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引用本文:吴薇薇，李莹莹，石莉.温针灸联合功能锻炼治疗肩周炎（寒凝筋脉证）的临床观察[J].世界中医药,2019,(12):.

温针灸联合功能锻炼治疗肩周炎（寒凝筋脉证）的临床观察

Clinical Observation on Warm Acupuncture Combined with Functional Exercise in the Treatment of Scapulohumeral Periarthritis(Cold Coagulating Muscles and Veins Syndrome)

投稿时间：2019-03-07

DOI：10.3969/j.issn.1673-7202.2019.12.060

中文关键词: 肩周炎寒凝筋脉证温针灸功能锻炼疼痛缓解肩关节活动度血清炎性反应因子中医内外合治

English Keywords:Periarthritis of shoulder Cold coagulation syndrome of muscles and veins Warming acupuncture Functional exercise Pain relief Shoulder range of motion Serum inflammatory factors TCM internal and external treatment

基金项目:海南省自然科学基金项目（817306）

作者	单位
吴薇薇，李莹莹，石莉	海南省人民医院，海口，570311

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中文摘要:

目的：探讨温针灸联合功能锻炼对肩周炎（寒凝筋脉证）患者疼痛缓解、肩关节活动度、血清炎性反应因子的影响。方法：选取2016年1月至2017年12月海南省人民医院收治的肩周炎（寒凝筋脉证）患者128例作为研究对象，按照随机数字表法分为对照组和观察组，每组64例。对照组患者给予功能锻炼，观察组患者则在对照组基础上加用温针灸联合治疗，2组均连续治疗4周为疗程。比较临床治疗的有效率，用视觉疼痛模拟评分（VAS）评价患侧肩部疼痛，用肩关节活动度（ROM）评价肩关节功能，测定血清中肿瘤坏死因子-α（TNF-α）、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素-10（IL-10）水平，统计复发情况。结果：观察组的临床有效率高达90.63%，相比于对照组的76.56%升高明显，差异有统计学意义（P<0.05）；与治疗前比较，治疗后2组患者的肩关节疼痛均有所改善，VAS评分均有所下降，同一时间点比较，以观察组的VAS评分明显低于对照组，差异有统计学意义(P<0.05)；治疗后，观察组患者的肩关节功能改善更明显，肩功能活动相关的前屈、外展、外旋、内旋度明显高于对照组，差异有统计学意义（P<0.05）；炎性反应状态改善更明显，血清中TNF-α、GM-CSF、IL-10水平明显低于对照组，差异有统计学意义（P<0.05）；随访6个月，观察组复发率5.41%明显低于对照组的复发率22.22%，差异有统计学意义（P<0.05）。结论：温针灸联合功能锻炼利于缓解肩周炎（寒凝筋脉证）患者的痛感，提高肩关节功能活动，其机制可能与抑制血清中TNF-α、GM-CSF、IL-10水平以减轻局部炎性反应损伤有关，且不易于复发，值得临床推广运用。

English Summary:

To investigate the effects of warm acupuncture combined with functional exercise on pain relief, shoulder range of motion and serum inflammatory factors in patients with periarthritis of shoulder(cold coagulating muscles and veins syndrome).Methods:From January 2016 to December 2017, 128 cases of scapulohumeral periarthritis(cold coagulating muscles and veins syndrome)admitted to Hainan General Hospital were selected as the research objects.According to the random number table method, they were divided into a control group and an observation group, with 64 cases in each group.Patients in the control group were given functional exercise, while patients in the observation group were treated with combined warm acupuncture and moxibustion on the basis of the control group.Both groups received continuous treatment for 4 weeks.The clinical efficacy was compared.Visual analogue scale(VAS)was used to evaluate the shoulder pain on the affected side.Range of motion(ROM)was used to evaluate shoulder function, and Tumor necrosis factor-α, Granulocyte macrophage-colony stimulating factor and interleukin-10 in serum was determined, and the recurrence rate was observed.Results:The clinical effective rate of the observation group was as high as 90.63%, which was significantly increased than that of the control group of 76.56%(P<0.05).Compared with before treatment, shoulder joint pain was improved in both groups after treatment, and VAS score was decreased in both groups.At the same time point, VAS score in the observation group was significantly lower than that in the control group(P<0.05).After treatment, the improvement of shoulder joint function was more significant in the observation group, and the forward flexion, abduction, external rotation and internal rotation related to shoulder function and activity were significantly higher than those in the control group(P<0.05).The levels of TNF-α, GM-CSF and IL-10 in serum were significantly lower than those in control group(P<0.05).Follow-up for 6 months, the recurrence rate of 5.41% in the observation group was significantly lower than that of 22.22% in the control group(P<0.05).Conclusion:Warm acupuncture combined with functional exercise is beneficial to alleviate the pain sensation of patients with periarthritis of shoulder(cold coagulating muscles and veins syndrome)and improve the functional activities of shoulder joint.The mechanism may be related to the inhibition of the levels of TNF-α, GM-CSF and IL-10 in serum to reduce local inflammatory injury, and it is not easy to relapse, so it is worthy of clinical promotion and application.

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