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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) ›› 2024, Vol. 18 ›› Issue (02) : 271 -276. doi: 10.3877/cma.j.issn.1674-134X.2024.02.016

临床经验

复方丹参片配合常规方案治疗冻结肩的临床疗效评估
闫延1, 崔德栋1, 李昕昊1, 龙毅1, 李成1, 侯景义1, 杨睿1,†()   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院运动医学科
  • 收稿日期:2023-11-10 出版日期:2024-04-01
  • 通信作者: 杨睿
  • 基金资助:
    国家自然科学基金(81972067); 国家自然科学基金(82002342); 中山大学中央高校基本科研业务费专项资金资助(2020004)

Clinical efficacy evaluation of compound Danshen tablets combined with routine treatment for frozen shoulder

Yan Yan1, Dedong Cui1, Xinhao Li1, Yi Long1, Cheng Li1, Jingyi Hou1, Rui Yang1,†()   

  1. 1. Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2023-11-10 Published:2024-04-01
  • Corresponding author: Rui Yang
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闫延, 崔德栋, 李昕昊, 龙毅, 李成, 侯景义, 杨睿. 复方丹参片配合常规方案治疗冻结肩的临床疗效评估[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 271-276.

Yan Yan, Dedong Cui, Xinhao Li, Yi Long, Cheng Li, Jingyi Hou, Rui Yang. Clinical efficacy evaluation of compound Danshen tablets combined with routine treatment for frozen shoulder[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 271-276.

目的

评估复方丹参片配合常规方案治疗冻结肩(FS)的临床疗效。

方法

回顾2022年4月至2023年7月于中山大学孙逸仙纪念医院门诊就诊的原发性冻结肩患者。患者均接受了功能锻炼、口服塞来昔布及单次肩关节注射治疗，其中因其他原因需在治疗期间口服复方丹参片者纳入复方丹参片组，其余患者根据基线数据按对照组∶复方丹参片组＝2 ∶1的比例进行匹配并纳入对照组。使用独立t检验和重复测量方差分析比较两组在患者治疗前、治疗后1～3个月的疼痛视觉模拟评分(VAS)、肩关节活动度(ROM)、美国肩肘外科医师协会(ASES)评分、Constant-Murley评分(CSS)和美国加州大学(UCLA)评分。

结果

复方丹参片组有18例、对照组有36例数据可供回顾分析。治疗后1个月，复方丹参片组患者的前屈上举活动度(147±22)°大于对照组的(134±32)°(t＝1.558，P＝0.003)。到第3个月时，复方丹参片组前屈上举、外展、体侧外旋、后伸内旋的活动度分别为(169±11)°、(160±23)°、(59±14)°、(11±3)，对照组活动度分别为(146±22)°、(131±29)°、(41±13)°、(13±3)；复方丹参片组活动范围优于对照组(t＝4.147、3.675、4.662、－1.693，均为P<0.05)。末次随访时复方丹参片组的ASES评分、CSS评分优于单纯肩关节注射治疗组(t＝2.361、2.088，均为P<0.05)。

结论

在常规治疗方案的基础上，使用复方丹参片可以更快缓解冻结肩患者的疼痛并促进肩关节功能恢复。

关键词: 滑囊炎, 丹参, 肩痛, 活动范围，关节
Objective

To retrospectively assess the clinical efficacy of compound Danshen tablets with conventional regimen in the treatment of frozen shoulder (FS).

Methods

Patients with primary FS who attended the outpatient clinic of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from April 2022 to July 2023 were reviewed. All the patients were treated with functional exercises, oral celecoxib and a single shoulder injection. Those who needed to take oral compound Danshen tablets during treatment for other reasons were included in the compound Danshen tablets group, and the other patients were matched and included in the control group based on baseline data in the 2 ∶1 ratio of control group : compound Danshe tablets group. The independent Student’s t test and repeated measures ANOVA were used to analyze the difference of visual analog scale (VAS), shoulder range of motion(ROM), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder scale (CSS) and University of California, Los Angeles (UCLA) score before treatment, and at one, three months after treatment.

Results

Data from 18 cases in the compound Danshen tablets group and 36 cases in the control group were available for retrospective analysis. At one month after treatment, the flexion mobility of the patients in the compound Danshen tablet group were significantly greater than those of the control group (147±22)° vs(134±32)°(t=1.558, P=0.003). At the third month, the ROM in flexion, abduction, lateral external rotation, and posterior extension internal rotation of the compound Danshen tablet group were(169±11)°, (160±23)°, (59±14)°, and(11±3) respectively, while the data of the control group were (146±22)°, (131±29)°, (41±13)°, and (13±3). The compound Danshen tablet group achieved superior ROM than the control group (t=4.147, 3.675, 4.662, -1.693, all P< 0.05). At the final follow-up, the ASES and CSS scores of the compound Danshen tablet group were significantly better than those of the control group (t=2.361, 2.088, both P<0.05).

Conclusion

On the basis of the conventional treatment program, the use of compound Danshen tablets can provide faster pain relief and promote functional recovery of the shoulder joint in patients with FS.

