中药熏洗配合肩关节镜下松解术治疗冻结期肩周炎的临床研究

发布时间：2018-08-11 13:06

【摘要】：目的:肩关节周围炎是一种骨科常见疾病,以肩周疼痛、活动障碍等症状为其特点。该疾病发病率高、病程长,引起了临床的广泛关注,但对其有效治疗方案仍存在争议。本文探讨中药熏洗法结合肩关节镜下松解手术治疗冻结期肩周炎的临床疗效,找到治疗该病有效、安全的治疗途径,为临床治疗提供依据。方法:2014年12月到2016年12月,病人来源为符合纳入标准的80例冻结期肩周炎的患者,随机分为两组:治疗组40例,运用中药熏洗结合肩关节镜下松解手术;对照组40例,仅仅使用肩关节镜下松解手术,不给予中药熏洗疗法。分析治疗前后两组肩部疼痛主观评分、CMS、肩关节活动度,评定两组治疗方案的综合疗效。全数实验数据采用SPSS17.0统计软件给予分析。结果:1.VAS评分术后2周,两组患者治疗后VAS评分较治疗前均明显降低,且差异有统计学意义,(P0.05)。术后6周,对比两组组间VAS评分有统计学差异,(P0.05)。术后3月,两组组间VAS评分无统计学差异,(P0.05)。说明治疗组在缓解近期疼痛方面优于对照组。2.肩关节CMS评分术后2周,对两组患者进行CMS评分比较,两组相对于治疗前均有统计学差异,(P0.05)。术后6周,对比两组CMS评分有统计学差异,(P0.05)。术后3月,对比两组CMS评分有统计学差异,(P0.05)。说明治疗组在改善肩关节功能的近期、远期疗效均优于对照组。3.肩关节ROM的分析术后两周,对两组患者进行ROM比较,两组相对于治疗前均有统计学差异,(P0.05)。术后6周,对比两组ROM有统计学差异,(P0.05)。术后3月,对比两组ROM评分有统计学差异,(P0.05)。说明术后配合中药熏洗治疗可以明显增加肩关节活动度。4.疗效综合评定术后6周及术后3月对两组疗效经Radit检验,治疗组的愈显率明显高于对照组,P0.05,差异具有统计学意义,说明治疗组在治疗冻结期肩周炎方面的近期、远期疗效均优于对照组。结论:研究证明,肩关节镜下松解手术具有微创、软组织损伤小、松解精准、术后恢复快等优点。中药熏洗可使药物有效成分直达病所,操作方便,毒副作用小,对冻结期肩周炎患者术后疼痛、肩关节活动度、肩关节功能均有明显改善。中药熏洗配合肩关节镜下松解手术治疗冻结期肩周炎的近远期疗效均优于单纯采用肩关节镜下松解手术治疗,适合临床推广及运用。
[Abstract]:Objective: periarthritis of shoulder is a common orthopedic disease characterized by shoulder pain and dyskinesia. The disease has a high incidence and a long course, which has attracted wide attention in clinical practice, but its effective treatment is still controversial. This paper discusses the clinical effect of fumigation and washing combined with shoulder arthroscopy in the treatment of frozen scapulohumeral periarthritis, and finds an effective and safe way to treat the disease, which provides the basis for clinical treatment. Methods: from December 2014 to December 2016, 80 patients with frozen scapulohumeral periarthritis were randomly divided into two groups: treatment group (n = 40), treated group (n = 40) and control group (n = 40). Only use shoulder arthroscopy release surgery, do not give Chinese medicine fumigation therapy. The subjective score of shoulder pain and the range of shoulder motion were analyzed before and after treatment. All experimental data were analyzed by SPSS17.0 software. Results 1. The VAS scores of the two groups were significantly lower than those before treatment 2 weeks after treatment, and the difference was statistically significant (P0.05). Six weeks after the operation, there was statistical difference in VAS score between the two groups (P0.05). Three months after operation, there was no significant difference in VAS score between the two groups (P0.05). It shows that the treatment group is superior to the control group in relieving short-term pain. 2. Two weeks after the shoulder joint CMS score, the two groups of patients were compared with the CMS score, the two groups compared to the treatment before the statistical difference (P0.05). Six weeks after operation, there was a statistical difference in CMS scores between the two groups (P0.05). 3 months after operation, compared with the two groups of CMS scores were statistically different (P0.05). The results showed that the long-term effect of the treatment group was better than that of the control group in improving the function of shoulder joint in the short-term. The analysis of shoulder joint ROM two weeks after operation, the two groups of patients were compared with ROM, the two groups were compared with the treatment before the statistical difference (P0.05). Six weeks after the operation, compared with the two groups, there was a statistical difference in ROM (P0.05). 3 months after operation, compared with the two groups of ROM scores were statistically different (P0.05). The results showed that the combination of fumigation and washing with traditional Chinese medicine after operation could obviously increase the range of shoulder motion. 4. Comprehensive evaluation of curative effect 6 weeks after operation and 3 months after operation, Radit test showed that the effective rate of treatment group was significantly higher than that of control group (P0.05), the difference was statistically significant, indicating that the treatment group in the treatment of frozen period shoulder periarthritis in the near future. The long-term curative effect was better than the control group. Conclusion: the results show that the arthroscopic release of shoulder has the advantages of minimally invasive, soft tissue injury, accurate release and quick postoperative recovery. Fumigation and washing of Chinese medicine can make the active components of medicine direct to the sick place, the operation is convenient, the toxic side effect is small, and the pain, the range of motion of shoulder joint and the function of shoulder joint of frozen period shoulder periarthritis patients after operation are obviously improved. The short-term and long-term curative effect of fumigation and washing combined with shoulder arthroscopy in the treatment of frozen shoulder periarthritis is better than that of shoulder arthroscopy alone, so it is suitable for clinical popularization and application.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R686

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