鲑鱼降钙素喷鼻剂配合常规方案治疗冻结肩的临床疗效研究

目的评估鲑鱼降钙素喷鼻剂配合常规方案治疗冻结肩的临床疗效。 方法收集2016年1月至2017年3月于中山大学孙逸仙纪念医院门诊就诊的原发性冻结肩患者。入组患者需经止痛药物及功能康复锻炼治疗6周以上，无明显改善但未行关节腔内注射治疗；拍摄X线片排除钙化性肌腱炎、肩关节骨关节炎，并根据体查选择性拍摄MR排除肩袖损伤。满足以上基本条件且无影像学异常的患者，可以自主选择进入降钙素组或对照组治疗。对照组予以功能锻炼、口服塞来昔布及单次肩关节注射治疗，降钙素组在对照组治疗方案的基础上加用鲑鱼降钙素喷鼻剂治疗3个月。评估患者治疗前、治疗后1、2、3、6个月疼痛视觉模拟评分(VAS)及肩关节活动度，并定期评估Constant评分及美国肩肘外科协会(ASES)评分。使用独立t检验及重复测量方差分析比较两组在各个时间点的临床数值差异。 结果降钙素组有39人、对照组有37人完成试验。在治疗后的第1个月，降钙素组的VAS评分(2.9±0.7)明显低于对照组(4.5±1.0)(t ＝－8.120，P <0.01)。到治疗的第2个月，前屈上举、外展、体侧外旋、后伸内旋的活动度在降钙素组分别为(121.7±18.5)°，(105.8±9.6)°，(30.6±7.7)°，(11.6±3.2)°；而对照组则分别为(104.9±19.0)°，(91.5±9.2)°，(21.5±6.4)°，(13.9±2.8)°；4个方向活动范围都优于对照组，差异有统计学意义(前屈上举F＝38.855，外展F＝41.204，体侧外旋F＝55.341,后伸内旋F＝7.963,均为P <0.05)。治疗后，降钙素组的Constant评分及ASES评分已接近正常，优于对照组(Constant评分F＝55.161，ASES评分F＝70.576，均为P <0.05 )。 结论在常规治疗方案的基础上，使用鲑鱼降钙素喷鼻剂可以更快地缓解冻结肩患者疼痛及更好地恢复患肩关节功能。

Evaluation of the clinical efficacy of salmon calcitonin intranasal spray combined with routine treatments in patients with frozen shoulder

ObjectiveTo evaluate the clinical efficacy of salmon calcitonin intranasal spray combined with routine treatments in patients with frozen shoulder. MethodsBetween January 2016 and March 2017, primary frozen shoulder patients visited the shoulder clinic of Sun Yat-sen Memorial Hospital were evaluated. Patients received at least six weeks analgesia and physiotherapy treatments without significant improvement and had not underwent articular injection were suitable to enter our study. Patients with calcific tendinitis, shoulder joint osteoarthritis or rotator cuff tears, examined by X-ray or MRI, were excluded. The eligible patients might enter the study and choose to use calcitonin intranasal spray or not in their treatments. Patients in the control group received physiotherapy, Celecoxib and single intra-articular injection. Patients in the calcitonin group utilized the same therapeutic scheme as control group and combined the application of nasal calcitonin spray for three months. Patients’ pain measured by visual analog scale (VAS), and shoulder range of motion were evaluated before treatment and at one, two, three and six months after the initial treatment. Constant score and ASES score were assessed regularly. Independent Student’s t test and repeated measures ANOVA were used to compare the statistic differences between the two groups at each time point. ResultsThere were 39 patients in the calcitonin group and 37 patients in the control group. At the first month after initial treatment, the VAS score in calcitonin group (2.9±0.7)was significantly lower than control group(4.5±1.0)(t =-8.120, P <0.01). At the second month, the shoulder range of motion in flexion, abduction, external rotation and internal rotation in the calcitonin group were (121.7±18.5)°, (105.8±9.6)°, (30.6±7.7)°, (11.6±3.2)°, respectively. However, the shoulder range of motion in flexion, abduction, external rotation and internal rotation in the control group were (104.9±19.0)°, (91.5±9.2)°, (21.5±6.4)°, (13.9±2.8)°, respectively. Patients received calcitonin achieved much apparent shoulder range of motion improvement than control group (flexion: F=38.855; abduction: F=41.204; external rotation: F=55.341; internal rotation, F=7.963; all P<0.05). At the final follow-up, the Constant score and ASES score in the calcitonin group were nearly normal, better than the control group (Constant score: F=55.161; ASES score: F=70.576, both P<0.05). ConclusionBased on the conventional treatments, adding salmon calcitonin intranasal spray can alleviate frozen shoulder patient’s pain faster and restore shoulder function better.