| Background:Patients with periarthritis of shoulder account for 2%～3% of the global total. More women suffer from periarthritis of shoulder than men,8% of the city populations. It is characterized by pains around the shoulder joints. The disease has a bad influence on people's life qualities and normal work. Acupotomologic therapy combinates the Chinese needles with the modern knives.In comparison with other therapies, it has a series of advantages such as short treatment duration, better effects, accurate therapy. However, research on periarthritis of shoulder, evaluation of documents, precise surgery pathways and hand skills is little.Purpose:1. Document research:analyze the related documents on acupotomologic therapy for periarthritis of shoulders.2. Experimental research:explore the anatomic pathways of acupotomologic therapy for periarthritis of shoulders, evaluate the associated points that should be noticed.3. Clinical research:observe effects of elastic/electric/Zhu acupotomologic manipulation respectively. Methods:1. Document research:take the periarthritis of shoulders and acupotomy as the key words; search the time range from January 1989 to December 2010.2. Experimental research:anatomize the upper limbs of adult corpses; observe the pathways of muscles, vessels, nerves. Measure the bonny marks with 10 scapula and 10 shoulder bones, secure surgery pathways for acupotomy.3. Clinical research:categorize the volunteers into three groups:randomly, elastic and routine acupotomy. Locate the treating area based on function-affected region, diagnostic points, operate the layer-by-layer elas c acupotomy and routine acupotomy, observe the results once a week and take four weeks as a trial cycle. After one cycle, observe the therapeutic effects. The electric group take special acupoints as points every other day, trice a week, and four weeks as a cycle. Evaluate the severity of pain, functional activities and therapeutics.Results1. Document research:132 articles associated with Periarthritis of shoulder during the past 21years have been retrieved, among which 128 are about clinical experiments, 1 experiment,2 summaries and 1 individual report. In the clinical documents, there are 32 RCTs, 6 CCTs,89 summaries and 1 comment. Among the 32RCTs,6 have inclusion/exclusion criteria, 4 have exclusion but no inclusion criteria, 21 have balancing tests,26 have clear diagnostic standards. Only 2 documents are about pure acupotomy therapy. 23 documents describe the main therapeutic positions.28 documents make clear instructions about the therapeutic effects.2. Experimental research:2.1 departure from the coracoid, which can relax musculus pectoralis minor,musculus coracobrachialis,short ending of the bicipital muscle of arm,ligamentum coracoacromiale,coracoclavicular ligament,ligamentum coracohumerale.2.2 surgery for the small nodule, which can relax the teretiscapularis,subscapularis,latissimus dorsi; surgery from the large nodule, which can relax the ectopectoralis,supraspinous muscle,infraspinous muscle,teres minor muscle,adhesion area of the coracohumeral ligament; surgery from the intratubercular sulcus, which can relax the tendinous sheath of the bicipital muscle,tendinous ligament of the bicipital muscle.2.3 surgery from the synovial bursa, which can relax the subacromial bursa;surgery from the supraspinous fossa, which can relax the supraspinous muscle's set point; infraspinous pathway, which can relax the infraspinous muscle's set point; upper angle of the scapula can relax the levator muscle of scapula; axillary aspect of the scapula pathway, which can relax the teres minor muscle's set point; vertebral aspect of the scapula pathway, which can relax the rhomboideus's set point and the infrascapular muscle; infra- angle of the scapula pathway, which can relax the set point of the major muscle 3. Clinical research3.1 self-comparisonDegree of pain and the functional activities have been greatly improved. The differences have statistical significance. (P<0.01) The group of patients'muscular power, group of ADL and group of morphological integral also have obvious improvement with statistical significance (P<0.01)3.2 comparision between groupsNo statistical significance existed in the elastic acupotomy group and routine acupotomy group comparison (P>0.05). Difference between elastic acupotomy group and electric acupotomy group had statistical significance(P <0.01). After treatment, the muscular power and ADL between the elastic acupotomy group with the standard group showed no statistical significant differences(P>0.01). The difference of the morphological integral in the elastic acupotomy group, electric acupotomy group and routine acupotomy group was of no statistical significance(P>0.05). The difference of muscular power and ADL integral between the elastic acupotomy group and the electric acupotomy group had statistical significance (P<0.01). There were statistically significant differences in muscular power and ADL integral between the standard acupotomy group and the electric acupotomy group (P<0.01).3.3 acceptanceDifferences of Horror, pain and acceptance among 3 groups have statistical significance (P<0.01). Single variance acupuncture is more easily to be accepted than acupotomy, while elastic operation has an obvious advantage to the standard.3.4 curative effectThe three groups'effect have significant difference via rank-sum test (P<0.01).No significant difference (P>0.05) exists between the elastic operation group and the routine group. The two groups share a significant difference (P<0.01) in effect.3.5 reoccurrence rateThe difference of the three groups'reoccurrence rate have statistical significance(P<0.05). No significant difference(P>0.05)between the elastic operation group and the routine group, while both share a significant difference (P<0.01) with the electric acupotomy group. Conclusions:1. Document research:We found that there was more clinic document than experimental document. It was very important to strengthen the experiment and mechanism investigation.2. Experimental research:We applied anatomic study on periarthritis of shoulder. The degrees of freedom included are shoulder flexion/extension, adduction/abduction, external rotation/internal rotation. We brought different routes together, according to their degrees.3. Clinic research:Elastic acupotomy proves to be excellent in healing Periarthritis of shoulder with good prognosis, low reoccurrence rate, and higher acceptance than standard acupotomy. It is worth of spreading.
|
PDF Full Text Request