奇穴特效针法与常规针法治疗肩关节周围炎改善疼痛及功能障碍的效果比较

目的：观察针刺健侧小腿穴位的奇穴特效针法对肩关节周围炎患者疼痛和运动功能的影响，并与传统针法进行比较。方法：选择2004—01／12在解放军广州疗养院颈肩腰腿痛中医特色疗法专科门诊及广州中医药大学第三附属医院骨科门诊就诊的肩关节周围炎患者115例，均符合《实用骨科学》中的诊断标准，随机分为治疗组80例，对照组35例。治疗组采用奇穴特效针法，取穴以左有病而右畔取，头有病而脚上针为原则，均取健侧小腿穴位，主穴肾关，配穴四肢或地皇。针法采用倒马针法、再配动气针法、削骨针法。对照组主穴取肩三针或肩骨禺、肩孺、肩孺，配穴取巨骨、曲池、合谷等，常规取穴，常规针法。两组均每天治疗1次，留针30min／次，每次治疗前后分别行疼痛程度（用0-10的数字进行量化，0对应无痛，10对应无法忍受）和肩关节运动功能（5级分类，0分为功能无限制，4分为严重限制）评估，1个疗程（5d）后进行综合效果评定，显效为肩痛显著缓解，肩关节运动功能提高2分以上。结果：进入结果分析治疗组和对照组分别保持为80和35例。①疼痛评分：1个疗程后治疗组评分显著低于对照组[（0．80&;#177;0．56）分，（2.25&;#177;0．44）分，（t=13．62，P〈0．01）]。②肩关节运动功能评分：1个疗程后治疗组评分显著低于对照组[（0．75&;#177;0．61）分，（1．97&;#177;0．45）分，（t=10．68，P〈0．01）]。③显效率：1个疗程后治疗组显著高于对照组[92．50％，34．29％，（X^2=43．75，P〈0．01）]。结论：与传统针刺疗法相比，奇穴特效针法治疗肩关节周围炎可以明显缓解疼痛、改善肩关节运动功能、提高干预效果，其原因可能与奇穴特效针法重视整体观念，能集中定向冲击病灶有关。     

不同治疗方法改善肩关节周围炎患者疼痛及关节活动障碍：效果比较分析

目的：探讨3种方法对肩关节周围炎(简称肩周炎)慢性疼痛及关节活动障碍的疗效，为临床提供选择最佳方案依据。方法：90例患者随机抽签法分为Ⅰ，Ⅱ，Ⅲ组，每组30例。Ⅰ组行星状神经节阻滞(stellateganglionblock，SGB)；Ⅱ组行肩胛上神经阻滞（suprascapularis nerve block，SNB)；Ⅲ组行臂丛神经阻滞加肩周局部神经阻滞(brachial plexus blocks and local nerve block，BPB+LNB)。3种治疗之后对患者使用视觉模拟评分法(VAS)进行主观疼痛改善评估。结果：治愈率Ⅰ组为66％(20／30)，Ⅱ组为70％(21／30)，Ⅲ组为90％(27／30)。Ⅲ组与Ⅰ，Ⅱ组比较差异有显著性意义(，=7．751，，=6．043，P&;lt;0．05)。疼痛改善评分Ⅰ组为1．97&;#177;2．40，Ⅱ组为1．83&;#177;2．42，Ⅲ组为0．63&;#177;1．10，Ⅲ组为最佳。结论：BPB+LNB是临床治疗肩周炎较好的方法，SGB，NSB可根据临床症状选择性应用。     

不同治疗方法改善肩关节周围炎患者疼痛及关节活动障碍:效果比较分析

目的:探讨3种方法对肩关节周围炎(简称肩周炎)慢性疼痛及关节活动障碍的疗效,为临床提供选择最佳方案依据。方法:90例患者随机抽签法分为I,II,III组,每组30例。I组行星状神经节阻滞(stellateganglionblock,SGB);II组行肩胛上神经阻滞(suprascapularisnerveblock,SNB);III组行臂丛神经阻滞加肩周局部神经阻滞(brachialplexusblocksandlocalnerveblock,BPB+LNB)。3种治疗之后对患者使用视觉模拟评分法(VAS)进行主观疼痛改善评估。结果:治愈率Ⅰ组为66%(20/30),II组为70%(21/30),III组为90%(27/30)。III组与I,II组比较差异有显著性意义(χ2=7.751,χ2=6.043,P<0.05)。疼痛改善评分I组为1.97±2.40,II组为1.83±2.42,III组为0.63±1.10,III组为最佳。结论:BPB+LNB是临床治疗肩周炎较好的方法,SGB,NSB可根据临床症状选择性应用。     

