摘要
目的:观察体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗桡骨茎突狭窄性腱鞘炎的临床疗效和安全性,探讨不同能量ESWT对疗效和安全性的影响。方法:选取90例桡骨茎突狭窄性腱鞘炎患者,随机分为低能量冲击波组、中能量冲击波组及局部封闭组,每组30例。低能量冲击波组和中能量冲击波组均采用ESWT治疗,低能量冲击波组能流密度0.1 mJ·mm^-2、中能量冲击波组能流密度0.2 mJ·mm^-2;局部封闭组采用2%盐酸利多卡因注射液和醋酸曲安奈德注射液局部封闭治疗。3组均每周治疗1次,连续治疗3次。采用视觉模拟量表(visual analogue scale,VAS)评定患者桡骨茎突部位的疼痛程度,采用Cooney腕关节评分量表评定总体疗效,同时观察治疗及随访期间的并发症发生情况。结果:①一般情况。至治疗结束时,共有3例患者主动要求退出试验,其中中能量冲击波组1例、局部封闭组2例。②疼痛VAS评分。时间因素和分组因素存在交互效应(F=4.046,P=0.011)。3组患者的桡骨茎突部位的疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=10.006,P=0.000)。治疗前后不同时点间疼痛VAS评分的差异有统计学意义,即存在时间效应(F=617.750,P=0.000);3组患者治疗前后的疼痛VAS评分均呈先降低后升高的趋势,但3组的变化趋势不完全一致[(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];治疗前3组疼痛VAS评分的差异无统计学意义(F=0.377,P=0.687);治疗结束时,低能量冲击波组的疼痛VAS评分低于中能量冲击波组和局部封闭组(P=0.010;P=0.004),中能量冲击波组和局部封闭组疼痛VAS评分的差异无统计学意义(P=0.697);治疗结束后6个月,低能量冲击波组的疼痛VAS评分低于中能量冲击波组和局部封闭组(P=0.000;P=0.000),中能量冲击波组和局部封闭组疼痛VAS评分的差异无统计学意义(P=0.359)。③Cooney腕关节评分。治疗前3组患者的Cooney腕关节评分比较,差异无统计学意义(F=1.078,P=0.345)。治疗结束时3组患者的Cooney腕关节评分均高于治疗前[(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];低能量冲击波组的Cooney腕关节评分高于中能量冲击波组和局部封闭组(P=0.019;P=0.000),中能量冲击波组的Cooney腕关节评分高于局部封闭组(P=0.020)。④并发症。中能量冲击波组2例出现局部肿胀,给予热敷及抬高患肢处理,1周后肿胀均消退。局部封闭组3例出现局部血肿,经冷疗及热敷处理,血肿均于10 d左右消退;2例治疗结束后出现皮下脂肪萎缩,服用谷维素、复合维生素B,随访预后良好。3组患者的并发症发生率比较,差异有统计学意义(χ^2=5.870,P=0.022);但3组并发症发生率两两比较,差异均无统计学意义(χ^2=0.553,P=0.457;χ^2=3.815,P=0.051;χ^2=0.734,P=0.392;α′=0.017)。结论:ESWT是治疗桡骨茎突狭窄性腱鞘炎的一种有效方法,其疗效优于局部封闭治疗,安全性与局部封闭治疗相当;采用ESWT治疗桡骨茎突狭窄性腱鞘炎,能流密度为0.1 mJ·mm^-2时的疗效优于能流密度为0.2 mJ·mm^-2时的疗效,2种能量治疗的安全性相当。
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 ESWTon 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 differ ence 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=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 statitical 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=0.39).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 com pared to medium-energy ESWT group and local blocking group,and were higher in medium-energy ESWT group compared to local bloc king 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 afected limbs.The local hematoma was found in 3 patients in local blocking group,and it subsided ater about 10-day treatment with cold therapy and hot compress.The subcutaneous lipoatrophy was found in 2 pa tients in local blocking group after the end of the treatment,and the 2 patients got a good prognosis ater oral applications of oryzanol and Vitamin B complex.There was statistical difference in complication incidences bet^veen the 3 groups(χ^2=5.870,P=0.022).Further pair wise comparison showed that there was no statistical difference in complication incidences bet^veen the 3 groups(χ^2=0.553,P=0.457;χ^2=3.815,P=0.051;χ^2=0.734,P=0.392;α′=.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 0.2mJ/mm(2)energy flux density in treatment of stenosing tendovaginitis of radial styloid,while they are similar to each other in the safety.
作者
刘欢
饶泉
周涛斌
谢邦椰
李振
刘小敏
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)
出处
《中医正骨》
2019年第12期10-14,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
腱嵌压
桡骨茎突
封闭疗法
体外冲击波疗法
临床试验
tendon entrapment
styloid process of radius
blocking therapy
extracorporeal shock wave therapy
clinical trial
