Ebenbichler G R, Erdogmus C B, Resch K L, Funovics M A, Kainberger F, Barisani G, Aringer M, Nicolakis P, Wiesinger G F, Baghestanian M, Preisinger E, Fialka-Moser V
Department of Physical Medicine and Rehabilitation, University of Hospital of Vienna, Austria.
N Engl J Med. 1999 May 20;340(20):1533-8. doi: 10.1056/NEJM199905203402002.
Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies.
We enrolled 63 consecutive patients (70 shoulders). Fifty-four patients (61 shoulders) completed the study. There were 32 shoulders in the ultrasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in nine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent) in the ultrasound-treatment group and improved in 7 shoulders (23 percent), as compared with respective values of 2 (8 percent) and 3 (12 percent) in the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greater improvements in the quality of life than those who had received sham treatment; at nine months, the differences between the groups were no longer significant.
In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement.
尽管超声疗法用于治疗肩部钙化性肌腱炎，但其疗效尚未得到严格评估。我们对经X线检查证实为有症状的钙化性肌腱炎患者进行了超声检查与假超声照射的随机双盲比较。患者被分配接受24次每次15分钟的治疗，治疗方式为脉冲超声（频率0.89兆赫；强度每平方厘米2.5瓦；脉冲模式1:4）或对钙化部位进行难以区分的假治疗。前15次治疗每天进行（每周5次），其余治疗每周3次，共3周。随机分组是根据肩部而非患者进行的，因此双侧肌腱炎患者可能接受其中一种或两种治疗。
我们连续纳入了63例患者（70个肩部）。54例患者（61个肩部）完成了研究。超声治疗组有32个肩部，假治疗组有29个肩部。治疗6周后，超声治疗组有6个肩部（19%）的钙沉积消失，9个肩部（28%）的钙沉积减少至少50%，而假治疗组分别为0个和3个肩部（10%）（P=0.003）。在9个月的随访中，超声治疗组有13个肩部（42%）的钙沉积消失，7个肩部（23%）的病情改善，而假治疗组分别为2个肩部（8%）和3个肩部（12%）（P=0.002）。治疗结束时，接受超声治疗的患者疼痛减轻程度更大，生活质量改善程度也比接受假治疗的患者更大；9个月时，两组之间的差异不再显著。
在有症状的肩部钙化性肌腱炎患者中，超声治疗有助于消除钙化，并与短期临床改善相关。