分期顺势针刀、针灸治疗肩关节周围炎的比较

目的：观察分期顺势治疗肩关节周围炎，针刀与针灸治疗的差异性。 方法：选择2004—11／2005—11四川省广元市中医院疼痛、针灸门诊患者，除自己要求针刀外，一般单数日为针刀治疗组，双数日为针灸对照组。诊断标准参照国家中医管理局1994年中医病证诊断疗效标准，肩周炎分期参照康复医学教材（3版），疼痛功能评估参考1990美国医学会永久病损指南及谟懒常数法。一般由3位医生同时分期、评估，排除神经根型颈椎病、结核、肿瘤（肺癌骨转移），骨折脱位，经常数量分法75分以下者为纳入病例。其中针刀治疗组疼痛期16例．平均功能积分31．6，粘连期20例，平均功能积分30．1；针灸对照组疼痛期15例，平均功能积分28．6，粘连期28例，平均功能积分30．4。两组积分经统计学处理．无显著性意义（其积分x^2=0．089，P〉0．75），说明两组具有可比性。分期多参照时区为主，结合症状，因个别因素不一致，如有的已推拿、针灸、封闭等干预治疗过、有的有不同程的外伤史。顺势主要顺应疾病的本身过程，具体体现在治疗疼痛期不配合手法，恢复期不顶治疗。针灸对照组采取针灸基本治疗，针刀治疗组采取针刀五点三维法治疗。针刀治疗7-10d 1次．一般一两次；针灸1次／d，6次／周，连续3周；两组均在20-30d内进行功能评估，均按35分以下为无效，36～55分为有效，56～75分为显效，76～95分为痊愈。 结果：79例患者，有6例未在规定时期复诊，纳入分析72圳。针刀治疗组痊愈26例，显效10例。治愈率72％；针灸对照组痊愈15例，显效21例，治愈率42％。两组疗效比较，差异显著（P〈0.05）。 结论：分期顺势治疗肩周炎疗效均较好，针刀明显优于针灸治疗。     

分期顺势针刀、针灸治疗肩关节周围炎的比较

目的:观察分期顺势治疗肩关节周围炎,针刀与针灸治疗的差异性。方法:选择2004-11/2005-11四川省广元市中医院疼痛、针灸门诊患者,除自己要求针刀外,一般单数日为针刀治疗组,双数日为针灸对照组。诊断标准参照国家中医管理局1994年中医病证诊断疗效标准,肩周炎分期参照康复医学教材(3版),疼痛功能评估参考1990美国医学会永久病损指南及谟懒常数法。一般由3位医生同时分期、评估,排除神经根型颈椎病、结核、肿瘤(肺癌骨转移),骨折脱位,经常数量分法75分以下者为纳入病例。其中针刀治疗组疼痛期16例,平均功能积分31.6,粘连期20例,平均功能积分30.1;针灸对照组疼痛期15例,平均功能积分28.6,粘连期28例,平均功能积分30.4。两组积分经统计学处理,无显著性意义(其积分χ2=0.089,P>0.75),说明两组具有可比性。分期多参照时区为主,结合症状,因个别因素不一致,如有的已推拿、针灸、封闭等干预治疗过、有的有不同程的外伤史。顺势主要顺应疾病的本身过程,具体体现在治疗疼痛期不配合手法,恢复期不预治疗。针灸对照组采取针灸基本治疗,针刀治疗组采取针刀五点三维法治疗。针刀治疗7～10d1次,一般一两次;针灸1次/d,6次/周,连续3周;两组均在20～30d内进行功能评估,均按35分以下为无效,36～55分为有效,56～75分为显效,76～95分为痊愈。结果:79例患者,有6例未在规定时期复诊,纳入分析72例。针刀治疗组痊愈26例,显效10例,治愈率72%;针灸对照组痊愈15例,显效21例,治愈率42%。两组疗效比较,差异显著(P<0.05)。结论:分期顺势治疗肩周炎疗效均较好,针刀明显优于针灸治疗。     

