目的:探讨高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤的疗效分析。方法:选取我院2018年11月至2020年11月收治的肩袖部分损伤患者60例作为研究对象,按数字表法将其随机分为对照组(n = 30)和观察组(n = 30),对照组给予肩峰下注射玻璃酸钠治疗,观察组给予高频超声精准定位下注射富血小板血浆结合针灸治疗,比较两组患者治疗临床效果;并于治疗前及治疗后3个月采用肩关节评分系统(UCLA)、美国肩肘关节外科医师协会评分(ASES)评分、肩关节功能测试CMS功能评分、视觉模拟法(VAS)评分评价两组患者肩功能;并于治疗后6个月观察两组患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。结果:观察组治疗有效率为96.67% (29/30)明显高于对照组73.33% (23/30),差异有统计学意义(p < 0.05);治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(p < 0.05);观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(p < 0.05)。结论:高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。 Objective: To investigate the therapeutic effect of high frequency ultrasound in the treatment of rotator cuff injury. Methods: 60 patients with partial rotator cuff injury admitted to our hospital from January 2017 to September 2020 were randomly divided into the control group (n = 30) and the observation group (n = 30) according to the numerical table method. The control group was given sodium hyaluronate injection under the acromion, the observation group was given platelet rich plasma injection combined with acupuncture treatment under the precise positioning of high frequency ultra sound, and the clinical treatment of the two groups was compared Before and 3 months after treatment, UCLA, ASES, CMS and VAS were used to evaluate the shoulder function of the two groups, and 6 months after treatment, including the time of pain disappearance and the time of calcification disappearance Time of disappearance of edema and recovery of activity func-tion. Results the effective rate of treatment in the observation group was 96.67% (29/30), which was significantly higher than that in the control group (73.33%), the difference was statistically significant (p < 0.05); after treatment, the scores of UCLA, ASES, CMS and VAS in the two groups were significantly higher than those before treatment, and the scores of UCLA, ASES, CMS and VAS in the observation group were significantly higher than those in the control group (p < 0.05); the time of pain disappearance and the disappearance of calcification focus in the observation group were significantly longer than those in the control group (p < 0.05). The time of loss, the time of disappearance of edema and the time of recovery of activity function were shorter than those of the control group (p < 0.05). Conclusion: Injection of platelet rich plasma combined with acupuncture and moxibustion under the precise location of high-frequency ultrasound can significantly improve the shoulder function of patients with partial rotator cuff injury, relieve pain, promote recovery, and have a significant effect.
目的:探讨高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤的疗效分析。方法:选取我院2018年11月至2020年11月收治的肩袖部分损伤患者60例作为研究对象,按数字表法将其随机分为对照组(n = 30)和观察组(n = 30),对照组给予肩峰下注射玻璃酸钠治疗,观察组给予高频超声精准定位下注射富血小板血浆结合针灸治疗,比较两组患者治疗临床效果;并于治疗前及治疗后3个月采用肩关节评分系统(UCLA)、美国肩肘关节外科医师协会评分(ASES)评分、肩关节功能测试CMS功能评分、视觉模拟法(VAS)评分评价两组患者肩功能;并于治疗后6个月观察两组患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。结果:观察组治疗有效率为96.67% (29/30)明显高于对照组73.33% (23/30),差异有统计学意义(p < 0.05);治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(p < 0.05);观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(p < 0.05)。结论:高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。
高频超声,富血小板血浆,针灸,肩袖部分损伤,疗效
Qingfeng Yi1, Huagang Hu2, Shaoming Zhu3, Jinhua Wu2
1Department of Ultrasound, Wenrong Hospital of Hengdian, Jinhua Zhejiang
2Department of Orthopedics, Wenrong Hospital of Hengdian, Jinhua Zhejiang
3Department of Ultrasound, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Zhejiang
Received: Dec. 23rd, 2020; accepted: Mar. 2nd, 2021; published: Mar. 26th, 2021
Objective: To investigate the therapeutic effect of high frequency ultrasound in the treatment of rotator cuff injury. Methods: 60 patients with partial rotator cuff injury admitted to our hospital from January 2017 to September 2020 were randomly divided into the control group (n = 30) and the observation group (n = 30) according to the numerical table method. The control group was given sodium hyaluronate injection under the acromion, the observation group was given platelet rich plasma injection combined with acupuncture treatment under the precise positioning of high frequency ultra sound, and the clinical treatment of the two groups was compared Before and 3 months after treatment, UCLA, ASES, CMS and VAS were used to evaluate the shoulder function of the two groups, and 6 months after treatment, including the time of pain disappearance and the time of calcification disappearance Time of disappearance of edema and recovery of activity function. Results the effective rate of treatment in the observation group was 96.67% (29/30), which was significantly higher than that in the control group (73.33%), the difference was statistically significant (p < 0.05); after treatment, the scores of UCLA, ASES, CMS and VAS in the two groups were significantly higher than those before treatment, and the scores of UCLA, ASES, CMS and VAS in the observation group were significantly higher than those in the control group (p < 0.05); the time of pain disappearance and the disappearance of calcification focus in the observation group were significantly longer than those in the control group (p < 0.05). The time of loss, the time of disappearance of edema and the time of recovery of activity function were shorter than those of the control group (p < 0.05). Conclusion: Injection of platelet rich plasma combined with acupuncture and moxibustion under the precise location of high-frequency ultrasound can significantly improve the shoulder function of patients with partial rotator cuff injury, relieve pain, promote recovery, and have a significant effect.
