| Objective:By comparing the changes of shoulder joint function in patients with shoulder joint dysfunction after breast cancer surgery in the comprehensive treatment group of traditional Chinese medicine(combined with massage and wuwei shuangbai powder for external application on the basis of shoulder joint function exercise)and the control group(simple shoulder joint function exercise),the differences in efficacy and safety between the two groups were evaluated.Methods:47 patients with shoulder joint dysfunction after breast cancer surgery were randomly divided into two groups,24 in the experimental group and 23 in the control group.The control group received shoulder joint functional exercise twice a day for 20 minutes each time for 4 consecutive months.In the treatment group,on the basis of shoulder joint functional exercise,massage and wuwei shuangbai powder were given for external application,and the treatment time was 40-60 minutes per time,2 times per week for 1 course of treatment,a total of 4 courses of treatment,a total of 1 month.After that,the patient maintained shoulder joint functional exercise for 3 months.The changes of shoulder pain,shoulder mobility,daily living ability,muscle strength and local joint morphology were evaluated before treatment,1,2,3,4 weeks after treatment and 1,2,3 months after follow-up.At the same time,adverse reactions during treatment were recorded to evaluate the safety of the two groups.Results:1.Comparing the total score of shoulder joint function of the affected side:(1)The results of intra-group comparison showed that the average total score of shoulder joint function of the experimental group and the control group before treatment was 60.25±10.43 and 64.39±5.67,respectively.The total score of shoulder joint function of the two groups showed an increasing trend from the first week after the intervention,and the difference was statistically significant(P<0.001).(2)The results of comparison between the two groups showed that there was no difference in the total score of the affected shoulder joint between the two groups after one week of treatment(P>0.05),but there was significant difference between the two groups after 2,3,4 weeks of treatment and 1,2 and 3 months of follow-up.The difference was statistically significant(P<0.05).2.VAS score of shoulder pain on the affected side:(1)The results of intra-group comparison showed that the average VAS score of shoulder pain before treatment in the experimental group and the control group were 5.75±1.78 and 5.61±0.9,respectively.The VAS score of shoulder pain in the two groups showed a downward trend from the first week of intervention,and there were differences after the first week of treatment.The differences were statistically significant(P<0.05).(2)The results showed that there was no difference in VAS pain score of affected shoulder joint between the two groups after 1 week of treatment(P>0.05),but there was significant difference in 2,3,4 weeks of treatment and 1,2 and 3 months of follow-up.The difference was statistically significant(P<0.05).3.Functional activity of the shoulder joint on the affected side:(1)The results of intra-group comparison showed that before treatment,the average score of shoulder joint activity of the experimental group and the control group were 13.04±3.17 and 14.26±2.43,respectively.After the first week of intervention,the score of shoulder joint activity of the two groups showed an upward trend,and there were differences after the first week of treatment.The differences were statistically significant(P<0.05).(2)The results showed that there was no difference in the average score of shoulder joint activity between the two groups after 1 and 2 weeks of treatment(P>0.05),but after 3 weeks of treatment,the score of shoulder joint activity in the experimental group was significantly higher than that in the control group(P<0.05).During the follow-up period,the shoulder motion score of the experimental group continued to be significantly different from that of the control group after 1 month of follow-up.The difference was statistically significant(P<0.05).However,there was no difference in the average shoulder motion score between the two groups after 2 and 3 months of follow-up,and the difference was not statistically significant(P>0.05).4.Comparisons of daily living ability of affected shoulder joint:(1)The results of intra-group comparison showed that the average daily living ability of the two groups was 25.54±5.36 and 27.91±2.23,respectively.The daily living ability score of the two groups showed an upward trend from the first week of intervention,and there were differences after the first week of treatment and during the follow-up period.The differences were statistically significant(P<0.05).(2)The results showed that there was no difference in the average daily living ability score between the two groups after 1,2 and 3 weeks of treatment(P>0.05),but after 4 weeks of treatment,the daily living ability score of the experimental group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).During the follow-up period,there was no significant differences in the average shoulder motion score between the two groups in 1,2 and 3 months(P>0.05).5.Comparison of muscle strength and local morphology:The average score of muscle strength and local morphology in each period was 5.00±0.0.There was no significant differences in muscle strength and local morphology between the two groups before and after treatment,and there was no difference between the two groups.Statistical analysis showed that there was no significant differences(P>0.05).6.Inter-group evaluation of curative effect:After treatment,the experimental group cured 4 people,markedly effective 18 people,ineffective 2 people;the control group cured 1 person,markedly effective 11 people,ineffective 11 people;the total improvement rate of the two groups was 91.7%compared with 52.2%.There was no significant differences in the curative effect ratio between the two groups after 2 weeks of treatment(P>0.05).There was significant difference in the curative effect ratio between the two groups after 3 and 4 weeks of treatment(P<0.05).There was significant difference in the curative effect ratio between the two groups after 1 and 2 month of follow-up(P<0.05),but there was no significant difference between the two groups after 3 months of follow-up.After statistical treatment,the difference was not statistically significant(P>0.05).7.Subgroup analysis of the two groups:The effect of improving shoulder joint function in the control group was not related to the operation method and the treatment method of axillary lymph nodes,but was related to the time of admission(P<0.05).On the basis of functional exercises,there was no significant correlation between the effect of massage combined with external application of Wuwei Shuangbai Powder on breast cancer patients after operation,the treatment of axillary lymph nodes,and the time of admission.The difference was not statistically significant(P>0.05).There was no significant difference between the two groups within 2 months of operation,breast conserving surgery and sentinel lymph node biopsy(P>0.05),but there was no significant difference between the two groups after 2 months of operation and axillary lymph node dissection(P<0.05).8.The adverse reactions during the treatment of this subject were skin flushing and itching in the experimental group(4.16%)and no adverse reactions in the control group.There was no significant differences between the two groups.There was no statistical difference(P>0.05).Conelusion:1.Simple shoulder function exercise and comprehensive external treatment of traditional Chinese medicine can effectively improve shoulder function of patients with shoulder dysfunction after breast cancer surgery.2.The curative effect of comprehensive external treatment group in alleviating shoulder pain,increasing shoulder mobility and improving daily living ability is obviously better than that of simple functional exercise group,and the recovery rate and apparent efficiency are also significantly higher than that of simple shoulder functional exercise group,and this study suggests that the optimal course of treatment is more than 3 weeks.3.Shoulder joint functional exercises as early as possible after 2 weeks of breast cancer surgery can improve shoulder joint function of the affected side more significantly,and this study suggests that it is best to exercise last for more than 4 months.4.Within 2 months after breast cancer surgery or patients undergoing sentinel lymph node biopsy can effectively improve shoulder joint function by simple shoulder joint functional exercise.For patients who underwent axillary lymph node dissection or 2 months after breast cancer surgery,massage combined with Wuwei Shuangbai powder external application is needed to significantly improve shoulder joint function.5.Comprehensive treatment of TCM has no serious adverse reactions and is reasonable to use. |
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