[1]李辉,刘涛△,胡大佑.魏氏伤科“肩六步”手法结合导引治疗冻结肩的临床研究[J].中国中医骨伤科杂志,2024,32(08):7-12.[doi:10.20085/j.cnki.issn1005-0205.240802 ]
　LI Hui,LIU Tao,HU Dayou.Clinical Study of Combining “Six-Step Shoulder Manipulation” of Wei's Traumatology with Daoyin Exercise to Treat Frozen Shoulders[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(08):7-12.[doi:10.20085/j.cnki.issn1005-0205.240802 ]
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魏氏伤科“肩六步”手法结合导引治疗冻结肩的临床研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年08期
页码:
7-12
栏目:
临床研究
出版日期:
2024-08-15

文章信息/Info

Title:
Clinical Study of Combining “Six-Step Shoulder Manipulation” of Wei's Traumatology with Daoyin Exercise to Treat Frozen Shoulders
文章编号:
1005-0205(2024)08-0007-06
作者:
李辉1; 刘涛2△; 胡大佑2
1上海市静安区闸北中心医院(上海,200070)；2上海交通大学医学院附属瑞金医院
Author(s):
LI Hui1; LIU Tao2△; HU Dayou2
1Jing'an District Zhabei Central Hospital,Shanghai 200070,China; 2Ruijing Hospital Affiliated to Shanghai Jiao Tong Univercity School of Medicine,Shanghai 200025,China.
关键词:
冻结肩;  魏氏伤科;  手法;  导引
Keywords:
frozen shoulders;  Wei's traumatology;  manipulation;  Daoyin exercise
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.240802
文献标志码:
A
摘要:
目的:观察魏氏伤科“肩六步”手法结合导引治疗冻结肩的临床疗效。方法:选取冻结肩患者120例,随机分成三组,即手法结合导引组(结合组)、手法组、导引组,每组各40例。比较三组患者治疗前、治疗后第4周和第8周疼痛视觉模拟量表(VAS)评分、Constant-Murley肩关节功能量表(CMS)评分、肩关节活动度(ROM)变化,评价三组患者治疗后总体疗效。结果:110例患者完成全部治疗及随访。治疗前三组患者疼痛VAS评分、CMS评分及肩关节活动度差异无统计学意义(P>0.05)。治疗后第4周,疼痛VAS评分结合组与手法组比较差异无统计学意义(P>0.05),结合组VAS评分显著小于导引组,差异有统计学意义(P<0.05); CMS评分结合组显著大于手法组和导引组,差异有统计学意义(P<0.05)。肩关节活动度比较:前屈、后伸、外展、外旋活动结合组与手法组差异无统计学意义(P>0.05); 结合组显著大于导引组,差异有统计学意义(P<0.05); 内收、内旋结合组与手法组和导引组差异无统计学意义(P>0.05)。治疗后第8周,结合组疼痛VAS评分显著低于手法组和导引组,差异有统计学意义(P<0.001),VAS评分手法组显著低于导引组,差异有统计学意义(P<0.05); CMS评分结合组显著高于手法组和导引组,差异有统计学意义(P<0.05),CMS评分手法组显著高于导引组,差异有统计学意义(P<0.001)。肩关节活动度比较,结合组显著大于手法组及导引组,差异有统计学意义(P<0.001)。三组疗效比较:总体疗效三组差异有统计学意义(P<0.05),两两比较结合组优于手法组和导引组(P<0.05),手法组与导引组比较差异无统计学意义(P>0.05)。结论:魏氏伤科“肩六步”手法结合导引能更快速有效治疗冻结肩,改善肩关节的整体功能。
Abstract:
Objective:To observe the clinical efficacy of combining “Six-Step Shoulder Manipulation” of Wei's traumatology with Daoyin exercise on the treatment of stiffened frozen shoulders.Methods:120 patients with frozen shoulders were selected and randomly divided into three groups,i.e.the manipulation combined with Daoyin exercise group(combination group),the manipulation group and the Daoyin exercise group.40 patients were included in each group in the clinical trial.The visual analogue scale(VAS)pain simulation score,shoulder functional evaluation(Constant-Murley shoulder function scale(CMS))score,range of motion(ROM),and