序贯五法改善肩关节周围炎患者关节功能障碍

为研究快速有效治疗肩周炎方法。将临床诊治的肩关节周围炎(肩周炎)患者100例,采用消炎镇痛液注射治疗、针刀及手法松解、HA-550型超激光疼痛治疗仪星状神经节照射,口服药物及功能锻炼(简称“序贯五法”)治疗。结果两个疗程达到临床治愈95例,显效25例,有效率100%。提示序贯五法可快速有效治疗肩周炎。     

关节松动术与推拿治疗肩关节周围炎疗效比较

目的观察80例肩关节周围炎(简称肩周炎)患者经过关节松动术和推拿治疗后的疗效.方法将80例肩周炎患者随机分为关节松动术组和推拿组,并分别给予关节松动术治疗和推拿治疗,治疗前、后进行肩关节活动度(ROM)和肩痛症状评估.结果两组患者治疗前、后肩关节ROM和肩痛症状较治疗前差异有非常显著性意义(P＜0.01);两组间肩关节ROM比较差异有非常显著性意义(P＜0.01),关节松动术组优于推拿组,肩痛症状改善两组比较差异无显著性意义.结论关节松动术是治疗肩周炎的有效方法.     

肩关节周围炎的物理治疗

肩关节周围炎目前以非手术治疗为主,治疗方案各有特色。采用物理方法治疗肩周炎患者64例,根据Constant-Murley肩关节功能评估标准评定,优良率为95.3%,疗效肯定。     

温电针刺肩周阿是穴及四关穴治疗肩关节周围炎50例分析

肩关节周围炎是临床上常见病,针灸疗法对其具有较好的临床疗效。笔者于2007—03—2009—08采用温电针刺肩周阿是穴及四关穴治疗肩关节周围炎50例,疗效满意,现将观察结果分析如下。     

手法治疗粘连性肩关节周围炎

采用滚揉、指按手法按摩并配合肩关节主动、被动运动治疗粘连性肩关节周围炎,痊愈55例,显效12例,无效1例。     

肩周筋膜炎的触发点针刺效应

目的:通过对肩周肌筋膜炎的患者进行触发点针刺治疗,以观察其临床效果。方法:选择2002-04/2004-10玉溪市人民医院骨科门诊治疗的肩关节周围炎(简称肩周炎)患者30例。肩关节前屈、外展受限。应用10g/L利多卡因注射液对肩周的三角肌、肱二头肌痛点进行针刺治疗,每隔7～12d1次,治疗两三次。并进行三角肌、肱二头肌的牵张锻炼,3次/d。治疗后3个月采用自拟评分对患者疼痛和肩关节活动度进行评定(共为8分,1分为无痛,8分为受累肌疼痛较重,整个肩关节活动受限,夜痛)。结果:按意向处理分析,30例患者均进入结果分析。①患者疼痛评分:治疗后3个月疼痛评分明显低于治疗前[(1.40±0.67),(5.90±0.99)分,t=48.7,P<0.01]。②患者肩关节活动度:治疗后平均外展、前屈角度明显大于治疗前治疗前(113.4°比46.3°,98.4°比33.5°)。结论:针刺治疗肩周肌筋膜炎能够明显地减轻疼痛,改善因其引起的肩关节活动障碍。     

肩周筋膜炎的触发点针刺效应

目的：通过对肩周肌筋膜炎的患者进行触发点针刺治疗，以观察其临床效果。方法：选择2002—04／2004—10玉溪市人民医院骨科门诊治疗的肩关节周围炎（简称肩周炎）患者30例。肩关节前屈、外展受限。应用10g／L利多卡因注射液对肩周的三角肌、肱二头肌痛点进行针刺治疗，每隔7～12d1次，治疗两三次。并进行三角肌、肱二头肌的牵张锻炼，3次／d。治疗后3个月采用自拟评分对患者疼痛和肩关节活动度进行评定（共为8分，1分为无痛，8分为受累肌疼痛较重，整个肩关节活动受限，夜痛）。结果：按意向处理分析，30例患者均进入结果分析。①患者疼痛评分：治疗后3个月疼痛评分明显低于治疗前[（1．40&;#177;0.67），（5．90&;#177;0．99）分，t=48．7，P〈0．01]。②患者肩关爷活动度：治疗后平均外展、前屈角度明显大于治疗前治疗前（113．4&;#176;比46.3&;#176;，98.4&;#176;比33．5&;#176;）。结论：针剌治疗肩周肌筋膜炎能够明显地减轻疼痛，改善因其引起的肩关节活动障碍。     

Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial

OBJECTIVES: To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness (Japanese: katakori) with those of sham acupuncture. DESIGN: Randomized-controlled trial. METHODS: Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness, who had no arm symptoms and gave informed consent, were randomly allocated to acupuncture or sham groups. Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks. In the acupuncture group the acupuncture needle was inserted to the muscle, then the sparrow pecking technique was applied five times. Sham acupuncture was done without insertion of the needle. Dull pain and stiffness were evaluated by visual analog scale (VAS) before, and every 2 days after the first needling for 1 month. Pressure pain threshold on the tender points was measured before and after each treatment. RESULTS: There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment. However, the acupuncture group showed significant reduction of VAS scores immediately after and/or 1 day after the real acupuncture treatments (P<0.01). The effect tended to be prolonged after repeated treatment. Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture. CONCLUSIONS: Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness, but this study was unable to demonstrate any long-term superiority over sham acupuncture.     

电员针—运动疗法治疗肩凝症生物力学初探

Objective To introduce the treatment for periarthritis of shoulder by detachment of impulse electrotherapeutic equipment and kinesiatrics,and discuss the principles of biomechanics.Method 76 cases with periarthritis of shoulder had been treated with electrotherapeutic equipment and tri dimensional movement,and mean treatment times were 8.2.Results 65 cases were fully recover,9 cases were effective,2 cases took a favorable turn and 0 case were non effective.Conclusion The therapeutic method is effective and aim directly at periarthritis of shoulder.We have explored the direction,strength and position of the force.     

Alflutop in local therapy of shoulder periarthritis

AIM: To study efficacy of a compound biological preparation alflutop in local therapy of shoulder periarthritis (SP), to compare its efficacy with that of periarticular diprospan. MATERIAL AND METHODS: The trial included 54 patients with SP. Clinical SP forms consisted of subacromial and subdeltoid bursitis (SSB) (42.6%), tendinitis (57.4%). Acute disease was diagnosed in 35.2% patients, chronic one--in 64.8%. Alflutop and diprospan were injected periarticularly. The patients were divided into three groups. Patients of group 1 (n = 15) received alflutop monotherapy (2 ml, 5 injections). Group 2 (n = 24) received a single injection of diprospan (7 mg). Group 3 (n = 15) patients were given combined treatment: a single injection (7 mg) of diprospan followed by alflutop infiltrations (2 mg, 5 injections). The efficacy of the treatment was judged by some score clinical parameters, dynamometrical findings, SDQ score set, thermographic and ultrasonic signs of periarticular inflammation. RESULTS: A course of periarticular alflutop infiltrations in SP demonstrated the same efficacy as a single dose diprospan. However, in acute SP with bursitis diprospan produced a significantly better results while alflutop was better in chronic SP with tendinitis. Diprospan combination with alflutop produced the highest therapeutic effect irrespective of the disease course and clinical SP course. CONCLUSION: Local administration of alflutop in SP as monotherapy alternative to glucocorticosteroids or in combination with diprospan is effective. A differentiated approach allowing for a clinical form and course of SP raises therapeutic efficacy noticeably.     

Management of hemiplegic shoulder pain following stroke

Shoulder pain is a common problem following stroke. Patients may present with varying degrees of paralysis (hemiplegia), which commonly affects the arm. As a consequence, the stability of the shoulder may be compromised with subsequent risk of damage to soft tissue structures. Patients with more severe paralysis of the arm are increasingly likely to develop shoulder pain. The underlying causes of shoulder pain, and the sources of this pain, have been the subject of debate and research for many years. There is recent evidence to suggest that damage to soft tissues can occur during post-stroke care in hospital. An evidence-based, multidisciplinary approach should be used to prevent damage to the shoulder and enable management of any complications that arise.