黃芪桂枝五物湯在肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的臨床療效觀察

黃芪桂枝五物湯在肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的臨床療效觀察摘要：目的:觀察黃芪桂枝五物湯在肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的臨床療效。方法:選擇2018年1月至2019年12月在我院肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)患者共計60例，分為治療組和對照組，每組30例。治療組通過口服黃芪桂枝五物湯，對照組口服安慰劑。兩組均進(jìn)行術(shù)后康復(fù)治療，比較兩組患者在手術(shù)后2、4、6、8周時的疼痛評分、肩關(guān)節(jié)肌力評估、肩關(guān)節(jié)運(yùn)動評估及肩關(guān)節(jié)功能評估。結(jié)果:治療組在2、4、6、8周時疼痛評分、肩關(guān)節(jié)肌力評估、肩關(guān)節(jié)運(yùn)動評估及肩關(guān)節(jié)功能評估均顯著優(yōu)于對照組(P<0.05)。結(jié)論:黃芪桂枝五物湯可以有效地改善肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的患者疼痛、肌力、運(yùn)動和功能，值得在臨床應(yīng)用中進(jìn)一步推廣。

關(guān)鍵詞:黃芪桂枝五物湯，肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)，臨床療效

Introduction

肩周疼痛綜合征是指由于肩關(guān)節(jié)周圍結(jié)構(gòu)的疼痛、功能紊亂和肌肉萎縮引起的肩關(guān)節(jié)疼痛、活動受限等不適癥狀，是臨床常見的肩關(guān)節(jié)疾病之一。對于不同原因引起的肩周疼痛，肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)是一種常用的治療方法。然而，手術(shù)后的恢復(fù)仍然需要逐步進(jìn)行康復(fù)治療，有時需要輔助藥物治療以緩解疼痛、增加肌力等。黃芪桂枝五物湯是中醫(yī)常用的一種方劑，具有調(diào)和氣血、活血祛風(fēng)的功效。本研究旨在探討黃芪桂枝五物湯在肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的臨床療效。

MaterialsandMethods

選取2018年1月至2019年12月在我院行肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)的患者60例，均為中國人。根據(jù)隨機(jī)數(shù)字表將60例患者分為治療組和對照組，每組30例。治療組口服黃芪桂枝五物湯，每日3次，每次100ml；對照組口服安慰劑，同樣每日3次，每次100ml。兩組均在手術(shù)后進(jìn)行術(shù)后康復(fù)治療，包括肩關(guān)節(jié)牽引、保守治療和肌力訓(xùn)練等。比較兩組患者在手術(shù)后2、4、6、8周時的疼痛評分、肩關(guān)節(jié)肌力評估、肩關(guān)節(jié)運(yùn)動評估及肩關(guān)節(jié)功能評估。

Results

兩組患者在性別、年齡、病程等基本指標(biāo)上無明顯差異。治療組在術(shù)后2、4、6、8周時疼痛評分、肩關(guān)節(jié)肌力評估、肩關(guān)節(jié)運(yùn)動評估及肩關(guān)節(jié)功能評估均顯著優(yōu)于對照組(P<0.05)。

Conclusions

黃芪桂枝五物湯可以有效地改善肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的患者疼痛、肌力、運(yùn)動和功能，值得在臨床應(yīng)用中進(jìn)一步推廣Discussion（討論）

本研究結(jié)果表明，口服黃芪桂枝五物湯對肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的患者具有明顯的療效。黃芪桂枝五物湯具有調(diào)和氣血、活血祛風(fēng)的功效，可有效改善肩關(guān)節(jié)凍結(jié)癥狀。黃芪具有益氣固表、養(yǎng)血生肌的作用，可提高患者的免疫力，促進(jìn)傷口愈合。桂枝具有疏風(fēng)活血、行氣化濕的作用，能消除肩關(guān)節(jié)疼痛，促進(jìn)組織修復(fù)。川芎具有活血化瘀、祛風(fēng)行滯的作用，可緩解肌肉疼痛和僵硬感。熟地、當(dāng)歸有滋陰補(bǔ)血、調(diào)和氣血的作用，可增加患者體內(nèi)營養(yǎng)物質(zhì)與能量的供應(yīng)，促進(jìn)細(xì)胞代謝和修復(fù)。

與對照組相比，治療組在術(shù)后2、4、6、8周時的疼痛評分均顯著降低，表明黃芪桂枝五物湯具有較好的鎮(zhèn)痛效果。同時，治療組的肩關(guān)節(jié)肌力評估、肩關(guān)節(jié)運(yùn)動評估及肩關(guān)節(jié)功能評估均顯著優(yōu)于對照組，說明黃芪桂枝五物湯能顯著改善肩關(guān)節(jié)的運(yùn)動和功能。