overall efficacy evaluation were used in this study.The VAS pain simulation score and CMS score were compared among the three groups at pre-treatment and at 4 and 8 weeks post-treatment.The overall efficacy was evaluated at 8 weeks post-treatment.Results:110 patients completed all treatment and follow-up.Prior to treatment initiation,the three groups displayed no significant differences in pain VAS scores,shoulder joint function(as measured by CMS),or range of shoulder joint motion(P>0.05).At 4 weeks after treatment,there was no significant difference in pain VAS scores between the combination group and the manipulation group(P>0.05),and the VAS scores of combination group was significantly smaller than those of the Daoyin exercise group(P<0.05).Significant improvements were noted across all groups in terms of shoulder joint function.Notably,the combination group experienced superior outcomes compared to both the manipulation and Daoyin exercise groups(P<0.05).Regarding range of motion,no significant disparity was found between the combination and manipulation groups in flexion,extension,abduction,and external rotation(P>0.05).However,the combination group exhibited significantly greater enhancements than the Daoyin exercise group in these same movements(P<0.05).Adduction and internal rotation did not show any significant difference when the combination group was compared with the manipulation and Daoyin exercise groups(P>0.05).By the eight-week mark,the combination group's pain VAS scores were significantly lower than those of the manipulation and Daoyin exercise groups(P<0.001),with the manipulation group also scoring significantly lower than the Daoyin exercise group(P<0.05).Furthermore,shoulder joint function scores were significantly higher in the combination group compared to the other two groups(P<0.05),with the manipulation group outperforming the Daoyin exercise group(P<0.001).In terms of range of motion,the combination group demonstrated significantly greater improvements than both the manipulation and Daoyin exercise groups(P<0.001).An overall comparison of therapeutic efficacy among the three groups indicated significant variances(P<0.05).The combination group was found to be superior to both the manipulation and Daoyin exercise groups(P< 0.05),whereas no significant difference was detected between the manipulation and the Daoyin exercise groups(P>0.05).Conclusion:Combining “Six-Step Shoulder Manipulation” of Wei's traumatology with Daoyin exercise can effectively treat frozen shoulders and improve the overall function of shoulder joints.

