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Medicine

小针刀治疗I-II期肩周炎的临床疗效

Published: November 17, 2023
doi:
10.3791/65904
, , ,
1Longhua Hospital,Shanghai University of Traditional Chinese Medicine, 2Key Laboratory of theory and therapy of muscles and bones,Ministry of Education

Summary

这里介绍的方案描述了详细的手术方法，并证明了小针刀治疗肩周炎的有效性。

Abstract

肩周炎是一种由劳损、外伤等原因引起的肩部无菌性炎症性疾病，导致肩关节疼痛和功能受限。这里介绍的方案演示了小针刀治疗肩周炎的操作，包括患者管理、材料准备、定位、操作和术后护理。该协议的目的是缓解肩周炎患者的疼痛和功能限制，提高其生活能力。在我们的研究中，76 名符合纳入标准的 I-II 期肩周炎患者被随机分为对照组和治疗组 （n=38）。对照组患者接受功能性运动，治疗组患者接受小针刀治疗和功能性运动。评估超声下的视觉模拟评分 （VAS）、Constant 和 Murley 评分 （CMS） 以及喙肱韧带 （CHL） 的厚度。小针刀治疗后，治疗组VAS评分（5.11±0.89）显著低于对照组（5.49±0.65;t=-2.065，p<0.05）; 治疗组的CMS评分（64.72±4.78）显著高于对照组（60.97±6.00;t=2.947，p<0.05）; 治疗组（2.38 ± 0.36）的CHL厚度显著降低，而对照组（2.57 ± 0.42;t=-2.117，p<0.05）。 这些结果表明，小针刀显著缓解了疼痛症状，改善了肩部功能，减少了CHL厚度，提高了生活质量，因此在I-II期肩周炎患者中具有显著的治疗效果。

Introduction

肩周炎是一种以疼痛和主动和被动肩部运动受限为特征的疾病，对患者的工作和生活造成极大的不便1。全球肩周炎发病率在女性中为2%-5%2,3且高于男性，显示出一定的遗传趋势4。肩周炎患者多为40-60岁5.此外，肩周炎由于恢复周期较长且临床实践中缺乏既定的治疗共识，带来了沉重的社会负担。

肩周炎的主要治疗方法有口服或外用草药、针灸、按摩、功能锻炼等6;然而，由于治疗频率高、耗时较长，患者依从性较差，无法满足患者改善疼痛和功能受限的迫切需求。因此，迫切需要在肩周炎患者的临床管理中寻找更有效的治疗方法。

小针刀疗法是中医药的一种特殊而有效的外疗，近几十年来在中医药领域迅速兴起7。具有见效快、疗效明确、重复性高等优点。而且，操作仪器价格便宜，容易获得，操作过程简单，方法不受环境和条件的限制。小针刀治疗后患者的正常工作和生活不受影响，因为微切口会很快恢复，而不会对身体造成伤害，引起感染或其他副作用8,9,10,11。系统评价表明，小针刀治疗肩周炎的疗效明显优于针灸、按摩和口服中药12,13。现代研究表明，小针刀治疗肩周炎的机理是疏通经络和侧支，促进气血循环，切剥离病变组织，去除粘连，促进组织修复，恢复人体的动态平衡14,15。

这里介绍的方案演示了小针刀在治疗肩周炎中的操作，包括患者管理、材料准备、定位、手术和术后护理。该协议的目的是缓解肩周炎患者的疼痛和功能限制，提高其生活能力。

随着小针刀疗法的发展，其应用已从治疗颈、肩、腰、腿痛等肌肉骨骼疾病扩展到内科、外科、妇科、儿科等疾病，在康复医学领域发挥着越来越重要的作用16。近年来，由于超声引导小针刀可视化疗法的应用，小针刀显示出更加准确、科学和安全的治疗效果，其发展进入了一个新的阶段17,18。

