．03）분，（85．65±7．46）분，F＝201．000，P＝0．000；（95．73±3．96）분，（92．57±5．81）분，（91．15±5．72）분，F＝163．000，P＝0．000]；치료개시후1 d、7 d、14 d、21 d화28 d，A조적평분균대우B조화C조（P＝0．010，P＝0．001；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000；P＝0．000，P＝0．000）。B조화C조환자적평분균우치료개시후21 d체도전유표준，이A조평분재치료개시후7d즉체도전유표준。②안전성평정결과。3조환자치료기간균미발생약물과민、훈침、혈당교대폭도파동、의원성골절、견관절관절낭파렬등불량사건。결론：관절강가압관주연합국부봉폐화수법치료능신속완해견주염환자적견부동통증상、개선관절공능，여관절강가압관주연합수법치료화국부봉폐연합수법치료상비，기효쾌、료효호，이차구유교고적안전성，치득림상추엄응용。
Objective:To observe the clinical curative effects and safety of articular cavity enhancing perfusion combined with blocking therapy and manipulation therapy in the treatment of periarthritis humeroscapularis(PH).Methods:One hundred and twenty-six patients with PH were randomly divided into 3 groups.Forty-three cases(group A)were treated with articular cavity enhancing perfusion combined with blocking therapy and manipulation therapy,42 cases(group B)were treated with articular cavity enhancing perfusion combined with manipulation therapy,while 41 cases(group C)were treated with blocking therapy combined with manipulation therapy.The clinical curative effects were evaluated according to the curative effect rating scale for PH before the treatment and at 1 ,7,1 4,21 and 28 days after the treat-ment.Meanwhile,the adverse events occurred in the three groups were observed.Results:There was statistical difference in the efficacy scores between different timepoints(F=4 746.830,P=0.000),in other words,there was time effect,There was interaction between time factor and grouping factor(F=1 66.330,P=0.000).There was statistical difference in the efficacy scores between the 3 groups in general, in other words,there was grouping effect(F=1 843.600,P=0.000).There was statistical difference in the efficacy scores between the 3 groups at pretreatment timepoints(44.1 3 +/-1 2.79,46.02 +/-1 0.38,45.63 +/-1 1 .06 points,F=21 0.91 7,P=0.076;66.39 +/-1 2.57,59.1 6+/-1 3.26,47.1 9+/-1 0.23 points,F=271 .000,P=0.000;81 .1 2+/-6.43,69.67+/-8.25,55.29 +/-9.38 points,F=633.400,P=0.000;91 .37+/-6.62,76.21 +/-8.36,60.62 +/-9.87 points,F=1 584.000,P=0.000;95.1 2 +/-4.28,90.20 +/-7.03,85.65 +/-7.46 points,F=201 .000,P=0.000;95.73 +/-3.96,92.57 +/-5.81 ,91 .1 5 +/-5.72 points,F=1 63.000,P=0.000).The efficacy scores of group A were higher than those of group B and group C at posttreatment timepoints(P=0.01 0,P=0.001;P=0.000,P=0.000;P=0.000,P=0.000;P=0.000,P=0.000;P=0.000,P=0.000).The efficacy scores of group B and group C reached to the recovery criteria 21 days after the treatment,while those of group A reached to the same level 7 days after the treatment.No adverse events such as drug allergy,needle syncope,wide fluctuations in blood sugar levels of patients with diabetes,iatrogenic fractures, rupture of capsule of shoulder joint were found in the 3 groups.Conclusion:For treatment of PH,the combination therapy of articular cavity enhancing perfusion and blocking and manipulation can alleviate shoulder pain and improve joint functions quickly,and it has better cura-tive effect and reacts more rapidly than the combination therapy of articular cavity enhancing perfusion and manipulation and the combina-tion therapy of blocking and manipulation,meanwhile it has high safety,so it is worthy of popularizing in clinic.