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[1]劉歡,饒泉,周濤斌,等.不同能量體外沖擊波治療橈骨莖突狹窄性腱鞘炎的臨床研究[J].中醫(yī)正骨,2019,31(12):10-14.
　LIU Huan,RAO Quan,ZHOU Taobin,et al.A clinical study of different energies extracorporeal shock wave therapy for treatment of stenosing tendovaginitis of radial styloid[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(12):10-14.
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不同能量體外沖擊波治療橈骨莖突狹窄性腱鞘炎的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年12期
頁碼:
10-14
欄目:
臨床研究
出版日期:
2019-12-20

文章信息/Info

Title:
A clinical study of different energies extracorporeal shock wave therapy for treatment of stenosing tendovaginitis of radial styloid
作者:
劉歡; 饒泉; 周濤斌; 謝邦椰; 李振; 劉小敏
(江西中醫(yī)藥大學(xué)附屬醫(yī)院,江西 南昌 330006)
Author(s):
LIU Huan; RAO Quan; ZHOU Taobin; XIE Bangye; LI Zhen; LIU Xiaomin
The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang 330006,Jiangxi,China
關(guān)鍵詞:
腱嵌壓;  橈骨莖突;  封閉療法;  體外沖擊波療法;  臨床試驗(yàn)
Keywords:
tendon entrapment;  styloid process of radius;  blocking therapy;  extracorporeal shock wave therapy;  clinical trial
摘要:
目的:觀察體外沖擊波療法(extracorporeal shock wave therapy,ESWT)治療橈骨莖突狹窄性腱鞘炎的臨床療效和安全性,探討不同能量ESWT對(duì)療效和安全性的影響。方法:選取90例橈骨莖突狹窄性腱鞘炎患者,隨機(jī)分為低能量沖擊波組、中能量沖擊波組及局部封閉組,每組30例。低能量沖擊波組和中能量沖擊波組均采用ESWT治療,低能量沖擊波組能流密度0.1 mJ·mm-2、中能量沖擊波組能流密度0.2 mJ·mm-2; 局部封閉組采用2%鹽酸利多卡因注射液和醋酸曲安奈德注射液局部封閉治療。3組均每周治療1次,連續(xù)治療3次。采用視覺模擬量表(visual analogue scale,VAS)評(píng)定患者橈骨莖突部位的疼痛程度,采用Cooney腕關(guān)節(jié)評(píng)分量表評(píng)定總體療效,同時(shí)觀察治療及隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:①一般情況。至治療結(jié)束時(shí),共有3例患者主動(dòng)要求退出試驗(yàn),其中中能量沖擊波組1例、局部封閉組2例。②疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=4.046,P=0.011)。3組患者的橈骨莖突部位的疼痛VAS評(píng)分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=10.006,P=0.000)。治療前后不同時(shí)點(diǎn)間疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=617.750,P=0.000); 3組患者治療前后的疼痛VAS評(píng)分均呈先降低后升高的趨勢(shì),但3組的變化趨勢(shì)不完全一致[(7.27±1.08)分,(1.63±0.93)分,(2.53±1.07)分,F=319.698,P=0.000;(7.45±1.06)分,(2.45±1.35)分,(3.86±1.55)分,F=161.775,P=0.000;(7.50±1.11)分,(2.57±1.26)分,(4.17±1.22)分,F=171.964,P=0.000]; 治療前3組疼痛VAS評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(F=0.377,P=0.687); 治療結(jié)束時(shí),低能量沖擊波組的疼痛VAS評(píng)分低于中能量沖擊波組和局部封閉組(P=0.010; P=0.004),中能量沖擊波組和局部封閉組疼痛VAS評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(P=0.697); 治療結(jié)束后6個(gè)月,低能量沖擊波組的疼痛VAS評(píng)分低于中能量沖擊波組和局部封閉組(P=0.000; P=0.000),中能量沖擊波組和局部封閉組疼痛VAS評(píng)分的差異無統(tǒng)計(jì)學(xué)意義(P=0.359)。③Cooney腕關(guān)節(jié)評(píng)分。治療前3組患者的Cooney腕關(guān)節(jié)評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(F=1.078,P=0.345)。治療結(jié)束時(shí)3組患者的Cooney腕關(guān)節(jié)評(píng)分均高于治療前[(53.67±5.38)分,(93.67±9.37)分,t=20.464,P=0.000;(52.03±6.06)分,(87.93±8.82)分,t=17.515,P=0.000;(54.14±5.67)分,(82.14±9.37)分,t=15.342,P=0.000]; 低能量沖擊波組的Cooney腕關(guān)節(jié)評(píng)分高于中能量沖擊波組和局部封閉組(P=0.019; P=0.000),中能量沖擊波組的Cooney腕關(guān)節(jié)評(píng)分高于局部封閉組(P=0.020)。④并發(fā)癥。中能量沖擊波組2例出現(xiàn)局部腫脹,給予熱敷及抬高患肢處理,1周后腫脹均消退。局部封閉組3例出現(xiàn)局部血腫,經(jīng)冷療及熱敷處理,血腫均于10 d左右消退; 2例治療結(jié)束后出現(xiàn)皮下脂肪萎縮,服用谷維素、復(fù)合維生素B,隨訪預(yù)后良好。3組患者的并發(fā)癥發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=5.870,P=0.022); 但3組并發(fā)癥發(fā)生率兩兩比較,差異均無統(tǒng)計(jì)學(xué)意義(χ2=0.553,P=0.457; χ2=3.815,P=0.051; χ2=0.734,P=0.392; α'=0.017)。結(jié)論:ESWT是治療橈骨莖突狹窄性腱鞘炎的一種有效方法,其療效優(yōu)于局部封閉治療,安全性與局部封閉治療相當(dāng); 采用ESWT治療橈骨莖突狹窄性腱鞘炎,能流密度為0.1 mJ·mm-2時(shí)的療效優(yōu)于能流密度為0.2 mJ·mm-2時(shí)的療效,2種能量治療的安全性相當(dāng)。
Abstract:
Objective:To observe the clinical curative effects and safety of extracorporeal shock wave therapy(ESWT)for treatment of stenosing tendovaginitis of radial styloid,and to explore the impact of energies of ESWT on clinical curative effects and safety.Methods:Ninety patients with stenosing tendovaginitis of radial styloid were selected and randomly divided into low-energy ESWT group,medium-energy ESWT group and local blocking group,30 cases in each group.The patients in low-energy ESWT group and medium-energy ESWT group were treated with ESWT with 0.1 mJ/mm(2)and 0.2 mJ/mm(2)energy flux density respectively,while the patients