Abstract:

Objective　To observe the clinical efficacy and safety of small-needle knife loosening combined with traditional Chinese medicine hot compress in the treatment of adhesive frozen shoulder syndrome. Methods　A total of 80 patients with adhesive frozen shoulder syndrome admitted to Baoji Second Hospital of Traditional Chinese Medicine from August 2023 to May 2024 were prospectively selected and were divided into two groups with 40 cases in each group by drawing lots. Group A included 12 males and 28 females, aged (57.74±7.88) years, the course of disease was (5.25±1.33) months, and there were 24 cases on the left shoulder and 16 cases on the right shoulder. Group B included 14 males and 26 females, aged (58.01±7.16) years, the course of disease was (5.21±1.42) months, and there were 21 cases on the left shoulder and 19 cases on the right shoulder. Group A was treated with small-needle knife loosening alone, once every two weeks, twice in total. Group B was treated with small-needle knife loosening combined with hot compress of traditional Chinese medicine: hot compress of traditional Chinese medicine was started 1 day after small-needle knife loosening, once a day, 30 min each time, continuous treatment for 4 weeks, and hot compress was suspended once in case of small-needle knife treatment day. The McGill pain questionnaire score, interleukin-10 (IL-10), IL-6, periarticular shoulder muscle strength, shoulder range of motion, and total clinical effective rate were compared between the two groups. t test and χ² test were used for statistical analysis. Results　After treatment, The Present Pain Intensity (PPI) scores [(1.45±0.34) and (0.85±0.22) points], Visual Analogue Scale (VAS) scores [(2.45±0.74) and (1.60±0.48) points], Pain Rating Index (PRI) scores [(10.10±1.78) and (6.75±1.26) points] in group A and B were lower than those before treatment, and those in group B were lower than those in group A (all P<0.05). After treatment, the levels of IL-10 in group A and B were higher than those before treatment, and the levels of IL-6 were lower than those before treatment; the level of IL-10 in group B was higher than that in group A, and the level of IL-6 was lower than that in group A (all P<0.05). After treatment, the peak anterior flexion moments [(42.63±4.22) and (51.04±4.89) N/m], average power of anterior flexion [(45.52±5.11) and (56.65±6.02) W], peak abduction moments [(44.15±4.29) and (52.05±5.21) N/m], and average power of abduction [(44.12±5.27) and (51.77±4.82) W] in group A and B were higher than those before treatment, and those in group B were higher than those in group A (all P<0.05). After treatment, the ranges of motion of shoulder anterior flexion, posterior extension, internal rotation, external rotation, and abduction in group A and B were higher than those before treatment, and those in group B were higher than those in group A (all P<0.05). The total effective rate of group B [95.00% (38/40)] was higher than that of group A [80.00% (32/40)], with a statistically significant difference (P<0.05). Conclusion Small-needle knife loosening combined with traditional Chinese medicine hot compresses in the treatment of adhesive frozen shoulder syndrome can reduce the pain, improve the degree of shoulder joint restriction, regulate the expressions of inflammatory factors, and improve the treatment efficacy.

Key words:

Adhesive frozen shoulder syndrome, Small-needle knife loosening, Traditional Chinese medicine hot compress, Shoulder joint restriction, Inflammatory factors

摘要：

目的　观察小针刀松解联合中药热敷治疗粘连性肩周炎的临床疗效与安全性。方法　前瞻性选取2023年8月至2024年5月宝鸡市第二中医医院收治的粘连性肩周炎患者80例，采用抽签法分为两组，每组40例。松解组男12例，女28例；年龄（57.74±7.88）岁；病程（5.25±1.33）个月；左肩24例，右肩16例。松解+热敷组男14例，女26例；年龄（58.01±7.16）岁；病程（5.21±1.42）个月；左肩21例，右肩19例。松解组单纯采用小针刀松解治疗，每2周一次，共2次。松解+热敷组采用小针刀松解联合中药热敷治疗，小针刀治疗后1 d开始中药热敷治疗，1次/d，每次30 min，连续治疗4周，如遇小针刀治疗日则暂停热敷一次。比较两组McGill疼痛问卷评分、白细胞介素-10（IL-10）、IL-6、肩关节周围肌力、肩关节活动度、临床总有效率。采用t检验、χ²检验进行统计学分析。结果　治疗后，松解组与松解+热敷组现有疼痛强度（PPI）评分［（1.45±0.34）分和（0.85±0.22）分］、视觉模拟评分法（VAS）评分［（2.45±0.74）分和（1.60±0.48）分］、疼痛分级指数（PRI）［（10.10±1.78）分和（6.75±1.26）分］均低于治疗前，且松解+热敷组低于松解组（均P<0.05）。治疗后，松解组与松解+热敷组IL-10高于治疗前、IL-6低于治疗前，且松解+热敷组IL-10高于松解组、IL-6低于松解组（均P<0.05）。治疗后，松解组与松解+热敷组前屈峰力矩［（42.63±4.22）N/m和（51.04±4.89）N/m］、前屈平均功率［（45.52±5.11）W和（56.65±6.02）W］、外展峰力矩［（44.15±4.29）N/m和（52.05±5.21）N/m］、外展平均功率［（44.12±5.27）W和（51.77±4.82）W］均大于治疗前，且松解+热敷组大于松解组（均P<0.05）。治疗后，松解组与松解+热敷组肩关节前屈、后伸、内旋、外旋、外展活动度均大于治疗前，且松解+热敷组大于松解组（均P<0.05）。松解+热敷组总有效率［95.00%（38/40）］高于松解组［80.00%（32/40）］，差异有统计学意义（P<0.05）。结论　小针刀松解联合中药热敷治疗粘连性肩周炎可减轻疼痛程度，改善肩关节受限，调节炎症因子表达，提高疗效。

关键词:

粘连性肩周炎, 小针刀松解, 中药热敷, 肩关节受限, 炎症因子