针刀整体松解术配合微波治疗类风湿肘关节僵硬的临床观察

关键词：针刀整体松解术  微波治疗  类风湿性关节炎  肘关节僵硬

Keywords:acupotomy  microwave therapy  rheumatoid arthritis  stiff elbow joint

摘要：

      摘要 目的：对比观察针刀整体松解术配合微波治疗类风湿肘关节僵硬临床疗效。 方法：将60例类风湿肘关节僵硬患者按随机数字表法随机分为针刀加微波组和针刀组，每组各30例。针刀加微波组采用针刀整体松解术配合微波治疗，针刀组单纯采用针刀治疗，疗程结束后进行疗效评定。 结果：两组临床疗效比较，针刀加微波组中，显效20例，总有效率为93.3%；针刀组显效12例，总有效率为67.7%。两组总有效率经统计学分析（P＜0.05），有显著性差异；治疗前，两组患者Mayo肘关节功能评分比较，无显著性差异（P＞0.05），表明两组具有可比性；治疗后2周两组Mayo肘关节功能评分呈上升趋势，且针刀加微波组上升更明显，较治疗前有显著性差异（P＜0.05）。治疗后半年两组Mayo肘关节功能评分比较，针刀加微波组Mayo功能呈持续性改善，较治疗后2周，差异具有显著性意义（P＜0.05）；与针刀组比较，差异具有显著性意义（P＜0.05）。而针刀组治疗后半年与治疗后2周，患者Mayo肘关节功能评分改善不明显，差异无显著性意义（P＞0.05）。治疗前，两组患者疼痛综合评分（含PRI总分、VAS评分、PPI积分）比较，无显著性差异（P＞0.05），表明两组具有可比性；治疗后2周，两组疼痛问卷（MPQ）评分呈下降趋势，针刀加微波组下降更明显，与治疗前相比较，有显著性差异（P＜0.05）。与针刀组治疗后比较，差异具有显著性意义（P＜0.05）。治疗后半年两组MPQ评分持续下降，与治疗后2周相比较，有显著性差异（P＜0.05）。与同一时间点针刀组比较，差异具有显著性意义（P＜0.05）。 结论：针刀整体松解增加了关节活动度，微波治疗能快速缓解术后的疼痛肿胀，起到镇痛消肿之效，避免针刀治疗后再发粘连，两种方法相互结合，相互补充，共同发挥治疗作用，值得在临床上广泛推广。

Abstract:

      Abstract Objective: To observe the clinical effect of overall acupotomy lysis combined with microwave on rheumatoid elbow stiffness. Method: Sixty cases of patients with rheumatoid elbow stiffness were randomly divided into acupotomy plus microwave group and acupotomy group, 30 cases in each group. Acupotomy plus microwave group adopted overall acupotomy lysis combined with microwave treatment, while acupotomy group treated by acupotomy only.We assessed the efficacy after treatment. Result: In the acupuncture plus microwave group, the total efficiency is 93.3%, while 67.7% in the acupotomy group.The total effective rate of the two groups has statistical significance (P＜0.05). Comparison of two groups of patients with Mayo score: to compare two groups of patients with Mayo score, there was (P＞0.05), the two groups showed no significant difference for Mayo score with comparability. After 2 weeks treatment, Mayo Elbow score increased for both groups with more obvious increase in the Acupotomy plus microwave group, which was comparable with that before treatment(P＜0.05). To compare Mayo Elbow function score after half a year's treatment, the Mayo function of acupuncture plus microwave group was continuously improved, which had statistical difference compared with that after 2 weeks treatment and in the acupotomy group(P＜0.05).However,at the same time, there was no difference for the acupotomy group (P＞0.05). Comparison of pain scores(PRI score, VAS score, PPI score) for two groups: before treatment, no significant difference was observed between two groups(P＞0.05). After 2 weeks treatment, MPQ scores of the two groups decreased and acupotomy plus microwave group showed more obvious decreased trend, which had significant difference compared with that before treatment and in the acupotomy group(P＜0.05).After half a year's treatment, the MPQ scores of the two groups continued to decline, which exhibited significant difference compared with that after 2 weeks treatment and in the acupotomy group(P＜0.05). Conclusion: The overall acupotomy lysis can increase joint activity. Moreover, microwave treatment can not only quickly relieve postoperative pain and swelling and but als has the swelling analgesic effect and avoid the recurrence of acupotomologic therapy-induced adhesion. The two methods are combined, complements each other and jointly play a role in treatment. It is worth widely spreading in clinic.