疗养院肩胛骨疼痛综合征患者医疗康复中物理治疗方法的有效性:随机临床研究

S. A. Pavlovskiy, A. D. Fesyun, T. Konchugova, M. Nikitin, D. Kulchitskaya
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引用次数: 0

摘要

引言。肩痛综合征(SPS)的高发病率决定了为这类患者开发新的综合康复方法的重要性。 目的评估冲击波疗法(SWT)和脉冲低频静电场(PLEF)对在疗养机构接受医疗康复的肩关节疼痛综合征患者的临床疗效,并与传统的疗养治疗进行比较。 材料和方法:对在国家康复和浴疗医学研究中心临床分中心 "Vulan "疗养院进行医疗康复的 90 名 31-68 岁 SPS 患者的医疗康复效率进行了比较分析。通过简单随机的方法,所有患者被分为 3 组,每组 30 人。第一组患者(对照组)接受传统的疗养治疗,包括臭氧疗法、体育锻炼疗法、正弦调制电流电疗和人工按摩。第二组患者(对比组)在上述综合治疗的基础上接受每周一次的 3 次肩关节 SWT 治疗。第三组患者(主要组)除接受传统治疗外,还接受了 3 次 SWT 和 8 次磁场 PLEF 治疗,每隔一天进行一次。康复效果根据疼痛综合征的严重程度(VAS 量表)和肩部斯旺森量表进行评估。康复前后的运动量用矫形角度计测量。微循环状态通过激光多普勒血流测量仪(LDF)进行评估。Leukert 量表用于评估健康状况。研究结果在康复措施开始 18 天后进行评估。 结果与讨论在传统疗养院治疗的基础上额外接受SWT和PLEF治疗的患者,疼痛综合征的严重程度明显减轻,主治组患者的疼痛减轻时间更早(第4-5天),而对比组患者在第14天就取得了相同的结果。对照组患者的 VAS 量表仅在康复疗程结束时才出现明显变化。在斯旺森量表上,主治组患者也取得了最显著的积极效果:疼痛平均减轻了 2.6 倍,肩关节活动量增加了 2.7 倍,日常生活活动量增加了 1.9 倍。在疼痛综合征和活动量方面,斯旺森量表评分与对比组存在统计学差异。与对照组相比,主要组和对比组在所有斯旺森量表指标上都存在可靠的差异。在根据 LDF 数据研究微循环动态时,发现只有接受创新物理治疗干预的组别在 LDF 图的主要指标上出现了可靠的变化。 结论:只有在接受创新物理疗法干预的组别中,LDF 图的主要指标才会发生可靠的变化。因此,将SWT和PLEF等现代物理治疗技术纳入SPS患者的疗养治疗计划,可以显著提高疗养机构开展医疗康复的效率。
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Effectiveness of Physiotherapy Methods in Medical Rehabilitation of Patients with Shoulder and Scapular Pain Syndrome in a Sanatorium: a Randomized Clinical Study
INTRODUCTION. The high prevalence of shoulder pain syndrome (SPS) determines the relevance of the development of new comprehensive methods of rehabilitation of this category of patients. AIM. To evaluate the clinical effectiveness of shockwave therapy (SWT) and pulsed low-frequency electrostatic field (PLEF) in patients with SPS undergoing medical rehabilitation in a sanatorium-resort organization in comparison with traditional health resort treatment. MATERIALS AND METHODS. The comparative analysis of medical rehabilitation efficiency was carried out in 90 patients with SPS aged 31–68 years undergoing medical rehabilitation in the health resort complex “Vulan” — a clinical branch of National Medical Research Center for Rehabilitation and Balneology. All patients were divided into 3 groups of 30 persons each by the method of simple randomization. Group 1 patients (control) received traditional health resort treatment, including ozokeritotherapy, physical exercise therapy, electrotherapy with sinusoidal modulated currents and manual massage. Patients of the second group (comparison) received against the background of the above complex 3 SWT procedures on the shoulder joint once a week. Group 3 patients (main group) received, in addition to traditional treatments, 3 SWT and 8 field PLEF treatments administered every other day. The effectiveness of rehabilitation was evaluated according to the severity of pain syndrome (VAS scale), Swanson’s scale for the shoulder. Movement volume before and after rehabilitation was measured with an orthopedic angle gauge. Microcirculation state was assessed by laser Doppler flowmetry (LDF). Leukert scale was used to assess the state of well-being. The results of the study were assessed 18 days after the beginning of rehabil itation measures. RESULTS AND DISCUSSION. Patients who additionally received SWT and PLEF against the background of traditional health resort treatment noted a significant reduction in the severity of pain syndrome, while in the main group pain regression was noted earlier (on day 4–5), whereas in the comparison group the same results were obtained by the day 14th . In the control group, patients noted significant changes on the VAS scale only by the end of the rehabilitation course. On the Swanson scale, the most significant positive results were also obtained by the patients in the main group: the pain decreased on average 2.6-fold, the volume of active movements in the shoulder joint increased 2.7-fold, and activity in everyday life 1.9-fold. Statistical differences in the Swanson Scale scores with the comparison group were obtained with regard to pain syndrome and volume of active movements. When comparing with the control group, reliable differences were revealed in all Swanson’s scale indicators in both the main group and the comparison group. When studying the dynamics of microcirculation according to LDF data, it was noted that reliable changes in the main indices of the LDF-gram were revealed only in the groups that received innovative physical therapy interventions. CONCLUSION. Thus, the inclusion of modern physiotherapeutic techniques of SWT and PLEF into the program of health resort treatment of patients with SPS allows to increase significantly the efficiency of medical rehabilitation carried out in the sanatorium organization.
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