肩周炎的社区康复

目的：探讨在社康中心治疗肩周炎的有效方法。方法：127例肩周炎随机分为两组,A组（62例）给予消炎痛＋推拿＋功能锻练,B组（65例）在A组治疗的基础上再给予曲安奈德＋利多卡因局部痛点封闭。结果：经2个疗程治疗,B组总有效率为98．46％,A组为85．48％,组间总有效率差异具有统计学意义（X^2=7．367,P〈0．01）,且B组痊愈率明显高于A组,差异有统计学意义（X^2=4．052,P〈0．05）。结论：部痛点封闭＋推拿＋功能锻练简单易行,疗效良好,是社康中心等基层医疗机构治疗肩周炎的有效方法。     

臭氧注射配合功能锻炼治疗肩周炎的临床观察

肩周炎是好发于中老人的常见疼痛性疾病,近一年来笔者运用臭氧注射配合功能锻炼,治疗肩周炎32例,取得了较好的临床效果。     

Frozen shoulder: A systematic review of therapeutic options

Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.     

超声引导下复方倍他米松联合玻璃酸钠注射治疗肩峰下滑囊炎的临床研究

目的评价超声引导下复方倍他米松联合玻璃酸钠注射治疗肩峰下滑囊炎（SAB）的疗效。 方法收集2013年1月至2014年9月因肩部疼痛于四川省人民医院附属医院超声科就诊的门诊患者200例,将其中72例诊断为单纯性SAB且欲行超声引导下肩峰下滑囊注射治疗的患者纳入本研究,随机分为2组。试验组给予复方倍他米松联合玻璃酸钠注射,对照组给予复方倍他米松注射,所有患者治疗后第1周和第4周进行电话随访,治疗前、后均进行疼痛评分（视觉模拟评分法,VAS）和肩关节主动外展活动度评分。 结果2组患者治疗后1周和4周,VAS评分及肩关节主动外展活动度评分均较治疗前明显改善（P均<0.05）。治疗后1周,试验组与对照组VAS评分及肩关节主动外展活动度评分比较,差异无统计学意义（P均>0.05）;治疗后4周,试验组VAS评分明显低于对照组（2.08±1.95 vs 3.14±2.0,P<0.05）,试验组肩关节主动外展活动度评分明显高于对照组（7.12±2.10 vs 6.11±1.93,P<0.05）。 结论超声引导下肩峰下滑囊内复方倍他米松联合玻璃酸钠注射可有效治疗SAB,其缓解疼痛及改善肩关节主动外展活动范围的短期疗效优于单一使用复方倍他米松注射治疗。     

Management of septic bursitis

Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.     

局部封闭联合小针刀和洛芬待因片口服联合中药热敷治疗膝关节鹅足滑囊炎的疗效比较

目的：比较局部封闭联合小针刀和洛芬待因片口服联合中药热敷治疗膝关节鹅足滑囊炎的临床疗效.方法：单侧膝关节鹅足滑囊炎患者85例,男27例,女58例;年龄38 ～81岁,中位数58岁;左侧34例,右侧51例;病程5d至8年,中位数11个月.按就诊顺序随机分为2组,观察组45例,对照组40例;观察组采用局部封闭联合小针刀治疗,对照组采用洛芬待因片口服联合中药热敷治疗.分别在治疗前、治疗后（观察组为治疗后1周,对照组为治疗1周后）,采用疼痛视觉模拟评分法对2组患者患膝疼痛情况进行评分,并对2组患者的疼痛评分和疗效进行比较.结果：治疗前2组患者患膝压痛、自发痛评分比较,组间差异均无统计学意义[（3.166±1.010）分,（3.019±1.069）分,t=0.402,P=0.553;（2.834±0.122）分,（2.791±0.139）分,t=0.523,P=0.326];治疗后2组患者患膝疼痛均有所缓解,且观察组疼痛缓解更明显,压痛和自发病评分均低于对照组[（0.938±0.171）分,（1.990±0.630）分,t=2.256,P=0.012;（0.806±0.220）分,（1.381±0.343）分;t=1.652,P =0.036];参照《中医病证诊断疗效标准》膝部滑囊炎疗效评定标准评价疗效,观察组治愈16例、好转24例、未愈5例,对照组治愈8例、好转21例、未愈11例,观察组疗效优于对照组（Z=-2.131,P=0.033）.结论：局部封闭联合小针刀治疗膝关节鹅足滑囊炎,可有效减轻患膝肿胀、缓解疼痛,有利于膝关节功能恢复,疗效优于洛芬待因片口服联合中药热敷.     

Pain,not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study

QuestionWhat are the functional differences between people with greater trochanteric pain syndrome (GT), hip osteoarthritis (OA) or an asymptomatic population as measured by walking, Time Up and Go, single leg standing and strength?DesignCross sectional study with blinded measurers.Participants38 participants with GT, 20 with end stage hip OA and 21 asymptomatic healthy control (AS) participants. All participants were women.Outcome measuresPain (numeric rating scale), Walking speed (m/s), cadence (steps/min) and step length (m) measured via the 10 m walk test and the Timed Up and Go; balance via single leg stance (s) duration; and hip abduction, adduction, medial and lateral rotation strength, standardized to body mass (BM) via the body mass average index (BMavg), measured via a wall mounted dynamometer.ResultsThe two symptomatic groups reported similar pain levels (p = 0.226), more pain then the AS group (p < 0.000). Compared to the AS participants, participants with GT or hip OA demonstrated lower walking speed (10mwt and TUG, p < 0.001), lower cadence and shorter duration single leg stance on the affected leg (p < 0.05). Participants with GT or hip OA also demonstrated bilaterally weaker hip abduction than the AS group (p ≤ 0.005). Compared to AS and GT participants, participants with hip OA demonstrated adduction weakness on the affected side (p = 0.008 and p = 0.002 respectively).ConclusionThere is a significant level of dysfunction and impairments associated with GT and hip OA. As activity limitations do not appear to be differentiated by structural impairments, we suggest that pain, rather than the underlying pathology may be the driving impairment that leads to walking and single leg standing dysfunction.     

The US,CT and MR findings of cubital bursitis: a report of five cases

 Objective. The purpose of the study was to evaluate the appearance of ”cubital bursitis” on ultrasonography and CT and MR imaging. ”Cubital bursitis” is a rare pathological condition involving a large swelling of the bicipito-radial or interosseous bursae located at the insertion of the distal biceps tendon on the radial tuberosity. Design and patients. We report on five patients with ”cubital bursitis” resulting from their work or sporting activities. All patients underwent an ultrasound and MR examination. CT scans were performed on two patients before and after contrast enhancement. Results. Ultrasound studies showed a fusiform anechoic or hypoechoic lesion. CT images showed the lesions but there were some difficulties in determining the exact extent of the bursae. MR imaging showed the enlarged bursae and their fluid content. Four patients each underwent a surgical procedure. Conclusion. Ultrasound and CT were effective in the evaluation of ”cubital bursitis”, but with some diagnostic difficulties. MR imaging is probably the method of choice for determining both the development of the bursae and their fluid content.     

曲安奈德（同息通）注射治疗肩周炎150例疗效观察

目的：观察曲安奈德注射（同息通）治疗肩周炎的疗效。方法：采用曲安奈德（同息通）、利多卡因等配制的阻滞液，阻滞．患侧颈丛、臂丛神经。结果：本组共150例，痊愈厦好转150例（治愈率62％，优良率100％。结论：曲安奈德（同息通）是一种安全的糖皮质激素药物，可供临床疼痛治疗中选择使用。