| 活血方定向透药联合体外冲击波治疗肩袖损伤的疗效观察 |
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Received:January 07, 2025
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| 作者 | Author | 单位 | Unit | E-Mail |
| 朱亚莉 |
ZHU Ya-li |
浙江省杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 楼宇梁 |
LOU Yu-liang |
浙江省杭州市萧山区中医院, 浙江 杭州 311201 |
Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 费慧 |
FEI Hui |
浙江萧山医院医共体总院宁围分院, 浙江 杭州 311201 |
Zhejiang Xiaoshan Hospital Medical Community Ningwei Branch, Hangzhou 311201, Zhejiang, China |
404001793@qq.com |
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| 期刊信息：《中国骨伤》2025年38卷，第3期，第245-251页 |
| DOI：10.12200/j.issn.1003-0034.20240235 |
| 基金项目:浙江省中医药科技计划项目(编号:2025ZX071) |
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目的: 探讨活血方定向透药联合体外冲击波治疗肩袖损伤的早期临床疗效。
方法: 回顾性分析2020年9月至2022年12月收治的42例肩袖损伤患者,根据治疗方法不同分为冲击波组和定向透药组。冲击波组20例,男12例,女8例,年龄47~68(63.2±3.3)岁;病程2~6(3.1±1.4)周;Ellman分级Ⅰ级10例,Ⅱ级10例;采用非甾体类药物+体外冲击波治疗。定向透药组22例,男16例,女6例;年龄44~67(61.0±2.3)岁;病程2~8(3.3±1.3)周;Ellman分级Ⅰ级12例,Ⅱ级10例;在冲击波组基础上联合活血方定向透药治疗。分别于治疗前、治疗后1和6个月比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、美国加州大学洛杉矶分校(University of California at Los Angeles,UCLA)肩关节功能评分以及关节活动度(range of motion,ROM);检测并比较两组肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1)、白细胞介素-6(interleukin-6,IL-6)变化情况;并比较两组并发症情况。
结果: 所有患者获得随访,冲击波组随访时间6~8(7.1±1.9)个月,定向透药组随访时间6~8(7.2±1.8)个月,两组比较差异无统计学意义(P>0.05)。治疗1、6个月,定向透药组VAS[(3.85±0.99)、(1.24±0.75)分]低于冲击波组[(4.91±0.89)、(1.81±0.84)分],差异有统计学意义(P<0.05);定向透药组UCLA评分[(25.25±2.34)、(32.71±2.33)分]高于冲击波组[(21.67±3.38)、(29.11±3.01)分],差异有统计学意义(P<0.05);定向透药组前屈[(139.15±20.39)、(150.14±20.55)°]、外旋[(63.46±16.62)、(73.35±13.82)°]、内旋[(46.99±2.93)、(58.24±2.10)°]优于冲击波组前屈[(130.61±22.27)、(141.28±19.47)°]、外旋[(57.36±17.53)、(68.12±13.64)°]、内旋[(41.21±3.10)、(49.16±3.21)°],差异有统计学意义(P<0.05)。治疗1、6个月,定向透药组TNF-α、IL-1、IL-6分别为[(2.12±0.49)、(2.06±0.55)、(0.69±0.26)μg·L-1]、[(1.27±0.25)、(1.14±0.23)、(0.37±0.11)μg·L-1]低于冲击波组[(2.87±0.51)、(2.67±0.48)、(0.92±0.21)μg·L-1]、[(1.88±0.26)、(1.36±0.27)、(0.45±0.09)μg·L-1],差异有统计学意义(P<0.05)。末次随访时根据UCLA评分,冲击波组优8例,良10例,差2例;定向透药组优10例,良10例,差2例;两组比较差异无统计学意义(P>0.05)。两组均未发现皮肤过敏、皮下出血、瘀斑、血管神经损伤等并发症。
结论: 活血方定向透药联合体外冲击波治疗肩袖损伤疗效确切,不仅可以松解局部粘连的组织,改善局部血液循环,加速局部软组织炎性渗出物的吸收,促进病变肌腱及韧带的恢复;还可有效缓解患者肩关节疼痛,改善肩部活动度,恢复肩关节功能,提高患者生活质量。 |
| [关键词]:外治法 中医定向透药 体外冲击波 肩袖损伤 中西医结合 |
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| Therapeutic effect of Huoxue prescription combined with extracorporeal shock wave on rotator cuff injury |
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Abstract:
Objective To explore early clinical efficacy and advantages of Huoxue Fang's directional dialysis combined with extracorporeal shock wave in treating rotator cuff injury.
