Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Center for Shockwave Medicine and Tissue Engineering, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Biomed Res Int. 2019 Mar 14;2019:2958251. doi: 10.1155/2019/2958251. eCollection 2019.
Extracorporeal shock wave therapy (ESWT) had been proved to be beneficial in calcific tendinosis; however, the treatment efficacy in noncalcific tendinosis of rotator cuff still remains controversial. The present study was to compare the outcomes ESWT among the noncalcific rotator cuff tendinosis and different types of calcific tendinosis on the basis of similar shoulder functional status.
A retrospective, comparative study was conducted with the enrollment of 20 patients in each group through propensity score matching in a 1:1:1 ratio from 291 patients who underwent single ESWT for painful shoulder tendinosis. The patients were divided into three groups which included noncalcified tendinosis (NCTS), type I dense calcified tendinosis of shoulder (DCTS), and type II and type III translucent calcified tendinosis of shoulder (TCTS) according to Gartner and Heyer classification. The clinical evaluation included the subjective pain score with visual analog scale (VAS) and functional outcome with Constant and Murley score (CMS).
Twelve months after ESWT, the VAS in TCTS (1.5 ± 2.48) was statistically significant lower than NCTS (2.9 ± 2.86) and DCTS (3.8 ± 2.46) (p=.011). For the functional outcome, the overall CMS was superior in TCTS than the NCTS and DCTS (86.9 ± 19.7 versus 78.7 ± 18.3 and 71.1 ± 17.8, p=.014). Besides, the subscales of pain score, strength, and range of motion in TCTS improved significantly better than NCTS and DCTS. 70% of patients were complaint-free in TCTS group, which was higher than the NCTS group (15%) and DCTS group (25%) (p<0.05).
The present study indicated that the high-dose ESWT posed superior clinical efficacy in type II/III calcification tendinosis rather than type I calcification and noncalcific shoulder tendinosis.
体外冲击波疗法（ESWT）已被证明对钙化性肌腱病有益；然而，在肩袖非钙化性肌腱病中的治疗效果仍存在争议。本研究旨在基于相似的肩部功能状态，比较 ESWT 在非钙化性肩袖肌腱病和不同类型钙化性肌腱病中的疗效。
通过倾向性评分匹配，以 1:1:1 的比例从 291 例接受单次 ESWT 治疗肩部疼痛性肌腱病的患者中，回顾性比较了每组 20 例患者。根据 Gartner 和 Heyer 分类，患者分为三组：非钙化性肌腱病（NCTS）、Ⅰ型肩致密钙化性肌腱病（DCTS）和Ⅱ型和Ⅲ型透明性钙化性肌腱病（TCTS）。临床评估包括视觉模拟量表（VAS）的主观疼痛评分和Constant 和 Murley 评分（CMS）的功能结果。
ESWT 后 12 个月，TCTS 的 VAS（1.5±2.48）显著低于 NCTS（2.9±2.86）和 DCTS（3.8±2.46）（p=.011）。对于功能结果，TCTS 的总体 CMS 优于 NCTS 和 DCTS（86.9±19.7 比 78.7±18.3 和 71.1±17.8，p=.014）。此外，TCTS 在疼痛评分、力量和运动范围的亚量表上的改善明显优于 NCTS 和 DCTS。TCTS 组 70%的患者无抱怨，高于 NCTS 组（15%）和 DCTS 组（25%）（p<0.05）。
本研究表明，高剂量 ESWT 在Ⅱ/Ⅲ型钙化性肌腱病中的临床疗效优于Ⅰ型钙化和非钙化性肩袖肌腱病。
