Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
J Shoulder Elbow Surg. 2014 Nov;23(11):1640-6. doi: 10.1016/j.jse.2014.06.036. Epub 2014 Sep 12.
Ultrasound (US)-guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy (ESWT) for function restoration and pain relief in patients with calcific tendinitis of the shoulder.
Fifty-four patients diagnosed with unilateral painful calcific tendinitis were randomly allocated to a US needling or ESWT group. The US needling group underwent US-guided needling and received a subacromial corticosteroid injection. The ESWT group received ESWT 3 times a week. All patients were prospectively evaluated; American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale for pain scores were recorded before the procedure and at 6 weeks, 12 weeks, 6 months, 12 months, and the last follow-up. The size and morphology of the deposits were evaluated by radiography.
The average follow-up period was 23.0 months. At last follow-up, the mean size of the deposits was significantly different between the 2 groups (P = .001); it decreased to 0.5 mm from 14.8 mm in the US needling group and to 5.6 mm from 11.0 mm in the ESWT group. There were also significant improvements in clinical outcomes in both groups after treatment (P < .05). At 1-year follow-up, the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment (90.3 and 74.6, respectively; P = .001), Simple Shoulder Test (83.3 and 70.8, respectively; P = .015), and visual analog scale for pain (1.4 and 3.3, respectively; P = .003).The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups (P > .05).
Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits. US-guided needling treatment, however, was more effective in function restoration and pain relief in the short term.
在肩袖钙化性肌腱炎患者中，与体外冲击波疗法（ESWT）相比，超声（US）引导下的针刺联合肩峰下皮质类固醇注射在功能恢复和疼痛缓解方面更有效。
将 54 例单侧肩袖钙化性肌腱炎患者随机分为 US 针刺组和 ESWT 组。US 针刺组接受 US 引导下的针刺，并接受肩峰下皮质类固醇注射。ESWT 组每周接受 3 次 ESWT。所有患者均进行前瞻性评估；美国肩肘外科医生协会（American Shoulder and Elbow Surgeons，ASES）评分、简单肩部测试（Simple Shoulder Test，SST）和视觉模拟评分（visual analog scale for pain scores，VAS）用于记录治疗前、治疗后 6 周、12 周、6 个月、12 个月和最后随访时的疼痛评分。通过 X 线摄影评估沉积物的大小和形态。
平均随访时间为 23.0 个月。末次随访时，两组之间沉积物的平均大小有显著差异（P =.001）；US 针刺组从 14.8mm 减小至 0.5mm，ESWT 组从 11.0mm 减小至 5.6mm。两组治疗后临床结局均有显著改善（P <.05）。在 1 年随访时，与 ESWT 组相比，US 针刺组的美国肩肘外科医生协会评估（分别为 90.3 和 74.6，P =.001）、简单肩部测试（分别为 83.3 和 70.8，P =.015）和视觉模拟评分（分别为 1.4 和 3.3，P =.003）的评分明显更好。两组中初始钙沉积大小与临床结局均呈弱相关（P >.05）。
两种治疗钙化性肌腱炎的方法均改善了临床结局并消除了钙沉积。然而，在短期随访中，US 引导下的针刺治疗在功能恢复和疼痛缓解方面更有效。
