目的:研究拉筋的临床效果,戳捏治疗肱骨外上髁炎。
方法:2018年1月至2021年12月,采用多中心随机对照研究方法,收集望京医院192例肱骨外上髁炎患者,北京电里医院,北京丰盛骨伤医院,分别,按随机数字表法分为治疗组和对照组。治疗组96例,包括36名男性和60名女性,年龄28~60岁,平均(41.20±5.50)岁,病程1~14天,平均(5.24±1.35)天,隔日治疗一次,共2周。对照组96例,包括33名男性和63名女性,年龄26~60岁,平均(43.35±7.75)岁,病程1~14天,平均(5.86±1.48)天,外用伏拉林联合肘关节固定术治疗2周。视觉模拟量表(VAS)和医院手术评分系统(HSS)肘部旋前角和旋后角,腕掌屈曲和背侧伸展角度,比较两组患者治疗前及治疗后1、3、5、7、11、13天的肘部压痛情况;比较治疗前及最终治疗后医院外科评分系统2(HSS2)。
结果:所有患者随访10~14天,平均(12±1.6)天。治疗组和对照组治疗前VAS分别为6.83±1.36和6.79±1.58,最终治疗后下降到1.49±1.09和2.11±1.81。治疗组治疗后第1、3、5、7、9、11、13天的VAS评分明显低于对照组(P<0.05)。两组患者治疗前HSS评分分别为61.73±11.00和36.47±12.45。分别,在最终治疗时增加到94.42±5.9和91.44±9.11。治疗组治疗后第1、3、5、7、9、11、13天的HSS显著高于对照组(P<0.05)。治疗后第5天,治疗组肘关节内外旋转角度分别为(66.41±12.69)°和(66.35±13.54)°,对照组分别为(62.08±16.03)°和(61.77±16.35)°。治疗后第7天,治疗组肘关节内外旋转角度分别为(69.79±12.64)°和(70.02±13.55)°,对照组为(65.28±15.86)°和(65.09±16.67)°。治疗组肘关节活动度高于对照组(P<0.05)。治疗后第5天,治疗组腕关节背屈和手掌屈曲角度分别为(39.43±15.94)°和(46.68±11.10)°,对照组为(38.51±18.49)°和(44.27±13.58)°。治疗后第7天,治疗组腕关节背屈和手掌屈曲角度分别为(42.52±16.50)°和(49.23±10.96)°,对照组为(41.18±20.09)°和(46.64±14.63)°。治疗组腕关节活动度高于对照组(P<0.05)。治疗后第13天,治疗组HSS2值93.61±6.32高于对照组92.06±7.94(P<0.05)。两组各时间点肘部压痛比较,差异无统计学意义(P>0.05)。
结论:Voltaren外治疗联合肘关节固定和肌腱牵拉,戳揉可有效改善肱骨外上髁炎的症状。与体外治疗相比,肌腱拉扯,戳捏具有镇痛时间长、肘关节功能恢复好等优点。
OBJECTIVE: To investigate clinical effect of tendons pulling,poking and kneading for the treatment of external humeral epicondylitis.
METHODS: From January 2018 to December 2021,a multicenter randomized controlled study was performed to collect 192 patients with external humeral epicondylitis in Wangjing Hospital,Beijing Dianli Hospital,and Beijing Fengsheng Osteotraumatology Hospital,respectively,and they were divided into treatment group and control group by random number table method. There were 96 patients in treatment group,including 36 males and 60 females,aged from 28 to 60 years old with an average of (41.20±5.50) years old;the course of disease ranged from 1 to 14 days with an average of (5.24±1.35) days;they were treated once every other day for 2 weeks. There were 96 patients in control group ,including 33 males and 63 females,aged from 26 to 60 years old with an average of (43.35±7.75) years old;the course of disease ranged from 1 to 14 days with an average of (5.86±1.48) days;they were treated with topical voltaalin combined with elbow joint fixation for 2 weeks. Visual analogue scale (VAS) and Hospital for Surgery Scoring System (HSS) elbow pronation and supination angles,wrist metacarpal flexion and dorsal extension angles,elbow tenderness between two groups were compared before treatment and at 1,3,5,7,11 and 13 days after treatment;Hospital for Surgery Scoring System 2 (HSS2) was compared before treatment and the final treatment.
RESULTS: All patients were followed up for 10 to 14 days with an average of (12±1.6) days. VAS between treatment group and control group before treatment were 6.83±1.36 and 6.79±1.58,respectively,and decreased to 1.49±1.09 and 2.11±1.81 after the final treatment. VAS of treatment group were significantly lower than those of control group at 1,3,5,7,9,11 and 13 days after treatment (P<0.05). HSS between two groups were 61.73±11.00 and 36.47±12.45 before treatment,respectively,and increased to 94.42±5.9 and 91.44±9.11 at the final treatment. HSS of treatment group were significantly higher than those of control group at 1,3,5,7,9,11 and 13 days after treatment (P<0.05). On the 5th day after treatment,the external and internal rotation angles of elbow in treatment group were (66.41±12.69) ° and (66.35±13.54) °,while those in control group were (62.08±16.03) ° and (61.77±16.35) °. On the 7th day after treatment,the external and internal rotation angles of elbow were (69.79±12.64) ° and (70.02±13.55) ° in treatment group,and (65.28±15.86) ° and (65.09±16.67) ° in control group. Elbow joint motion in treatment group was higher than that in control group (P<0.05). On the 5th day after treatment,angles of wrist dorsiflexion and palm flexion were (39.43±15.94) ° and (46.68±11.10) ° in treatment group,and (38.51±18.49) ° and (44.27±13.58) ° in control group. On the 7th day after treatment,angles of wrist dorsiflexion and palm flexion were (42.52±16.50) ° and (49.23±10.96) ° in treatment group,and (41.18±20.09) ° and (46.64±14.63) ° in control group. The motion of wrist joint in treatment group was higher than that in control group (P<0.05). On the 13th day after treatment,HSS2 in treatment group 93.61±6.32 were higher than those in control group 92.06±7.94(P<0.05). There was no significant difference in elbow tenderness between two groups at each time point (P>0.05).
CONCLUSIONS: Voltaren external treatment combined with elbow fixation and tendons pulling,poking and kneading could effectively improve symptoms of external humeral epicondylitis. Compared with voltaren external treatment,tendons pulling,poking and kneading has advantages of longer analgesic time and better elbow function recovery.