超声引导下精准定位体外冲击波治疗肩袖钙化性肌炎疗效的临床研究

楼红侃　王萍儿

[关键词] 肩袖钙化性肌炎;体外冲击波;超声引导;痛点定位

[中图分类号] R691.4;R445.1          [文献标识码] B          [文章编号] 1673-9701（2021）20-0089-04

Clinical research on the therapeutic efficacy of ultrasound guided precision orientation of extracorporeal shock wave on calcific myositis of rotator cuff

LOU Hongkan1   WANG Ping′er2

1.Department of Orthopedics， Ningbo Hospital of Traditional Chinese Medicine， Ningbo   315000， China; 2.Zhejiang Chinese Medical University， Hangzhou   310053， China

[Abstract] Objective To explore the therapeutic efficacy of ultrasound guided precision orientation of extracorporeal shock wave therapy （ESWT） and pain point orientation of ESWT on calcific myositis of rotator cuff. Methods A total of 80 patients treated with shock wave in Ningbo Hospital of Traditional Chinese Medicine from February 2017 to November 2018 were randomly divided into the control group （n=40） and the treatment group（n=40）. The control group was treated with pain point orientation of ESWT， while the treatment group was treated with ultrasound guided precision orientation of ESWT. The VAS， CMS scores and calcification foci absorption were compared. Results After 2 months， there was no significant difference in VAS， CMS score and calcification absorption between the treatment group and the control group（P>0.05）; 1 year later， the scores of VAS and CMS and calcification foci absorption in the treatment group were significantly better than those in the control group（P<0.05）. Conclusion Ultrasound guided precision orientation of ESWT and pain point orientation of ESWT have clinical efficacy in the treatment of calcific myositis of rotator cuff， but the long-term efficacy of ultrasound guided precision orientation of ESWT is better.

[Key words] Calcific myositis of rotator cuff; Extracorporeal shock wave; Ultrasound guided; Pain point orientation

肩袖鈣化性肌炎（Rotator cuff calcific tendinosis，RCCT）以肩袖钙盐沉积在变性的肌腱中为特征，是引起肩关节疼痛及活动受限的常见病因之一，好发年龄为40～50岁，女性稍多于男性[1]，钙化性肌腱炎的发病率为2.7%～20.0%[2]。最常见的发病部位是冈上肌腱，其次是冈下肌、小圆肌、肩胛下肌肌腱，钙化灶刺激肩峰下滑囊，引起疼痛症状，肌腱内大块钙化斑块的浸润，可导致肌纤维断裂和肌腱的破坏。主要临床表现为：①钙盐吸收阶段可出现肩部剧烈疼痛，夜间可痛醒;②肱骨大结节处压痛明显;③患者通常在钙化阶段的吸收期，疼痛剧烈时寻求治疗，夜间痛醒;也有一部分患者在评估肩袖撞击综合征时偶然发现;④患肢无力，手臂上举困难;⑤肩部X线片或MRI提示肩袖处高密度影。肩袖钙化性肌腱炎的传统治疗方法主要包括休息、非甾体抗炎药、关节腔注射疗法、中医疗法、物理治疗及手术治疗等[3-4]。本研究以体外冲击波为主要治疗手段，观察其对肩袖钙化性肌炎患者的短中期疗效，现报道如下。

1 资料与方法

1.1 一般资料

收集2017年2月至2018年11月符合骨科疾病诊断标准[5]的肩袖钙化性肌炎的患者80例，其中男46例，女34例，年龄40～57岁，平均（44.15±1.43）岁;没有明确的创伤史或手术治疗史，肩部疼痛及活动痛，夜间加重，可放射到手，但无感觉异常，肩关节活动受限，上举、外展尤为明显，肩周压痛，肩部肌肉痉挛或萎缩，经X线或MRI等影像学检查提示肩袖组织有钙化灶。将所有的患者按照随机数字表法分为超声引导下精准定位体外冲击波组（治疗组）和痛点定位体外冲击波组（对照组），每组各40例，均采用瑞士EMS Swiss DolorClast体外冲击波治疗仪，该研究经宁波市中医院伦理委员会批准。