Keywords:High Frequency Ultrasound, Platelet Rich Plasma, Acupuncture, Rotator Cuff Partial Injury, Curative Effect
Copyright © 2021 by author(s) and Hans Publishers Inc.
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肩关节是人体活动度最大、最不稳定的典型的球窝关节,而其中肩袖是维持肩关节动态稳定的重要部位,当肩袖发生损伤时将引起肩关节疼痛,使肩部主动活动受限 [
选取我院2018年11月至2020年11月收治的肩袖部分损伤患者60例作为研究对象,按数字表法将其随机分为对照组(n = 30)和观察组(n = 30)。纳入标准:① 所有患者均经影像学检查确诊为肩袖部分损伤;② 表现患侧上肢活动受限、肩关节疼痛;③ 或家属均同意并签署知情同意书。排除标准:① 合并心、肝、肾等重大器官严重障碍者;② 肩关节内有内容物者,包括金属或非金属;③ 肩部损伤部位皮肤破损者;④ 合并感染或恶性肿瘤者;⑤ 妊娠及哺乳期妇女;⑥ 不配合研研究者。其中对照组男17例,女13例;年龄31~75岁,平均年龄(52.14 ± 7.61)岁;病程10 d~2.22个月,平均病程(43.31 ± 11.49) d;受损部位:左侧16例,右侧14例;损伤原因:运动13例,跌倒17例。观察组男15例,女15例;年龄31~76岁,平均年龄(52.12 ± 7.64)岁;病程10 d~2.18个月,平均病程(43.34 ± 11.36) d;受损部位:左侧17例,右侧13例;损伤原因:运动12例,跌倒18例。两组患者年龄、性别、病程等基本资料上相比差异无统计学意义(p < 0.05),具有可比性。
1) 对照组:给予肩峰下注射玻璃酸钠治疗,先对肩峰下间隙进行穿刺标记,采用含玻璃酸钠透明的质酸盐(厂家:生化学工业株式会社高,批准文号:H20140533,规格:每支2.5 mL)的注射器针头进行穿刺注射,每周注射1次,治疗疗程为5周。
2) 观察组:给予高频超声精准定位下注射富血小板血浆结合针灸治疗:抽取患者肘静脉血40 ml,加枸橼酸钠5 ml抗凝,于3200 r/min,4 min行第1次离心,后缓慢转动红细胞腔悬锁帽,锁定血清腔白膜层,倒转装置3300 r/min,5 min进行第2次离心,离心后旋转PRP锁定杆,混匀后将制备好的PRP抽取备用。取坐位,于局部麻醉下进行治疗,于患肩采用超声探头放置行肩袖部分损伤病灶的定位,标记最恰当的穿刺点位置。在高频超声引导下将制备出的4 ml PRP注入标记穿刺点。针灸治疗:治疗时患者取端坐位,使用0.25 mm × 40 mm的无菌针灸针,待将损伤部位常规消毒后,用泻法将针灸针垂直刺入于皮肤患侧巨骨、肩髎、肩前、肩贞、肩内陵和曲池等穴位,以患者能耐受刺激强度以及2~3 cm深度为佳。每次治疗时间为30 min,1次/每周,共治疗6次。
1) 较两组患者治疗临床效果;① 治愈,疼痛反应得到显著改善及控制,肩功能恢复较佳;② 好转,疼痛反应及肩功稍有改善,但效果并不显著;③ 无效,患者经过治疗后,疼痛反应并未得到任何改变。治疗有效率 = (治愈 + 好转)/总例数 × 100%。
2) 并于治疗前及治疗后3个月采用肩关节评分系统(UCLA)、美国肩肘关节外科医师协会评分(ASES)评分、肩关节功能测试CMS功能评分、视觉模拟法(VAS)评分评价两组患者肩功能。UCLA肩关节评分系统(the university of California at Los Angeles shoulder rating scale, UCLA)包括疼痛、功能、活动、力量、满意度五个方面,总分35分。分数越高肩功能越好。美国肩肘医师协会评分(Automated Software Evaluation System, ASES)包括主观疼痛和生活功能2个方面,总分100分,分数越高则肩关节功能越好。肩关节功能测试CMS功能评分(Constant-Murley Shoulder Function Score Scale, CMS)包括疼痛、活动、力量、活动度等4个方面,分数越高表示肩功能越好。视觉模拟法(VAS)分值为0~10分,分值越高则表示患者疼痛越严重。
3) 并于治疗后6个月观察两组患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。
采用SPSS21.0统计软件处理数据,以均数±标准差表示定量资料,采用t检验;以百分比表示定性资料,采用X2检验,多组多分类资料用秩和检验z,以p < 0.05表示差异有统计学意义。
观察组治疗有效率为96.67% (29/30)明显高于对照组73.33% (23/30),差异有统计学意义(p < 0.05);如表1所示。