Key words: Bursitis, Salvia miltiorrhizae, Shoulder pain, Range of motion, articular
表1 一般临床资料比较
Table 1 Baseline characteristics
分组Groups 例数Case number 年龄[岁，(±s)]Age (years) 男性[例(%)]Male 治疗前病程[个月，(±s)]Disease duration before treatment (months) 合并症[例(%)]Complication
糖尿病Diabetes 甲状腺疾病Thyroid diseases
复方丹参片组Compound Danshen tablet group 18 53.2±7.9 6(33.0) 4.5±1.3 3(17.0) 0
对照组Control group 36 52.2±10.1 13(36.0) 4.6±1.7 6(17.0) 2(6.0)
统计值Statistical value   t ＝0.388 χ2＝0.041 t ＝0.369 χ2＝0.228
P值   >0.05 >0.05 >0.05 >0.05
图1 治疗前后两组肩关节VAS(疼痛视觉模拟评分)评分的变化
Figure 1 Changes of the shoulder VAS (visual analogue scale) score of two groups before and after treatment
图2 治疗前后两组患者肩关节活动度的变化。图A为前屈上举活动度变化；图B为外展活动度变化；图C为体侧外旋活动度变化；图D为后伸内旋活动度变化，其中后伸内旋活动度使用患侧拇指能触摸到的最高椎体棘突表示注：*-该时间点复方丹参片组与对照组比较差异有统计学意义(P<0.05)
Figure 2 Changes in shoulder joint mobility in two groups before and after treatment. A is the change of anterior flexion and supination; B is the change of abduction; C is the change of lateral external rotation; D is the change of posterior extension and internal rotation, which is evaluated by the highest vertebral spinous process that can be touched by the thumb of the affected sideNote: *-the difference between the compound Danshen tablet group and the control group is statistically significant (P<0.05)
表2 两组患者ASES评分在治疗前后的变化(±s)
Table 2 Changes in ASES scores before and after treatment in both groups
分组Groups 例数Case number 治疗前Before treatment 治疗1个月a One month after treatment 治疗3个月b Three months after treatment
复方丹参片组Compound Danshen tablet group 18 48±16 67±16 77±8
对照组Control group 36 49±19 60±15 69±13
F值   时间效应：55.939；组间效应：4.570；交互作用：2.838
P值   时间效应：0.777；组间效应：0.011；交互作用：0.022
表3 两组患者CSS评分在治疗前后的变化(±s)
Table 3 Changes in CSS scores before and after treatment in both groups
分组Groups 例数Case number 治疗前Before treatment 治疗1个月a One month after treatment 治疗3个月b Three months after treatment
复方丹参片组Compound Danshen tablet group 18 56±13 69±9 80±9
对照组Control group 36 60±16 61±13 74±11
F值   时间效应：50.344;组间效应：5.365；交互作用：5.125；
P值   时间效应：0.332；组间效应：0.04；交互作用：0.042
表4 两组患者UCLA评分在治疗前后的变化(±s)
Table 4 Changes in UCLA scores before and after treatment in both groups
分组Groups 例数Case number 治疗前Before treatment 治疗1月One month after treatment 治疗3个月Three months after treatment
复方丹参片组Compound Danshen tablet group 18 20±4 24±5 26±5
对照组Control group 36 19±5 23±6 26±5
F值   时间效应：41.326；组间效应：0.314；交互作用：0.437
P值   均为>0.05
[1]
Shah N, Lewis M. Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections[J]. Br J Gen Pract, 2007, 57(541): 662－667.
[2]
Lho YM, Ha E, Cho CH, et al. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder[J]. J Shoulder Elbow Surg, 2013, 22(5): 666－672.
[3]
Hand GCR, Athanasou NA, Matthews T, et al. The pathology of frozen shoulder[J]. J Bone Joint Surg Br, 2007, 89(7): 928－932.
[4]
Müller LP, Müller LA, Happ J, et al. Frozen shoulder: a sympathetic dystrophy？[J]. Arch Orthop Trauma Surg, 2000, 120(1－2): 84－87.
[5]
Cho CH, Bae KC, Kim DH. Treatment strategy for frozen shoulder[J]. Clin Orthop Surg, 2019, 11(3): 249－257.
[6]
Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up[J]. J Bone Joint Surg Am, 1992, 74(5): 738－746.
[7]
Li ZM, Xu SW, Liu PQ. Salvia miltiorrhizaBurge (Danshen): a golden herbal medicine in cardiovascular therapeutics[J]. Acta Pharmacol Sin, 2018, 39(5): 802－824.
[8]
Millar NL, Meakins A, Struyf F, et al. Frozen shoulder[J/OL]. Nat Rev Dis Primers, 2022, 8(1): 59. DOI: 10.1038/s41572-022-00386-2.
[9]
Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment[J]. JBone Joint Surg Am, 2000, 82(10): 1398－1407.
[10]
杨睿，邓海权，汤毅勇，等. 鲑鱼降钙素喷鼻剂配合常规方案治疗冻结肩的临床疗效研究[J/CD]. 中华关节外科杂志(电子版), 2018, 12(2): 147－152.
[11]
杨成城. 丹参封闭针麻下强力推拿治疗肩周炎100例[J]. 广西赤脚医生，1978(11): 10－11.
[12]
彭梅仙，向静，陈毅文，等. 丹参注射液关节腔注射联合液压扩张法治疗疼痛期冻结肩疗效观察[J]. 实用中医药杂志，2021, 37(7): 1091－1093.
[13]
杜冠华，张均田. 丹参水溶性有效成分——丹酚酸研究进展[J]. 基础医学与临床，2000, 20(5): 10－14.
[14]
Gao HY, Li GY, Lou MM, et al. Hepatoprotective effect of Matrine salvianolic acid B salt on Carbon Tetrachloride-Induced Hepatic Fibrosis[J/OL]. J Inflamm, 2012, 9(1): 16. DOI: 10.1186/1476-9255-9-16.
[15]
Yan Y, Zhou M, Meng K, et al. Salvianolic acid B attenuates inflammation and prevent pathologic fibrosis by inhibiting CD36-mediated activation of the PI3K-Akt signaling pathway in frozen shoulder[J/OL]. Front Pharmacol, 2023, 14: 1230174. DOI: 10.3389/fphar.2023.1230174.
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