发散型体外冲击波治疗青少年游泳运动员冈上肌肌腱病的前瞻对照研究

doi:10.3877/cma.j.issn.1674-134X.2018.02.002

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 153 -157. doi: 10.3877/cma.j.issn.1674-134X.2018.02.002

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发散型体外冲击波治疗青少年游泳运动员冈上肌肌腱病的前瞻对照研究

刘剑虹¹, 陈宝旋¹, 李之琛², 张姝江², 卢伟杰²^,^†(

)

^1. 510630　广州市体育科学研究所
^2. 510120　广州医科大学附属第一医院关节外科

收稿日期:2017-12-12 出版日期:2018-04-01
通信作者: 卢伟杰
基金资助:
广东省体育局项目：广州市优秀青少年游泳运动员肩关节损伤的原因分析及防治的研究(GDSS2016138)

Prospective controlled trial on radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers

Jianhong Liu¹, Baoxuan Chen¹, Zhichen Li², Shujiang Zhang², Weijie Lu²^,^†()

^1. Guangzhou Institute of Sports Science, Guangzhou 510630, China
^2. Orthropeadic Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China

Received:2017-12-12 Published:2018-04-01
Corresponding author: Weijie Lu
About author:
Corresponding author: Lu Weijie, Email: 13902280296@139.com

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引用本文：

刘剑虹, 陈宝旋, 李之琛, 张姝江, 卢伟杰. 发散型体外冲击波治疗青少年游泳运动员冈上肌肌腱病的前瞻对照研究[J/OL]. 中华关节外科杂志(电子版), 2018, 12(02): 153-157.

Jianhong Liu, Baoxuan Chen, Zhichen Li, Shujiang Zhang, Weijie Lu. Prospective controlled trial on radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(02): 153-157.

目的

评价发散型体外冲击波应用于青少年游泳运动员冈上肌肌腱病的疗效及安全性。

方法

采用前瞻性随机对照研究方法，将16名经临床及核磁共振确诊为肩袖冈上肌肌腱病并排除冈上肌撕裂的青少年游泳运动员随机分配到对照组及发散型体外冲击波治疗组(rESWT组)，对照组7例采用冰敷、按摩、中频治疗仪治疗，rESWT组9例采用冰敷、发散型体外冲击波治疗。在治疗前及随访期内评估运动员可视化疼痛评分(VAS)，简明肩关节测试评分(SST)，Constant评分，治疗后复查肩关节MRI评价冈上肌肌腱的肌腱病分级。采用独立样本t检验进行组间对照，P< 0.05为差异具有统计学意义。

结果

rESWT组治疗后6周及12周时VAS评分显著低于对照组(6周：t＝3.757, P<0.01；12周：t ＝3.982, P<0.01)。与治疗前相比，治疗后MRI复查未见冈上肌肌腱信号改变。未发生冲击波治疗相关并发症。

结论

发散型体外冲击波可以在短期内有效改善青少年游泳运动员冈上肌肌腱病的肩痛症状，远期效果尚不明确。

关键词: 肩关节, 肌腱病, 体外冲击波治疗, 并发症

Objective

To evaluate the efficacy and safety of radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers.

Methods

The study was designed as a prospective randomized controlled trial. After supraspinatus tear was excluded, 16 juvenile swimmers who were diagnosed supraspinatus tendinopathy by clinical examination and magnetic resonance imaging were enrolled in the study and were divided into control group and radial extracorporeal shockwave therapy (rESWT) group randomly.Ice compress, massage, modulated medium frequency electrotherapy were prescribed in the control group and meanwhile ice compress and rESWT were applied in the rESWT group. Visual analogue scale(VAS), simple shoulder test score, Constant score were used to evaluate before the treatment and at six weeks and 12 weeks after the last treatment. Independent t test was applied for comparing the results of both groups. P<0.05 was considered as significant difference.

Results

Compared to the control group, the VAS score of rESWT group was significantly lower at six weeks(t=3.757, P<0.01) and 12 weeks(t=3.982, P<0.01) after the last rESWT. Compared to baseline, MRI scan after rESWT showed no significant change of supraspinatus. None of the complications related to rESWT was observed.

Conclusion

It shows a better short-term result of rESWT in releasing shoulder pain in juvenile swimmers with supraspinatus tendinopathy; the long term results are not clear.

Key words: Shoulder, Tendinopathy, Extracorporeal shockwave therapy, Complications

表1 两组运动员治疗前基线值比较结果(±s)

组别	例数	VAS	SST	Constant
对照组	7	2.7±0.7	10.6±0.1	94.6±0.2
rESWT组	9	2.6±0.8	10.7±0.1	94.3±0.3
t值	?	0.976	1.171	0.873
P值	?	>0.05	>0.05	>0.05

表1 两组运动员治疗前基线值比较结果(±s)

组别	例数	VAS	SST	Constant
对照组	7	2.7±0.7	10.6±0.1	94.6±0.2
rESWT组	9	2.6±0.8	10.7±0.1	94.3±0.3
t值	?	0.976	1.171	0.873
P值	?	>0.05	>0.05	>0.05

表2 对照组与rESWT组运动员治疗后VAS，SST，Constant评分比较(±s)

组别	例数	VAS(6周)	VAS(12周)	SST(6周)	SST(12周)	Constant(6周)	Constant(12周)
对照组	7	2.7±0.6	3.0±0.7	11±0.5	11±0.5	94.7±1.1	94.7±1.1
rESWT组	9	1.0±0.2	0.8±0.2	10.9±0.5	11.2±0.3	95.9±2.1	96.1±1.5
t值	?	3.757	3.982	1.572	1.116	1.474	1.712
P值	?	< 0.01	< 0.01	>0.05	>0.05	>0.05	>0.05

表2 对照组与rESWT组运动员治疗后VAS，SST，Constant评分比较(±s)

组别	例数	VAS(6周)	VAS(12周)	SST(6周)	SST(12周)	Constant(6周)	Constant(12周)
对照组	7	2.7±0.6	3.0±0.7	11±0.5	11±0.5	94.7±1.1	94.7±1.1
rESWT组	9	1.0±0.2	0.8±0.2	10.9±0.5	11.2±0.3	95.9±2.1	96.1±1.5
t值	?	3.757	3.982	1.572	1.116	1.474	1.712
P值	?	< 0.01	< 0.01	>0.05	>0.05	>0.05	>0.05

图1 某17岁男性运动员rESWT治疗前后MRI表现。图A　示治疗前T1加权像冈上肌内部广泛信号增高，肌腱厚度增加；图B　示治疗前T2加权像冈上肌内部高信号，非液体信号；图C、D　分别示治疗后冈上肌T1/2加权像改变，与治疗前比较无明显变化

表3 对照组与rESWT组治疗前后冈上肌MRI评分比较(±s)

分组	例数	治疗前	治疗后
对照组	7	1.9±0.7	2.0±0.6
rESWT组	9	2.3±0.7	2.4±0.7
t值	?	1.350	1.323
P值	?	>0.05	>0.05

表3 对照组与rESWT组治疗前后冈上肌MRI评分比较(±s)

分组	例数	治疗前	治疗后
对照组	7	1.9±0.7	2.0±0.6
rESWT组	9	2.3±0.7	2.4±0.7
t值	?	1.350	1.323
P值	?	>0.05	>0.05

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