单纯皮质类固醇注射与早期肩周炎额外物理治疗的比较
Corticosteroid injection alone additional physiotherapy treatment in early stage frozen shoulders.
作者信息
Kraal Tim, Sierevelt Inger, van Deurzen Derek, van den Bekerom Michel Pj, Beimers Lijkele
机构信息
Department of Orthopedic Surgery, Slotervaart Center of Orthopedic Research and Education, Amsterdam 1066 EC, The Netherlands.
Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Amsterdam 1091 AC, The Netherlands.
出版信息
World J Orthop. 2018 Sep 18;9(9):165-172. doi: 10.5312/wjo.v9.i9.165.
AIM
To investigate the additional value of physiotherapy after a corticosteroid injection in stage one or two idiopathic frozen shoulders (FSs).
METHODS
A two center, randomized controlled trial was done. Patients with a painful early stage idiopathic FS were eligible for inclusion. After written consent, patients were randomly allocated into two groups. All patients received an ultrasound-guided intra-articular corticosteroid injection. One group underwent additional physiotherapy treatment (PT) and the other group did not (non-PT). The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes were pain (numeric pain rating scale), range of motion (ROM), quality of life (RAND-36 score), and patient satisfaction. Follow-up was scheduled after 6, 12 and 26 wk.
RESULTS
Twenty-one patients were included, 11 patients in the non-PT and ten in the PT group, with a mean age of 52 years. Both treatment groups showed a significant improvement at 26 wk for SPADI score (non-PT: = 0.05, PT: = 0.03). At the 6 wk follow-up, median SPADI score was significant decreased in the PT group (14 IQR: 6-38) the non-PT group (63 IQR: 45-76) ( = 0.01). Pain decreased significantly in both groups but no differences were observed between both treatment groups at any time point, except for night pain at 6 wk in favor of the PT group ( = 0.02). Significant differences in all three ROM directions were observed after 6 wk in favor of the PT group ( ≤ 0.02 for all directions). A significantly greater improvement in abduction ( = 0.03) and external rotation ( = 0.04) was also present in favor of the PT group after 12 wk. RAND-36 scores showed no significant differences in health-related quality of life at all follow-up moments. At 26 wk, both groups did not differ significantly with respect to any of the outcome parameters. No complications were reported in both groups.
CONCLUSION
Additional physiotherapy after corticosteroid injection improves ROM and functional limitations in early-stage FSs up to the first three months.
目的
探讨在一、二期特发性冻结肩（FS）中，皮质类固醇注射后进行物理治疗的附加价值。
方法
开展一项双中心随机对照试验。入选有疼痛症状的早期特发性FS患者。获得书面同意后，将患者随机分为两组。所有患者均接受超声引导下关节内皮质类固醇注射。一组接受附加物理治疗（PT），另一组不接受（非PT）。主要结局指标为肩痛及功能障碍指数（SPADI）。次要结局包括疼痛（数字疼痛评分量表）、活动范围（ROM）、生活质量（RAND-36评分）及患者满意度。计划在6周、12周和26周后进行随访。
结果
共纳入21例患者，非PT组11例，PT组10例，平均年龄52岁。两组在26周时SPADI评分均有显著改善（非PT组：=0.05，PT组：=0.03）。在6周随访时，PT组的SPADI评分中位数显著降低（14，四分位间距：6-38），非PT组为（63，四分位间距：45-76）（=0.01）。两组疼痛均显著减轻，但在任何时间点，两组间均未观察到差异，除了6周时夜间疼痛PT组更有优势（=0.02）。6周后，在所有三个ROM方向上均观察到显著差异，PT组更有优势（所有方向≤0.02）。12周后，外展（=0.03）和外旋（=0.04）方向上PT组也有显著更大的改善。RAND-36评分在所有随访时间点的健康相关生活质量方面均无显著差异。在26周时，两组在任何结局参数方面均无显著差异。两组均未报告并发症。
结论
皮质类固醇注射后附加物理治疗可改善早期FS在头三个月内的ROM及功能受限情况。
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