in local blocking group were treated with local injection of 2% lidocaine hydrochloride and triamcinolone acetate.All patients in the 3 groups were treated once a week for consecutive 3 times.The radial styloid pain degree and the total clinical curative effects were evaluated by using visual analogue scale(VAS)and Cooney wrist scoring scale respectively,and the complication incidences were observed during the treatment and follow-up period.Results:One patient in medium-energy ESWT group and two patients in local blocking group requested to drop out of the trial.There was interaction between time factor and group factor in pain VAS scores(F=4.046,P=0.011).There was statistical difference in the radial styloid pain VAS scores between the 3 groups in general,in other words,there was group effect(F=10.006,P=0.000).There was statistical difference in radial styloid pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=617.750,P=0.000).The radial styloid pain VAS scores presented a time-dependent trend of decreasing firstly and increasing subsequently in the 3 groups,while the 3 groups were inconsistent with each other in the variation tendency(7.27+/-1.08,1.63+/-0.93,2.53+/-1.07 points,F=319.698,P=0.000; 7.45+/-1.06,2.45+/-1.35,3.86+/-1.55 points,F=161.775,P=0.000; 7.50+/-1.11,2.57+/-1.26,4.17+/-1.22 points,F=171.964,P=0.000).There were no statistical difference in pain VAS scores between the 3 groups before the treatment(F=0.377,P=0.687).At the end of the treatment,the pain VAS scores were lower in low-energy ESWT group compared to medium-energy ESWT group and local blocking group(P=0.010; P=0.004),and there were no statistical difference in pain VAS scores between medium-energy ESWT group and local blocking group(P=0.697).At 6 months after the end of the treatment,the pain VAS scores were lower in low-energy ESWT group compared to medium-energy ESWT group and local blocking group(P=0.000; P=0.000),and there were no statistical difference in pain VAS scores between medium-energy ESWT group and local blocking group(P=0.359).There were no statistical difference in Cooney wrist scores between the 3 groups before the treatment(F=1.078,P=0.345).The Cooney wrist scores were higher after the end of the treatment compared to pre-treatment in the 3 groups(53.67+/-5.38 vs 93.67+/-9.37 points,t=20.464,P=0.000; 52.03+/-6.06 vs 87.93+/-8.82 points,t=17.515,P=0.000; 54.14+/-5.67 vs 82.14+/-9.37 points,t=15.342,P=0.000).The Cooney wrist scores were higher in low-energy ESWT group compared to medium-energy ESWT group and local blocking group,and were higher in medium-energy ESWT group compared to local blocking group(P=0.019; P=0.000; P=0.020).The local swelling was found in 2 patients in medium-energy ESWT group,and it subsided after 1-week treatment with hot compress and raising the affected limbs.The local hematoma was found in 3 patients in local blocking group,and it subsided after about 10-day treatment with cold therapy and hot compress.The subcutaneous lipoatrophy was found in 2 patients in local blocking group after the end of the treatment,and the 2 patients got a good prognosis after oral applications of oryzanol and Vitamin B complex.There was statistical difference in complication incidences between the 3 groups(χ2=5.870,P=0.022).Further pairwise comparison showed that there was no statistical difference in complication incidences between the 3 groups(χ2=0.553,P=0.457; χ2=3.815,P=0.051; χ2=0.734,P=0.392; α'=0.017).Conclusion:ESWT is an effective method for treatment of stenosing tendovaginitis of radial styloid,and it surpasses local blocking therapy in clinical curative effects,while they are similar to each other in the safety.The curative effect of ESWT with 0.1 mJ/mm(2)energy flux density is better than that of ESWT with 0.2 mJ/mm(2)energy flux density in treatment of stenosing tendovaginitis of radial styloid,while they are similar to each other in the safety.

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通訊作者:劉小敏 E-mail:[email protected](收稿日期:2019-10-08 本文編輯:李曉樂)
更新日期/Last Update: 2019-12-15