超聲引導(dǎo)下精準(zhǔn)定位體外沖擊波治療肩袖鈣化性肌炎療效的臨床研究

樓紅侃　王萍兒

[關(guān)鍵詞] 肩袖鈣化性肌炎;體外沖擊波;超聲引導(dǎo);痛點(diǎn)定位

[中圖分類號] R691.4;R445.1? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）20-0089-04

Clinical research on the therapeutic efficacy of ultrasound guided precision orientation of extracorporeal shock wave on calcific myositis of rotator cuff

LOU Hongkan1? ?WANG Ping′er2

1.Department of Orthopedics， Ningbo Hospital of Traditional Chinese Medicine， Ningbo? ?315000， China; 2.Zhejiang Chinese Medical University， Hangzhou? ?310053， China

[Abstract] Objective To explore the therapeutic efficacy of ultrasound guided precision orientation of extracorporeal shock wave therapy （ESWT） and pain point orientation of ESWT on calcific myositis of rotator cuff. Methods A total of 80 patients treated with shock wave in Ningbo Hospital of Traditional Chinese Medicine from February 2017 to November 2018 were randomly divided into the control group （n=40） and the treatment group（n=40）. The control group was treated with pain point orientation of ESWT， while the treatment group was treated with ultrasound guided precision orientation of ESWT. The VAS， CMS scores and calcification foci absorption were compared. Results After 2 months， there was no significant difference in VAS， CMS score and calcification absorption between the treatment group and the control group（P>0.05）; 1 year later， the scores of VAS and CMS and calcification foci absorption in the treatment group were significantly better than those in the control group（P<0.05）. Conclusion Ultrasound guided precision orientation of ESWT and pain point orientation of ESWT have clinical efficacy in the treatment of calcific myositis of rotator cuff， but the long-term efficacy of ultrasound guided precision orientation of ESWT is better.

[Key words] Calcific myositis of rotator cuff; Extracorporeal shock wave; Ultrasound guided; Pain point orientation

肩袖鈣化性肌炎（Rotator cuff calcific tendinosis，RCCT）以肩袖鈣鹽沉積在變性的肌腱中為特征，是引起肩關(guān)節(jié)疼痛及活動(dòng)受限的常見病因之一，好發(fā)年齡為40～50歲，女性稍多于男性[1]，鈣化性肌腱炎的發(fā)病率為2.7%～20.0%[2]。最常見的發(fā)病部位是岡上肌腱，其次是岡下肌、小圓肌、肩胛下肌肌腱，鈣化灶刺激肩峰下滑囊，引起疼痛癥狀，肌腱內(nèi)大塊鈣化斑塊的浸潤，可導(dǎo)致肌纖維斷裂和肌腱的破壞。主要臨床表現(xiàn)為：①鈣鹽吸收階段可出現(xiàn)肩部劇烈疼痛，夜間可痛醒;②肱骨大結(jié)節(jié)處壓痛明顯;③患者通常在鈣化階段的吸收期，疼痛劇烈時(shí)尋求治療，夜間痛醒;也有一部分患者在評估肩袖撞擊綜合征時(shí)偶然發(fā)現(xiàn);④患肢無力，手臂上舉困難;⑤肩部X線片或MRI提示肩袖處高密度影。肩袖鈣化性肌腱炎的傳統(tǒng)治療方法主要包括休息、非甾體抗炎藥、關(guān)節(jié)腔注射療法、中醫(yī)療法、物理治療及手術(shù)治療等[3-4]。本研究以體外沖擊波為主要治療手段，觀察其對肩袖鈣化性肌炎患者的短中期療效，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料

收集2017年2月至2018年11月符合骨科疾病診斷標(biāo)準(zhǔn)[5]的肩袖鈣化性肌炎的患者80例，其中男46例，女34例，年齡40～57歲，平均（44.15±1.43）歲;沒有明確的創(chuàng)傷史或手術(shù)治療史，肩部疼痛及活動(dòng)痛，夜間加重，可放射到手，但無感覺異常，肩關(guān)節(jié)活動(dòng)受限，上舉、外展尤為明顯，肩周壓痛，肩部肌肉痙攣或萎縮，經(jīng)X線或MRI等影像學(xué)檢查提示肩袖組織有鈣化灶。將所有的患者按照隨機(jī)數(shù)字表法分為超聲引導(dǎo)下精準(zhǔn)定位體外沖擊波組（治療組）和痛點(diǎn)定位體外沖擊波組（對照組），每組各40例，均采用瑞士EMS Swiss DolorClast體外沖擊波治療儀，該研究經(jīng)寧波市中醫(yī)院倫理委員會批準(zhǔn)。