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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 571 -576. doi: 10.3877/cma.j.issn.1674-134X.2023.04.017

临床经验

体外冲击波疗法辅助治疗肩袖修补术后关节僵硬
吴俊贤, 曾俊杰, 许有银, 苑博†()   
  1. 100123　北京，民航总医院骨科
  • 收稿日期:2022-06-12 出版日期:2023-08-01
  • 通信作者: 苑博

Effect of extracorporeal shock wave therapy on post-operative shoulder stiffness after rotator cuff suture

Junxian Wu, Junjie Zeng, Youyin Xu, Bo Yuan†()   

  1. Department of 0rthopedics, Civil Aviation General Hospital, Peking University, Beijing 100123, China
  • Received:2022-06-12 Published:2023-08-01
  • Corresponding author: Bo Yuan
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吴俊贤, 曾俊杰, 许有银, 苑博. 体外冲击波疗法辅助治疗肩袖修补术后关节僵硬[J]. 中华关节外科杂志(电子版), 2023, 17(04): 571-576.

Junxian Wu, Junjie Zeng, Youyin Xu, Bo Yuan. Effect of extracorporeal shock wave therapy on post-operative shoulder stiffness after rotator cuff suture[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 571-576.

目的

探讨体外冲击波(ESWT)辅助康复训练治疗肩袖修补术后关节僵硬的疗效。

方法

回顾性收集2016年3月至2021年6月北京民航总医院41例肩袖修补术后关节僵硬患者的临床资料，根据是否行ESWT分为冲击波组与非冲击波组，收集包括肩关节活动度(前屈、外展、外旋、体侧内旋)、治疗前及治疗后肩关节Constant-Murley评分、加州大学洛杉矶分校肩关节评分(UCLA)、视觉模拟评分(VAS)。通过两独立因素t检验、秩和检验比较两组治疗前基础资料差异及治疗前与治疗3个月肩关节活动度差异，通过重复测量方差分析比较两组治疗2周、1个月、3个月Constant-Murley评分、UCLA评分、VAS评分差异。

结果

冲击波组治疗3个月肩关节前屈、外旋、外展活动度以及Constant评分、UCLA评分、VAS评分为(149.3±12.7)°、(124.6±4.1)°、(42.4±2.5)°、(88.4±3.3)、(30.1±1.9)、(1.9±0.5)，较治疗前(106.7±9.6)°、(77.2±4.9)°、(25.6±5.1)°、(68.6±2.1)、(17.7±2.4)、(6.5±0.9)明显改善(t＝－13.907、－38.526、－7.572、－15.450，F＝723.354、492.503、318.293；均为P<0.05)，并且治疗3个月肩关节外展及外旋活动度、UCLA评分均较非冲击波组的(120.7±6.5)°、(37.5±7.0)°、(28.9±1.3)更优(t＝2.361、3.278，F＝4.937；均为P<0.05)，两组前屈活动度、Constant评分及VAS评分差异无统计学意义(P>0.05)。

结论

体外冲击波辅助训练可有效改善肩袖修补术后关节僵硬的关节活动度及关节功能评分，并在改善外旋及外展活动度上较传统手法疗效更佳。

关键词: 回旋套损伤, 体外冲击波疗法, 关节镜检查
Objective

To explore the effect of extracorporeal shock wave therapy(ESWT) on post-operative joint stiffness after treated with rotator cuff suture.

Methods

A retrospective study was conducted in the patient who suffered from shoulder stiffness after treated with rotator cuff suture in the Civil Aviation General Hospital from March 2016 to June 2021. Forty-one patients were enrolled in this study, the patients were divided into ESWT group and non-EWST group, and the range of motion of shoulder joint(flexion, abduction, lateral rotation, internal rotation), before operation and at two weeks, one month and three months after operation, Constant-Murley score and University of California, Los Angeles score(UCLA) and visual analogue scale(VAS) were collected. Repeated measures analysis of variance was used to analyze the data of Constant-Murley, UCLA and VAS scores. Two independent sample t test was used to compare range of motion of shoulder before surgery and at three months after surgery.

