1.陇东学院,甘肃省庆阳市西峰区兰州路45号,745000
2.甘肃省庆阳市中医医院
3.天津中医药大学第一附属医院
jpjs_cn@sina.com
收稿:2021-12-17,
修回:2022-04-25,
纸质出版:2022-07-02
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白杨,宏亚丽,王薇等.滞动针针刺肌筋膜激痛点对粘连性肩关节囊炎患者局部软组织结构和温度的影响[J].中医杂志,2022,63(13):1256-1264.
BAI Yang,HONG Yali,WANG Wei,et al.The Effect of Stuck-moving Needle Acupuncture at Myofascial Trigger Point on the Local Soft Tissue Structure and Temperature Treatment of Adhesive Capsulitis Patients[J].Journal of Traditional Chinese Medicine,2022,63(13):1256-1264.
白杨,宏亚丽,王薇等.滞动针针刺肌筋膜激痛点对粘连性肩关节囊炎患者局部软组织结构和温度的影响[J].中医杂志,2022,63(13):1256-1264. DOI: 10.13288/j.11-2166/r.2022.13.012.
BAI Yang,HONG Yali,WANG Wei,et al.The Effect of Stuck-moving Needle Acupuncture at Myofascial Trigger Point on the Local Soft Tissue Structure and Temperature Treatment of Adhesive Capsulitis Patients[J].Journal of Traditional Chinese Medicine,2022,63(13):1256-1264. DOI: 10.13288/j.11-2166/r.2022.13.012.
目的
2
观察滞动针针刺肌筋膜激痛点治疗粘连性肩关节囊炎的效应及可能机制。
方法
2
72例粘连性肩关节囊炎患者随机分为滞动针针刺激痛点组、普通针刺组、康复功能锻炼组,每组24例。康复功能锻炼组给予肩关节康复功能锻炼,滞动针针刺激痛点组在康复功能锻炼的基础上联合滞动针针刺肩关节激痛点,普通针刺组在康复功能锻炼基础上针刺患侧肩髃、肩髎、肩贞、肩前、阿是穴。各组均隔日治疗1次,每周3次,治疗3周共9次。分别于治疗前后进行疼痛视觉模拟评分(VAS评分)并据此于治疗后判定临床疗效;采用肌骨超声观察治疗前后肩关节健侧和患侧盂肱关节腋下囊厚度、喙肱韧带厚度;采用红外热成像技术测量治疗前后肩关节患侧及健侧肩前部、肩侧部、肩后部的温度。
结果
2
治疗期间脱落2例,最终纳入分析滞动针针刺激痛点组24例,普通针刺组、康复功能锻炼组各23例。治疗后各组患者VAS评分均较本组治疗前下降(
P
<0.01);滞动针针刺激痛点组VAS评分低于康复功能锻炼组、普通针刺组,普通针刺组VAS评分低于康复功能锻炼组(
P
<0.05或
P
<0.01)。滞动针针刺激痛点组、普通针刺组、康复功能锻炼组患者愈显率分别为87.50%(21/24)、69.57%(16/23)、43.48%(10/23),滞动针针刺激痛点组愈显率高于康复功能锻炼组(
P
<0.01)。治疗前与本组健侧比较,各组患者患侧盂肱关节腋下囊、喙肱韧带厚度均增厚,肩前部、肩侧部、肩后部患侧温度升高(
P
<0.01);与本组治疗前比较,各组患者治疗后患侧盂肱关节腋下囊、喙肱韧带厚度均减少,肩前部、肩侧部、肩后部患侧温度亦降低(
P
<0.01)。滞动针针刺激痛点组对患侧盂肱关节腋下囊、喙肱韧带厚度的改善优于普通针刺组和单纯康复功能锻炼组(
P
<0.01),普通针刺组与康复功能锻炼组两项指标比较差异无统计学意义(
P
>0.05);滞动针针刺激痛点组在改善肩前部、肩侧部、肩后部温度患侧与健侧差值方面均优于康复功能锻炼组(
P
<0.05),滞动针针刺激痛点组与普通针刺组以上指标比较差异无统计学意义(
P
>0.05)。
结论
2
滞动针针刺肌筋膜激痛点治疗粘连性肩关节囊炎可明显改善患者肩关节疼痛并提高疗效,其可能是通过改善肩关节局部软组织形态和循环状态发挥治疗作用。
Objective
2
To explore the effect and mechanism of stuck-moving needle acupuncture at myofascial trigger points (MTrPs) in the treatment of adhesive capsulitis (AC).
Methods
2
Seventy-two cases of AC were randomly divided into stuck-moving needle acupuncture at MTrPs group, conventional acupuncture group, and functional exercise rehabilitation group, with 24 cases in each group. The functional exercise rehabilitation group received shoulder joint rehabilitation exercises, while the stuck-moving needle acupuncture group additionally accepted stuck-moving needle acupuncture at the MTrPs of the shoulder joints, and the conventional acupuncture group additionally received acupuncture at
Jianyu
(LI 15),
Jianliao
(SJ 14),
Jianzhen
(SI 9),
Jianqian
and ashi acupoints on the affected shoulder. Each group was treated once every other day, 3 times a week for 3 weeks, and 9 times in total. The pain visual analog scale (VAS) score was assessed before and after treatment, and the clinical effect was evaluated. Musculoskeletal ultrasound was used to observe the changes in the thickness of the axillary capsule of the glenohumeral joints and the thickness of the coracohumeral ligament on both unaffected and affected shoulders. Infrared thermal imaging technology was used to measure the changes of the temperature in the front, side and back of the shoulders before and after treatment.
Results
2
Two cases fell off during treatment, and finally 24 cases in the stuck-moving needle acupuncture group, 23 cases in the conventional acupuncture group and 23 cases in the functional exercise rehabilitation group were included in the analysis. After treatment, the VAS scores in all groups were reduced (
P
<0.01), and much lower score was found in the stuck-moving needle acupuncture group than in the other two groups, as well as in the conventional acupuncture group than in the functional excercise rehabilitation group (
P
<0.05 or
P
<0.01). The cure and markedly effective rates of the stuck-moving needle acupuncture group, conventional acupuncture group, and functional exercise rehabilitation group were 87.50% (21/24), 69.57% (16/23), and 43.48% (10/23), respectively, favoring the stuck-moving needle acupuncture group than the functional exercise rehabilitation group (
P
<0.01). Compared to those of the unaffected shoulder before treatment, the thickness of the axillary capsule of the glenohumeral joints and the coracohumeral ligament of the affected shoulder were thickened, and the temperatures of the front, side, and back of the affected shoulder increased (
P
<0.01); compared to those of the affected shoulder before treatment, the thickness of the axillary capsule of the glenohumeral joints and the coracohumeral ligament of the affected shoulder after treatment were reduced, and the temperatures of the front, side, and back of the affected shoulder decreased (
P
<0.01). The stuck-moving needle acupuncture group was better than the other groups in improving the thickness of the axillary capsule of the glenohumeral joints and the coracohumeral ligament of the affected shoulder (
P
<0.01), while there was no significant difference between the conventional acupuncture group and functional exercise rehabilitation group (
P
>0.05). The stuck-moving needle acupuncture group was superior than the functional exercise rehabilitation group in improving the temperatures of the front, side and back side of both unaffected and affected shoulders (
P
>0.01), but was not significantly different with the conventional acupuncture group (
P
>0.05).
Conclusion
2
Stuck-moving needle acupuncture at MTrPs can improve the shoulder pain and increase the clinical effect in the treatment of AC patients, possibly by changing the local soft tissue structure and circulation state of shoulder joints.
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