Ko Jih-Yang, Huang Chung-Cheng, Huang Po-Hua, Chen Jeng-Wei, Liao Chin-Yi, Kuo Shu-Jui
Department of Orthopaedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital Kaohsiung.
Center for Shockwave Medicine and Tissue Engineering, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital Kaohsiung.
Int J Surg. 2024 Dec 1;110(12):7421-7433. doi: 10.1097/JS9.0000000000002063.
The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears.
Eligible patients were randomized into three groups: three HA injections combined with two sham ESWT (HA), three HA injections combined with one ESWT and one sham ESWT (HA + 1 ESWT), or three HA injections combined with two ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant-Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed preintervention and at 1, 3, 6, and 12 months postinitial HA injection. Shoulder MRI was conducted before and 12 months after the intervention.
All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP ( P =0.011) and CMS ( P =0.018) at 1 month, and in MP ( P =0.014) and CMS ( P =0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF ( P =0.027), IR ( P =0.019), and SROM ( P =0.025) at 1 month, and in ABD ( P =0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF ( P =0.013), IR ( P =0.019), and SROM ( P =0.025) at 1 month, and in FF ( P =0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans.
ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.
本研究调查了肩峰下注射透明质酸（HA）与体外冲击波疗法（ESWT）联合应用于治疗无完全撕裂的肩袖损伤的疗效。
符合条件的患者被随机分为三组：三次HA注射联合两次模拟ESWT（HA组）、三次HA注射联合一次ESWT和一次模拟ESWT（HA + 1次ESWT组）或三次HA注射联合两次ESWT（HA + 2次ESWT组），分配比例为1:1:1。在首次注射HA前以及注射后1、3、6和12个月评估视觉模拟量表（VAS）、Constant-Murley评分（CMS）、活动范围（ROM）和肩外展肌肉力量（MP）。在干预前后进行肩部MRI检查。
所有相关参数在基线时组间无显著差异，但在整个研究过程中组内均有显著改善。与HA组相比，HA + 1次ESWT组在1个月时MP（P = 0.011）和CMS（P = 0.018），以及在6个月时MP（P = 0.014）和CMS（P = 0.005）有更显著改善。与HA组相比，HA + 2次ESWT组在1个月时FF（P = 0.027）、IR（P = 0.019）和SROM（P = 0.025），以及在6个月时ABD（P = 0.022）有更大改善。值得注意的是，与HA + 1次ESWT组相比，HA + 2次ESWT组在1个月时FF（P = 0.013）、IR（P = 0.019）和SROM（P = 0.025），以及在3个月时FF（P = 0.007）有更大改善。此外，HA + 1次ESWT组MRI扫描显示肌腱病变分级或撕裂状态无恶化。
对于无完全撕裂的肩袖损伤患者，ESWT与HA注射联合应用可带来额外益处。
