| Objective:Subacromial impingement syndrome was firstly proposed by Neer in 1972.Its main clinical manifestations are shoulder pain and mobility disorder.When the shoulder flexes forward or abducts,the coracromial arch and the greater tuberosity of the humerus are repeatedly rubbed,impinged and compressed by a variety of factors,resulting in injury and degeneration of rotator cuff,biceps,long head tendon and other tissues.In China,the proportion of patients with subacromial impingement syndrome in shoulder pain is 36.08%.Currently Subacromial impingement syndrome under conservative treatment and surgical treatment,treatment main points by the Dutch orthopaedic association under the acromion impingement actively recommend conservative treatment in the guidelines of the intervention,and only a small number of patients with conservative treatment effect is not satisfied or diagnostic clear use surgical treatment for severe rotator cuff tear.Moreover,some researchers believe that conservative treatment and surgical treatment have similar efficacy in Bigliani Type ? and Type? subacromial impingement syndrome,pointing out that acromial morphology is closely related to different pathological changes,clinical manifestations and treatment options.Acupotomy is an important part of conservative treatment,and the theory of meridian-tendons plays a guiding role in the selective treatment of acupotomy.However,in clinical practice,the application of acupotomy in the treatment of subacromial impingement syndrome according to the acromial morphology still needs to be discussed continuously.Therefore this study through the observation based on the reinforcement theory of acupotomy therapy Bigliani type ?subacromial impingement syndrome of clinical curative effect,and compared with conventional oral non-steroidal anti-inflammatory drugs(nsaids),and then discusses the meridian-tendons theory to guide the application and advantages in acupotomy therapy subacromial impingement syndrome,and further optimization of acupotomy therapy for choosing subacromial impingement syndrome under way,Therefore,it provides theoretical basis and ideas for acupotomy treatment of subacromial impingement syndrome.Methods:In this study,72 cases with subacromial impingement syndrome of Bigliani type? were enrolled in an open randomized controlled trial.They were divided into normal group and treatment group by the registration order,with 36 case in each group.Patients in both groups adoped functional training of scapularis muscle and rotator cuff muscle group.The control group received oral diclofenac sodium capsule,and the experimental group received acupotomy.General patient data,such as gender,age,course of disease,medical history and imaging data,were collected before treatment.VAS scores were performed before,one week after,two weeks after and four weeks after treatment to evaluate the improvement of shoulder pain within and between groups before and after treatment.Constant-Murley score and abductor and flexion range of motion were performed at the same time points to evaluate the improvement of daily activities,active range of motion and abductor muscle strength within and between groups before and after treatment.Excel was used for data collection and management,and SPSS 20.00 was used for data processing and statistical analysis,and Origin2017 is used for drawing.Results:70 cases were followed up,and 2 cases fell out.The difference of gender,age,course of disease and shoulder position between the two groups was not statistically significant(P>0.05).VAS score in the control group decreased from 5.35±0.67 to 1.59±0.96 four weeks after treatment,with statistical significance at each time point(P<0.05).The experimental group decreased from 5.67±0.83 before treatment to 0.18±0.36 four weeks after treatment,and the difference at each time point were statistically significant(P<0.05).Constant-Murley score in the normal group increased from 42.21±3.42 before treatment to 71.15±12.07 four weeks after treatment,with statistical significance at each time point(P<0.05).The experimental group increased from 46.50±3.80 before treatment to 90.95±5.17 four weeks after treatment;and the difference was statistically significant at each time point(P<0.05).The flexion activity of the control group increased from 34.71±7.48 before treatment to 68.26±19.55 four weeks after treatment,and the difference at each time point was statistically significant(P<0.05).The flexion activity of the experimental group increased from 42.64±6.71 before treatment to 100.28±6.09 four weeks after treatment,and the difference at each time point was statistically significant(P<0.05).The degree of abduction activity in the control group increased from 40.15±6.91 before treatment to 80.59±18.58 four weeks after treatment,with statistical significance at each time point(P<0.05).The range of abduction motion of the experimental group increased from 41.53±6.30 before treatment to 105.28±8.78 four weeks after treatment,and the difference at each time point was statistically significant(P<0.05).There were statistically significant differences in VAS score,Constant-Murley score,shoulder flexion and abduction range of motion between two groups,time and interaction between two groups(P<0.05).One month after treatment,the total effective rate of the normal group and treatment group was 88.24%and 100%respectively.There was statistical significance between the two groups(P<0.05).Conclusion:Both acupotomology therapy and oral diclofenac capsule combined with scapular muscle and rotator cuff muscle group training can relieve shoulder pain in patients with Bigliani type ? subacromial impingement syndrome,and improve shoulder abduction,flexion and external rotation activities,and acupotomy therapy can improve shoulder pain and mobility more significantly.Moreover,according to the meridian-tendons theory,it can effectively guide acupotomy to select points for the treatment of subacromial impingement syndrome,improve the understanding of the nature of the disease,and improve the treatment effect. |
PDF Full Text Request