Protocol

本研究方案已获得上海中医药大学附属龙华医院人体研究伦理委员会批准（批准文号：2023-LHXS-030）。在试验之前，研究中的每位患者都提供了书面知情同意书。选取2022年12月至2023年5月上海中医药大学附属龙华医院康复科I-II.期腰周炎患者76例，符合纳入标准，随机分为对照组和治疗组，每组38例。操作者必须熟悉肩关节的解剖结构和具体的手术方法。 1. 招募患者</…

Representative Results

对照组1例患者因疼痛加重而接受其他治疗（关节内类固醇注射），故终止试验，对照组其余37例患者纳入最终统计分析。对于治疗组2例超声检测不到CHL的患者，因此取消了检测，治疗组其余36例患者进入最终统计分析。 基线特征两组患者在性别、年龄、患侧、病程和分期方面的差异相当（p > 0.05）。对照组男性13例，女性24例，治疗组男性19例，女性17例?…

Discussion

在这项研究中，我们发现小针刀治疗显着缓解了I-II期肩周炎患者的疼痛症状，改善了肩关节功能，减少了CHL的厚度，并改善了生活质量。小针刀疗法对肩周炎有确切的效果。然而，手术地点是有争议的。由于知识背景不同，可以选择许多手术部位，用小针刀治疗肩周炎。主要手术部位是压痛穴、穴位和特定的解剖部位。因为治疗原理相似，无论选择什么手术部位，都能达到一定的治疗效果，但治…

Disclosures

The authors have nothing to disclose.

Acknowledgements

感谢（1）国家自然科学基金（81973877）、（2）《上海市进一步加快中医药传承创新发展三年行动计划》（ZY （2021-2023）-0201-01）、（3）浦东新区卫生系统浦东名医师培训计划（PWRzm2020-15）和（4）中医康复服务提升项目（医疗032）的财政支持。

Materials

Disposable sterile injection needle Shanghai Mishava Medical Industry Co., Ltd 601900973 Type specification:0.5 x 38 RWLB
Disposable sterile small needle-knife Wujiang Yunlong Medical equipment Co., Ltd PR-4040 Type specification:40 mm x 40 mm 
Disposable sterile syringe Shandong Weigo Group Medical polymer Products Co., Ltd 601909174 Type specification:10 mL
Lidocaine hydrochloride Shanghai Hefeng Pharmaceutical Co., Ltd 6904996104121 Type specification:5 mL
Marker pen Zebra Trading (Shenzhen) Co., Ltd 4901681518111 Type specification:1.0 mm/0.5 mm
Sterile absorbent cotton ball Shanghai Honglong Medical Supplies Equipment Co., Ltd 601905637 Type specification:0.3  25 g
Sterile disposable medical plastic cup Shanghai Honglong Medical Supplies Equipment Co., Ltd 709008633 Type specification:Waist-shaped disc
Sterile dressing block Ningbo Haishu Shenyuan Medical Materials Co.,  Ltd 601909470 Type specification:7.5 cm x 7.5 cm x 8 floors
Sterile medical tweezers Shanghai Honglong Medical Supplies Equipment Co.,Ltd 603917444 Type specification:Small size
Sterile rubber surgical gloves Guilin Hengbao health protection Co.,  Ltd 6971787071320 Type specification:6.5
Sterile self-adhesive dressing Shanghai ISO Medical Products Co., Ltd 601909414 Type specification:10 cm x 15 cm
Sterile water for injection Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd 6938493300953 Type specification:5 mL
Type II skin disinfectant Shanghai Likang Disinfection high-tech Co., Ltd 6909157000359 Type specification:500 mL/ bottle
Ultrasound Suzhou Daer Medical Equipment Co., Ltd 100018857 uSmart3300 portable color ultrasound system
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Tags

Keyword Extraction: Small Needle KnifeFrozen ShoulderClinical EfficacyStage I-IIPain FunctionLife AbilityTherapeutic EffectsRepeatabilityAvailabilityPatient ManagementVisual Analogue ScoresConstant And Murley ScoresCoracohumeral Ligament Thickness
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Guo, S., Liu, D., Yang, Y., Hu, Z. Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder. J. Vis. Exp. (201), e65904, doi:10.3791/65904 (2023).
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