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中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (03) : 226 -231. doi: 10.3877/cma.j.issn.2095-5790.2022.03.007

论著

力偶练习和肩肱节律调整对肩袖损伤保守治疗影响的临床研究
赵琛1,(), 胡锐1, 周红1, 王芳1, 胡真1, 文凡1   
  1. 1. 610000 成都,四川省骨科医院筋伤科
  • 收稿日期:2022-06-09 出版日期:2022-08-05
  • 通信作者: 赵琛

Clinical study on the effect of coupling exercise and shoulder-brachial rhythm adjustment on conservative treatment of rotator cuff injury

Chen Zhao1,(), Rui Hu1, Hong Zhou1, Fang Wang1, Zhen Hu1, Fan Weng1   

  1. 1. Department of Muscle Traumatology, Sichuan Orthopedic Hospital, Chengdu 610000, China
  • Received:2022-06-09 Published:2022-08-05
  • Corresponding author: Chen Zhao
引用本文:

赵琛, 胡锐, 周红, 王芳, 胡真, 文凡. 力偶练习和肩肱节律调整对肩袖损伤保守治疗影响的临床研究[J/OL]. 中华肩肘外科电子杂志, 2022, 10(03): 226-231.

Chen Zhao, Rui Hu, Hong Zhou, Fang Wang, Zhen Hu, Fan Weng. Clinical study on the effect of coupling exercise and shoulder-brachial rhythm adjustment on conservative treatment of rotator cuff injury[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(03): 226-231.

目的

对非手术治疗的肩袖损伤患者,采取结合肩胛骨周围肌肉平衡的力偶训练,同时对肩关节活动范围、肩部疼痛等指标做相应测定与分析,以期了解治疗效果,进而规范肩痛患者的治疗方案。

方法

选取肩关节疼痛患者共100例,随机分为两组,每组各50例,一组采取传统保守治疗方法(对照组);另一组采用力偶练习和调整肩胛骨节律(实验组)。记录两组患者治疗前、治疗3个月后、6个月后及12个月后患者的视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会评分(American shoulder and elbow surgeons'form, ASES)、肩胛骨侧方移位实验(later scapular slide test,LSST)测试数据,并进行统计学比较。

结果

实验组与对照组在治疗后12个月,其VAS评分都较治疗前显著下降(P<0.05)。实验组的ASES功能评分在治疗后,相较治疗前有显著改善(P<0.05),而对照组无变化。实验组在三个姿势下的LSST测试,相较治疗前有显著改善(P<0.05),而对照组无变化。

结论

采用传统保守治疗及力偶练习和调整肩胛骨节律治疗均能显著缓解肩关节疼痛,但力偶练习和调整肩胛骨节律治疗能够更显著地改善肩关节功能,在此方面优于传统保守治疗。

Background

Shoulder pain and dysfunction are common problems in clinical practice. Many studies on other shoulder joint lesions and injuries have proved that rotator cuff injury, acromion impaction syndrome, shoulder instability, and other shoulder joint diseases are related to the shoulder blade's abnormal position and movement trajectory and abnormal changes in shoulder blade movement. Normal shoulder joint movement needs humerus joints, the acromioclavicular joints, the sternoclavicular joint, and the shoulder of the chest wall joint to coordinate with each other. When their interaction is abated, stamina and coordination become poor, weak muscle strength and stability of the shoulder blade less, poor posture and lack of core stability, and shoulder joint pain and injury on the probability increase. In rotator cuff injury, exercise therapy can also relieve pain and restore shoulder function for patients who do not meet the indications for surgery. Many studies have found that patients with rotator cuff injury have abnormal changes in scapular movement, mostly caused by force couple imbalance and shoulder-brachial rhythm disorder. The muscle groups around the shoulder joint in the shoulder joint lift, the formation of two directions of force, counterclockwise rotation of force including deltoid bundle, trapezius upper, middle, lower and serratus anterior muscle; The clockwise pair includes a posterior bundle of the deltoid, infraspinatus, teres minor, teres major, latissimus dorsi, rhomboid, etc. At the same time, they cooperate to form the shoulder-brachial rhythm and complete the 180° full radian abduction, which is produced by the 120° abduction of the glenohumeral joint and the 60° upward rotation of the scapulothoracic joint, with a motion ratio of approximately 2:1.

Objective

For patients with rotator cuff injury treated with non-surgical treatment, couples training combined with the balance of the muscles around the scapula was adopted. The range of motion of the shoulder joint, shoulder pain, and other indicators were measured and analyzed accordingly to understand the treatment effect and then standardize the treatment plan for patients with shoulder pain.

Methods

A total of 100 people with shoulder joint pain were randomly divided into two groups, each group of 50 people. A group adopts the traditional conservative treatment (control group) , another group of couple practice and adjust the rhythm of the scapula (experimental group) , and the record two groups of patients before and three months after treatment, patients with six months and 12 months treatment of VAS score, ASES score, LSST test Data, and statistical comparison.

Results

The pain scores of the experimental and control groups significantly decreased 12 months after treatment compared with those before treatment (P<0.05) . The ASES function score in the experimental group was greatly improved after treatment compared with before treatment (P<0.05) , while there was no change in the control group. The LSST test in the experimental group under three postures was significantly improved compared with before treatment (P<0.05) , while there was no change in the control group.

Conclusion

The therapy of coupling exercise and scapula rhythm adjustment can relieve shoulder pain and improve function, which is better than traditional non-operative therapy.

表1 两组患者治疗前后VAS评分比较(分,±s)
表2 两组患者治疗前后的ASES功能评分比较(分,±s)
图1 站立位时健侧与患侧LSST比较注:与同一组健侧比较,aP<0.05;与对照组健侧比较,bP<0.05;与对照组患侧比较,cP<0.05;与治疗前比较,dP<0.05;LSST为肩胛骨侧方移位实验
图2 叉腰位时健侧与患侧LSST比较注:与同一组健侧比较,aP<0.05;与对照组健侧比较,bP<0.05;与对照组患侧比较,cP<0.05;与治疗前比较,dP<0.05;LSST为肩胛骨侧方移位实验
图3 外展内旋位时健侧与患侧LSST比较注:与同一组健侧比较,aP<0.05;与对照组健侧比较,bP<0.05;与对照组患侧比较,cP<0.05;与治疗前比较,dP<0.05;LSST为肩胛骨侧方移位实验
图4 各姿势LSST趋势比较注:LSST为肩胛骨侧方移位实验
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