Results

flexion, abduction, lateral rotation, Constant-Murley, UCLA and VAS score of EWST group at three months after surgery were as followed: (149.3±12.7)°, (124.6±4.1)°, (42.4±2.5)°, (88.4±3.3), (30.1±1.9), and (1.9±0.5), which were significantly better than preoperative ones [ (106.7±9.6)°, (77.2±4.9)°, (25.6±5.1)°, (68.6±2.1), (17.7±2.4), (6.5±0.9)]( t=-13.907, -38.526, -7.572, -15.450; F=723.354, 492.503, 318.293; all P<0.05), and abduction, external rotation and UCLA score at three months after surgery were statistically better than those of non-ESWT group (120.7±6.5)°, (37.5±7.0)°, (28.9±1.3)(t=2.361, 3.278, F=4.937, all P<0.05).

Conclusion

ESWT is an effective way to improve the range of motion and functional scores on the patient who suffered from postoperative shoulder stiffness after rotator cuff suture, which is also better than traditional rehabilitation.

Key words: Rotator cuff injury, Extracorporeal shock wave therapy, Arthroscopy
表1 两组基础资料比较
Table 1 General information of patients
分组Groups 例数Case number 脂肪浸润分级Fatty infiltration degree 年龄[岁，(±s)] Age
Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级
冲击波组EWST group 27 8 10 6 3 77±7
非冲击波组Non-EWST group 14 4 5 3 2 78±7
F值   Z＝－0.553 t＝0.728
P值   >0.05 >0.05
分组Groups 例数Case number 撕裂程度Tear degree 身体质量指数[kg/m2, (±s)] Body mass index
小型Mild 中型Moderate 大型Large 巨大型Huge
冲击波组EWST group 27 4 8 8 7 27±3
非冲击波组Non-EWST group 14 2 4 6 2 27±3
F值   Z＝－0.286 t＝－0.467
P值   >0.05 >0.05
表2 两组治疗前后肩关节活动度比较[°，(±s)]
Table 2 Range of motion of shoulder in two groups before treatment and three months after treatment
分组Groups 例数Case number 治疗前Before treatment 治疗后3个月Three months after treatment
前屈Anteflexion 外展Abduction 外旋External rotation 前屈Anteflexion 外展Abduction 外旋External rotation
冲击波组EWST group 27 106.7±9.6 77.2±4.9 25.6±5.1 149.3±12.7 124.6±4.1 42.4±2.5
非冲击波组Non-EWST group 14 104.6±13.2 76.8±4.2 23.6±5.0 142.5±14.1 120.7±6.5 37.5±7.0
t值   0.561 0.284 1.197 1.557 2.361 3.278
P值   >0.05 >0.05 >0.05 >0.05 0.023 <0.01
表3 两组患者治疗前后肩关节评分比较(±s)
Table 3 Comparison of functional scores between the two groups before and after treatment
分组Groups 例数Case number Constant-Murley评分
治疗前Before treatment 治疗后2周Two weeks after treatment 治疗后1个月One month after treatment 治疗后3个月Three months after treatment
冲击波组EWST group 27 68.6±2.1 76.4±3.2 84.1±2.4 88.4±3.3
非冲击波组Non-EWST group 14 67.4±1.3 72.1±2.3 82.6±2.4 86.6±3.2
F值   3.514 14.234 3.275 2.293
P值   >0.05 <0.01 >0.05 >0.05
分组Groups 例数Case number UCLA
治疗前Before treatment 治疗后2周Two weeks after treatment 治疗后1个月One month after treatment 治疗后3个月Three months after treatment
冲击波组EWST group 27 17.7±2.4 21.9±2.3 26.3±1.8 30.1±1.9
非冲击波组Non-EWST group 14 17.1±2.6 19.8±1.7 23.1±1.3 28.9±1.3
F值   0.610 7.587 22.290 4.937
P值   >0.05 0.016 <0.001 0.045
分组Groups 例数Case number VAS
治疗前Before treatment 治疗后2周Two weeks after treatment 治疗后1个月One month after treatment 治疗后3个月Three months after treatment
冲击波组EWST group 27 6.5±0.9 3.9±0.9 3.0±0.9 1.9±0.5
非冲击波组Non-EWST group 14 6.6±1.5 4.7±0.9 3.3±1.0 2.3±0.8
F值   0.016 6.158 0.881 2.489
P值   >0.05 0.028 >0.05 >0.05
图1 体外冲击波治疗前后患侧肩关节MRI改变。图A体外冲击波治疗前可见肌腱周围渗出明显；图B治疗3个月可见渗出较前明显减少
Figure 1 MRI changes before and after extracorporeal shock wave therapy(ESWT). A shows significant exudation around tendon before ESWT; B shows the exudation significantly reduced after three months of treatment
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