参考文献/References:

[1] 中华中医药学会骨伤科分会.中医骨伤科临床诊疗指南·肩关节周围炎:T/CACM 11792019[J].上海中医药杂志,2022,56(3):1-5.
[2] KWAEES T A,CHARALAMBOUS C P.Rates of surgery for frozen shoulder:an experience in England[J].Muscles,Ligaments and Tendons Journal,2015,5(4):276-279.
[3] COHEN C,TORTATO S,SILVA O B S,et al.Association between frozen shoulder and thyroid diseases:strengthening the evidences[J].Revista Brasileira De Ortopedia,2020,55(4):483-489.
[4] 编辑部.上海交通大学附属瑞金医院“魏氏伤科”被列入上海市非物质文化遗产[J].上海交通大学学报(哲学社会科学版),2011,19(5):96.
[5] 杜炯,李飞跃.魏氏伤科学术经验概论[J].中外医学研究,2010,8(28):117-118.
[6] 李辉,刘涛,胡大佑.胡大佑三联外治法治疗冻结肩经验介绍[J].新中医,2020,52(11):208-210.
[7] 陈朝蔚,魏贤振,李飞跃,等.魏氏伤科导引联合关节镜手术治疗原发性冻结肩的疗效分析[J].老年医学与保健,2021,27(5):1042-1044.
[8] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:190-191.
[9] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].2版.北京:人民军医出版社,1995:1439-1441.
[10] LHO Y M,HA E,CHO C H,et al.Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder[J].Journal of Shoulder and Elbow Surgery,2013,22(5):666-672.
[11] 张涛,梁英,高敏,等.盂肱关节腔容量的测量对冻结肩临床分期及治疗影响的研究[J].中华老年骨科与康复电子杂志,2020,6(6):346-350.
[12] PARK G Y,KWON D R,CHO H K,et al.Clinical impairments and rotator cuff tendon pathology in primary and intrinsic secondary adhesive capsulitis[J].American Journal of Physical Medicine & Rehabilitation,2024,103(4):340-345.
[13] 方业汉,周钢,黄晖,等.关节镜下同期治疗肩袖损伤与冻结肩的临床分析[J].中国运动医学杂志,2018,37(7):565-569.
[14] 周玉兰,袁德超,吴超,等.超声引导下肩关节腔注射联合液压扩张治疗不同临床分期冻结肩[J].华西医学,2021,36(12):1679-1685.
[15] 邱文聪,魏锦强,曹学伟,等.关节镜下松解与麻醉下手法松解治疗冻结肩疗效比较的Meta分析[J].中国骨与关节损伤杂志,2022,37(2):113-117.
[16] COOLS A M,WITVROUW E E,DECLERCQ G A,et al.Scapular muscle recruitment patterns:trapezius muscle latency with and without impingement symptoms[J].The American Journal of Sports Medicine,2003,31(4):542-549.
[17] WOODS D A,LOGANATHAN K.Recurrence of frozen shoulder after manipulation under anaesthetic(MUA):the results of repeating the MUA[J].The Bone & Joint Journal,2017,99-B(6):812-817.
[18] 刘丹,李武,潘杰灵,等.推拿治疗筋痹的理论探析[J].中医药导报,2023,29(5):124-127.
[19] 姜昆,罗素兰,李志远,等.罗氏正筋八法理论探讨及应用[J].中华中医药杂志,2019,34(12):5551-5554.
[20] 赵明宇,杨超凡,秦庆广,等.平乐正骨“筋滞骨错”理论指导下手法治疗冻结肩的临床研究[J].中华中医药杂志,2017,32(8):3846-3848.
[21] 方仪德,许金海,叶洁,等.国医大师施杞整肩三步九法治疗肩周炎的学术思想及临证经验[J].中国中医骨伤科杂志,2022,30(10):74-75.
[22] 艾买提·依米尔,闫慧新,杨林浩,等.严隽陶从筋论治肩关节周围炎学术经验撷英[J].上海中医药杂志,2023,57(3):34-37.
[23] 薛彬,李飞跃.李国衡教授对魏氏伤科治伤手法的学术贡献初探[J].中国中医骨伤科杂志,2017,25(12):77-78.
[24] 刘涛,谢贤斐,张昊.魏氏伤科传统手法作用初探[J].中医文献杂志,2018,36(2):36-38.
[25] 谢辉,唐成林,陈晓琳,等.按摩促进骨骼肌损伤后肌纤维再生机理的研究[J].重庆医科大学学报,2015,40(2):171-175.
[26] 张芷齐,赵娜,庞庚,等.按揉法对骨骼肌钝挫伤大鼠肌肉纤维化的影响[J].辽宁中医杂志,2020,47(3):197-199.
[27] 郑宽广,陈志标,许美珍,等.运动式推拿疗法联合关节松动术对冻结肩患者疼痛、肩关节活动及血清炎症指标的影响[J].陕西中医,2021,42(3):372-375.
[28] 刘光明,李飞跃.李飞跃治疗冻结肩经验拾萃[J].中医文献杂志,2020,38(6):57-60.
[29] 杨铎,程国杰,唐文献.运动疗法治疗冻结肩的临床进展[J].新疆中医药,2023,41(6):133-136.
[30] 张怀志,陈白,黄肖海,等.八段锦运动治疗肩周炎的临床效果[J].临床合理用药杂志,2018,11(21):85-87.
[31] 杨佳昕,邰东旭.五禽戏对冻结肩关节功能恢复的疗效观察[J].实用中医内科杂志,2020,34(11):65-68.
[32] 周超,刘彦,李伟.关节松动术、太极拳、β-七叶皂甙钠静脉滴注联合治疗肩关节周围炎[J].中华物理医学与康复杂志,2008,30(8):527-528.
[33] 付士芳,李跃彤,任凤蛟,等.中医传统功法易筋经在骨伤科疾病康复中的研究进展[J].天津中医药,2022,39(5):675-680.
[34] 李飞跃.魏氏伤科治疗学:治伤手法、导引疗法及用药[M].上海:上海科学技术出版社,2015:23-26.

备注/Memo

备注/Memo:
基金项目:2021年上海市静安区医学科研课题(中医2021ZY03) △通信作者 E-mail:Echo_It@126.com
更新日期/Last Update: 2024-08-05