摘要
目的系统验证富血小板血浆(PRP)联合银质针导热疗法治疗顽固性肩周炎的临床疗效与安全性,为基层医疗机构快速评估与推广提供高质量循证依据。方法采用前瞻性队列研究设计,选取我院推拿科符合顽固性肩周炎诊断标准的160例住院患者,随机分为联合组、银质针组、PRP组、单纯西医对照组,每组各40人。四组于治疗前及治疗后1周、1个月、2个月,采用视觉模拟评分(VAS)、Constant-Murley肩关节功能评分(CMS)、量角器测量肩关节活动度评估疗效,统计总有效率与不良反应发生率。结果四组患者基线资料(年龄、性别、病程、基线疗效指标)均衡可比(P>0.05)。治疗后各时间点,联合组疗效指标均显著优于单纯治疗组(P<0.001):治疗后2月,联合组VAS 1.30±0.30分(银质针组3.10±0.50分、PRP组3.40±0.60分、西医组4.10±0.60分)、CMS84.50±3.60分(银质针组67.80±3.50分、PRP组65.20±3.40分、西医组57.40±4.50分)、肩关节前屈149.80±8.20°(银质针组127.50±7.00°、PRP组124.60±6.80°、西医组115.80±6.90°),均显著优于三组(P<0.001)。联合组总有效率92.50%,显著高于银质针组72.50%、PRP组67.50%及西医组52.50%(P<0.05),且西医组自限性缓解率仅35.00%,证实联合组疗效不依赖疾病自限。不良反应方面,联合组、银质针组、PRP组不良反应率无差异(5.00%、2.50%、5.00%,P>0.05),均为1级红肿(3~5天消退);西医组不良反应率15.00%(胃肠道反应),显著高于联合组(P<0.05)。结论PRP联合银质针导热治疗顽固性肩周炎可有效缓解疼痛、减轻炎症反应、改善肩关节功能,疗效优于单一PRP或银质针治疗,高度契合基层医疗机构临床需求,可作为顽固性肩周炎优选治疗方案。
Ojective To systematically verify the clinical efficacy and safety of platelet-rich plasma(PRP)combined with silver needle thermotherapy in the treatment of refractory adhesive capsulitis(RAC),and to provide highquality evidence-based support for the rapid evaluation and promotion of this therapy in primary medical institutions.Methods A prospective cohort study was conducted.A total of 160 inpatients meeting the diagnostic criteria for RAC were enrolled from the Department of Tuina(Massage)of our hospital.They were randomly assigned to four groups(40 patients per group):the combined group(PRP+silver needle thermotherapy),the silver needle group(silver needle thermotherapy alone),the PRP group(PRP alone),and the conventional Western medicine(CWM)control group.Efficacy was assessed in all four groups before treatment and at 1 week,1 month,and 2 months post-treatment using the Visual Analog Scale(VAS)for pain,Constant-Murley Shoulder Function Score(CMS),and goniometric measurement of shoulder range of motion(ROM).The total effective rate and incidence of adverse events(AEs)were calculated.Results Baseline characteristics(age,sex,disease duration,and baseline efficacy indicators)were balanced and comparable across the four groups(P>0.05).At each post-treatment time point,efficacy indicators of the combined group were significantly superior to those of the single-treatment groups(P<0.001).At 2 months post-treatment:VAS score:1.30±0.30 in the combined group vs.3.10±0.50(silver needle group),3.40±0.60(PRP group),and 4.10±0.60(CWM control group);CMS:84.50±3.60 in the combined group vs.67.80±3.50(silver needle group),65.20±3.40(PRP group),and 57.40±4.50(CWM control group);shoulder flexion ROM:149.80±8.20°in the combined group vs.127.50±7.00°(silver needle group),124.60±6.80°(PRP group),and 115.80±6.90°(CWM control group).All efficacy indicators of the combined group were significantly superior to those of the other three groups(P<0.001).The total effective rate of the combined group was 92.50%,which was significantly higher than that of the silver needle group(72.50%),PRP group(67.50%),and CWM control group(52.50%)(P<0.05).Additionally,the spontaneous remission rate of the CWM control group was only 35.00%,confirming that the efficacy of the combined group was independent of the self-limiting nature of RAC.Regarding AEs:No significant difference in AE incidence was observed among the combined group(5.00%),silver needle group(2.50%),and PRP group(5.00%)(P>0.05).All AEs in these three groups were Grade 1 erythema and swelling(per CTCAE 5.0),which resolved spontaneously within 3~5 days.The AE incidence of the CWM control group was 15.00%(mainly gastrointestinal reactions),which was significantly higher than that of the combined group(P>0.05).Conclusions PRP combined with silver needle thermotherapy effectively relieves pain,reduces inflammatory responses,and improves shoulder function in patients with refractory adhesive capsulitis.Its efficacy is superior to that of PRP alone or silver needle thermotherapy alone,aligns well with the clinical needs of primary medical institutions,and can be recommended as a preferred treatment for refractory adhesive capsulitis.
作者
王嘉嘉
刘宇河
廖信祥
廖雅斌
黎展文
刘明豪
廖健明
钟潇羽
庞金海
安平
WANG Jiajia;LIU Yuhe;LIAO Xinxiang;LIAO Yabin;LI Zhanwen;LIU Minghao;LIAO Jianming;ZHONG Xiaoyu;PANG Jinhai;AN Ping(Department of Massage,Traditional Chinese Medicine Hospital of Yulin,Yulin 537000,China;Department of Traditional Chinese Medicine,Nanning Maternity and Child Health Hospital,Nanning 530000,China)
出处
《四川中医》
2026年第2期79-86,共8页
Journal of Sichuan of Traditional Chinese Medicine
基金
广西中医药适宜技术开发与推广项目(GZSY2025103)。
关键词
富血小板血浆
银质针导热疗法
顽固性肩周炎
保守治疗
Platelet-rich plasma
Silver needle thermal therapy
Refractory adhesive capsulitis
Conservative treatment
