| Objective: Periarthritis of shoulder is common disease in the elderly people, is the widespread chronic aseptic inflammation which is caused by degenerative changes of articular capsule of the shoulder joint and its surrounding soft tissue, with shoulder joint pain, activity limitations as its main characteristic. The case rate of the general crowd is 2%. There are 7% patient for shoulder pain in orthopedics out-patient clinic.Correct selection of therapeutic regimen, relieving pain in time, controlling inflammation, alleviating synarthrophysis and improving functional disturbance are the important turning point of rising periarthritis of shoulder cure rate. It's also the domestic and foreign scholars' investigative focus.The treatment of periarthritis of shoulder can be divided into two types: surgery and non-surgical treatment. Open operation has many deficients, such as the bigger damages, difficulty rehabilitation training after operation, postoperative adhesions again and so on. So it has more limitations. At present, the most scholars advocate to cure periarthritis of shoulder with associated application of non-surgical treatment, so as to make up for each other's deficiencies and enhances the curative effect. Research shows that the effective power of combined therapy and monotherapy were 93% and 60% respectively. And the curative effect of treatment by stages is obviously better than non-staging treatment. According to the different staging of periarthritis of shoulder, the emphasis of treatment is different. The acute stage of it focuses on dephlogisticate and alleviating pain. The accretio stage focuses on loose adhesion. The catabasis focuses on restoration of function. Etiopathogenisis and pathology of periarthritis of shoulder is very complicated. There are many methods of treatment, and every of them has itself advantages and disadvantages. Therefore, searching for an effective, short time of therapy, less painful and economical treatment plan on the basis of strict definition and normative categorization are the current important topic.Method: We observed 150 patients of periarthritis of shoulder whose the course of disease is within half a year ( acute stage, accretio stage ) and divided them into 3 groups randomly, nerve block group?physiatrics group? nerve block and physiatrics group. At the same time, the three group are assisted with exercise therapy. After 20 days we contrast the difference of pain scoring, shoulder joint motion function scoring, total effective rate between Pretherapy and post-treatment, the difference of the time that achieving criterion of cure, the difference of cure rate of the three groups in acute stage and accretio stage. All measurement data are expressed as mean±s. The difference of two groups and fore-and-aft treatment in the same group is expressed with the t-test. The difference of multitude groups multitude is expressed with analysis of variance, one-factor analysis of variance with regular variance. The difference of treatment group and two control groups is expressed with Dunnett t-test, rank sum test with heterogeneity of variance. The difference of enumeration data is expressed with x2 test.Result:①We completed 146 clinical observations. Total effective rate ( 100% ) of treatment group is obviously better than the first control group ( total effective rate 80.85%, P<0.01 ) and the second control group ( total effective rate 85.71%, P<0.01 );②Total effective rate of the three groups for curing patients of periarthritis of shoulder in acute stage ( within two months ) is 100% without removing case. The cure rate of the first control group is 64.71%, similar with the treatment group ( cure rate, 68.75% ). And there is significant difference of cure rate between the first control group and the second control group ( cure rate, 26.67% );③For patients of periarthritis of shoulder in acute stage, total effective rate of the treatment group ( 100% ) is better than the first control group ( total effective rate, 70.00%, P<0.05 ) and the second control group ( total effective rate, 79.41%, P<0.05 ). The cure rate of the second control group ( 35.29% ) is better than the second control group. There isn't significant difference between the second control group and the treatment group.④We discovered that total curative effect of the treatment in acute stage of periarthritis of shoulder is better after contrasting every group of acute stage and accretion stage. And there is significant difference of curative effect between acute stage and accretion stage.⑤The course of the treatment group that achieving criterion of cure is shortest in all groups ( 13.03±1.52 days ) without removing case.⑥The post-treatment pain index of patients decreased, the shoulder joint motion function scoring increased, there is significant difference between the treatment group and the control group ( P<0.05 ).Conclusion: The result of experiment demonstrated the comprehensive rehabilitation care is better than monotherapy. The comprehensive rehabilitation care can significantly decurtate course of treatment, the post-treatment pain scoring decreased significantly and the shoulder joint motion function scoring increased significantly. In the process of treatment there isn't any removing case, the tolerance of patients is good and the monotherapy of nerve block could gain the similar curative effect of the combined therapy.The early treatment of periarthritis of shoulder is very significanct for increasing cure rate, decreasing the occurrence of dysfunction. The treatment plan of comprehensive rehabilitation could educe joint action of various kinds method, decurtate course of treatment, relieve pain efficiently, prevent synarthrophysis, accrete range of motion, promote functional recovery. It's easy to accept for patients and worth spreading in every hospital, as an effective, short time of therapy, less painful and economical treatment plan. |
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