组别 | 治愈 | 好转 | 无效 | 治疗有效率 |
---|---|---|---|---|
观察组(n = 30) | 20 | 8 | 2 | 96.67% (29/30) |
对照组(n = 30) | 17 | 6 | 7 | 73.33% (23/30) |
X2 | 4.70 | |||
p | <0.05 |
表1. 两组患者临床治疗效果比较
治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(p < 0.05),如表2所示。
组别 | UCLA | ASES | CMS | VAS | ||||
---|---|---|---|---|---|---|---|---|
治疗前 | 治疗后 | 治疗前 | 治疗后 | 治疗前 | 治疗后 | 治疗前 | 治疗后 | |
观察组(n = 30) | 11.23 ± 2.32 | 32.11 ± 3.19 | 51.12 ± 5.24 | 92.13 ± 4.21 | 50.13 ± 4.67 | 88.32 ± 5.41 | 7.01 ± 2.41 | 1.21 ± 0.32 |
对照组(n = 30) | 11.27 ± 2.43 | 25.73 ± 3.18 | 51.09 ± 5.17 | 82.24 ± 5.85 | 50.14 ± 4.62 | 80.27 ± 5.34 | 6.98 ± 2.36 | 3.75 ± 0.86 |
t | 0.06 | 7.75 | 0.02 | 7.51 | 0.008 | 5.80 | 0.04 | 15.16 |
p | >0.05 | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 |
表2. 两组患者治疗前后肩功能情况比较
观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(p < 0.05),如表3所示。
组别 | 疼痛消失时间 | 术后钙化灶消失时间 | 水肿消失时间 | 活动功能恢复时间 |
---|---|---|---|---|
观察组(n = 30) | 115.67 ± 15.34 | 93.22 ± 12.42 | 81.24 ± 9.42 | 15.61 ± 10.72 |
对照组(n = 30) | 152.27 ± 16.24 | 137.42 ± 12.45 | 112.73 ± 11.79 | 142.43 ± 11.89 |
t | 8.97 | 13.76 | 11.42 | 43.38 |
p | <0.05 | <0.05 | <0.05 | <0.05 |
表3. 两组患者恢复情况比较
有研究数据显示,肩袖部分损伤在肩关节疾病中发病率为15%~40%左右,具有一定的多发性,该类疾病主要是由于肱骨大结节在超常范围内急剧转动多次引起劳损而造成的 [
本研究结果发现,观察组治疗有效率为96.67%明显高于对照组73.33%,差异有统计学意义;治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组;观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短。这是由于富血小板血浆(PRP)可修复组织细胞和再生,活化后可释放血小板衍生因子(platelet derived growth factor, PDGF)、血管内皮生长因子(vascular endothelial growth factor, VEGF)以及转化生长因子-β (transforming growth factor-beta, TGF-β)等多种生长因子,促进损伤修复 [
作为一种安全、有效的治疗方法在临床上已得到广泛应用,在基础和肩袖损伤动物实验当中,PRP均可起到良好的效果,为在肩袖损伤的治疗提供较好的发展前景 [
综上所述,高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。
易庆丰,胡华刚,朱少明,吴锦华. 高频超声精准定位下注射富血小板血浆结合针灸治疗肩袖部分损伤的疗效分析Analysis of the Therapeutic Effect of High Frequency Ultrasound and Precise Location of Platelet Rich Plasma Injection Combined with Acupuncture on Partial Rotator Cuff Injury[J]. 医学诊断, 2021, 11(01): 54-59. https://doi.org/10.12677/MD.2021.111009