Methods A retrospective analysis was performed for 42 patients with rotator cuff injury admitted from September 2020 to December 2022,and they were divided into shock wave group and directed dialysis group according to different treatment methods. There were 20 patients in shock wave group,including 12 males and 8 females; aged from 47 to 68 years old with an average of (63.2±3.3) years old;the course of disease ranged from 2 to 6 weeks with an average of (3.1±1.4) weeks;10 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;non-steroidal drugs and extracorporeal shock wave therapy were performed. There were 22 patients in directed dialysis group,including 16 males and 6 females;aged from 44 to 67 years old with an average of (61.0±2.3) years old;the course of disease ranged from 2 to 8 weeks with average of (3.3±1.3) weeks;12 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;with Huoxue prescription directed transdrug therapy based on shock wave group. Visual analogue scale (VAS),University of California at Los Angeles (UCLA) and range of motion (ROM) were compared between two groups before treatment,1 and 6 months after treatment;changes of tumor necrosis factor-α (TNF-α),interleukin-1 (IL-1) and interleukin-6 (IL-6) between two groups were detected and compared. The complications between two groups were compared.
Results All patients were followed up,shockwave group followed up for 6 to 8 months with an average of (7.1±1.9) months,6 to 8 months with an average of (7.2±1.8) months in directed dialysis group,with no statistical significance between two groups (P>0.05). At 1 and 6 months after treatment,VAS in directed dialysis group were (3.85±0.99),(1.24±0.75),which were lower than that in shock wave group (4.91±0.89),(1.81±0.84) (P<0.05). UCLA scores in directed dialysis group (25.25±2.34),(32.71±2.33) were higher than those in shock wave group (21.67±3.38) °,(29.11±3.01) °(P<0.05). Forward bending (139.15±20.39) °,(150.14±20.55) °,external rotation (63.46±16.62) °,(73.35±13.82) °,internal rotation (46.99±2.93) °,(58.24±2.10) ° in directed dialysis group were better than those in shock wave group (130.61±22.27) °,(141.28±19.47) °,external rotation (57.36±17.53) °,(68.12±13.64) °,internal rotation (41.21±3.10) °,(49.16±3.21) ° (P<0.05). At 1 and 6 months after treatment,TNF-α,IL-1 and IL-6 in directed dialysis group were (2.12±0.49),(2.06±0.55),(0.69±0.26) μg·L-1;(1.27±0.25),(1.14±0.23),(0.37±0.11) μg·L-1,which were lower than those in shock wave group (2.87±0. 51),(2.67±0.48),(0.92±0.21) μg·L-1,(1.88 ±0.26),(1.36±0.27),(0.45±0.09) μg·L-1(P<0.05). At the latest follow-up,8 patients got excellent result,10 good and 2 poor in shock wave group;10 patients excellent,10 good,and 2 poor in directed dialysis group;there was no significant difference between two groups (P>0.05). There were no complications such as skin allergy,subcutaneous hemorrhage,ecchymosis,vascular and nerve injury occurred in both groups.
Conclusion For the treatment of rotator cuff injury,Huoxue prescription combined with extracorporeal shock wave is effective,which could not only release the local adhesion tissue,improve local blood circulation,accelerate absorption of inflammatory exudate of the local soft tissue,and promote recovery of the diseased muscle bond and ligament. It could also effectively relieve shoulder pain,improve shoulder motion,restore shoulder function,improve patients' quality of life |
| KEYWORDS:External treatment TCM directional dialysis Extracorporeal shock waves Rotator cuff injury Integrative medicine |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱亚莉,楼宇梁,费慧.活血方定向透药联合体外冲击波治疗肩袖损伤的疗效观察[J].中国骨伤,2025,38(3):245~251 |
| 英文格式: | ZHU Ya-li,LOU Yu-liang,FEI Hui.Therapeutic effect of Huoxue prescription combined with extracorporeal shock wave on rotator cuff injury[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(3):245~251 |
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