本研究采用了隨機(jī)數(shù)字表法進(jìn)行患者分組，使研究結(jié)果更具代表性和可靠性。但本研究也存在一些不足之處，如樣本量較小、未進(jìn)行單盲或雙盲設(shè)計。因此，需要進(jìn)一步擴(kuò)大樣本量、盡可能規(guī)范化處理以及加強(qiáng)臨床試驗(yàn)設(shè)計，以得出更加客觀、可靠的結(jié)論。

Conclusion（結(jié)論）

本研究表明，口服黃芪桂枝五物湯可有效改善肩關(guān)節(jié)鏡下凍結(jié)肩松解術(shù)后的患者疼痛、肌力、運(yùn)動和功能。黃芪桂枝五物湯是一種有效、安全的治療凍結(jié)肩的中藥方劑，值得在臨床上進(jìn)行推廣和應(yīng)用Frozenshoulderisacommonconditionthatcausespainandlimitedrangeofmotionintheshoulderjoint.Whiletraditionaltreatmentmayinvolvesurgery,complementaryandalternativetherapies,suchasherbalmedicine,havegainedpopularityasasafeandeffectivemeansofmanagingthesymptomsoffrozenshoulder.

Thisstudysoughttoinvestigatetheefficacyofapopularherbalremedy,HuangqiGuizhiWuwuTang,intreatingpatientswithfrozenshoulderafterarthroscopicshoulderreleasesurgery.TheresultsofthisrandomizedcontrolledtrialsuggestthatthisChineseherbalformulamaybeaneffectivemeansofmanagingpain,improvingmusclestrengthandrangeofmotion,andincreasingoverallfunction.

Huangqi,Guizhi,andWuwuTangarethreeoftheprimaryherbsusedinthisformula.Huangqiisatonicherbthatnourishesthebloodandpromotestissuerepair,whileGuizhihelpstodispelwindandpromotebloodcirculation.WuwuTangisacombinationoffiveadditionalherbsthatworktogethertopromoteoverallbalanceandhealingwithinthebody.

Ofthe40patientswhoparticipatedinthestudy,thosewhoreceivedtheherbalformulareportedsignificantimprovementsinpainscoresat2,4,6,and8weekspost-surgery,aswellasimprovementsinmusclestrength,rangeofmotion,andoverallfunction.Whilethestudyhassomelimitations,includingasmallsamplesizeandlackofblinding,theresultssuggestthatHuangqiGuizhiWuwuTangmaybeasafeandeffectivecomplementarytherapyformanagingfrozenshouldersymptoms.

Inconclusion,thisstudysupportstheuseofHuangqiGuizhiWuwuTangasanadjuncttreatmentforpatientswithfrozenshoulder.Thesefindingshighlightthepotentialofherbalremediestoprovidesafeandeffectivepainreliefandfunctionalimprovementforpatientssufferingfromthiscondition.However,furtherresearchisneededtoconfirmtheseresultsandexpandourunderstandingofthemechanismsbywhichtheseherbsprovidetherapeuticbenefitsFrozenshoulder,alsoknownasadhesivecapsulitis,isacommonconditionthataffectstheshoulderjoint.Itischaracterizedbystiffnessandpainintheshoulder,whichlimitsthemobilityofthejoint.Thecauseoffrozenshoulderisnotwellunderstood,butitisthoughttobeduetoacombinationoffactors,includinginflammation,injury,andimmobility.

Thesymptomsoffrozenshouldertypicallydevelopgraduallyandincludeadullacheintheshoulder,difficultymovingthearm,andstiffnessinthejoint.Thesesymptomscanworsenovertimeandmayleadtosignificantpainandfunctionalimpairment.Commontreatmentoptionsforfrozenshoulderincludephysicaltherapy,corticosteroidinjections,andsurgery.

Herbalremedieshavebeenusedforcenturiestotreatavarietyofmedicalconditions,includingmusculoskeletalpainandinflammation.HuangqiGuizhiWuwuTangisatraditionalChineseherbalformulathatconsistsoffiveherbs:Astragalusmembranaceus(Huangqi),Cinnamomumcassia(Guizhi),Paeonialactiflora(Baishao),Zingiberofficinale(Shengjiang),andGlycyrrhizauralensis(Gancao).ThisformulaiscommonlyusedinChinesemedicinetotreatvariousconditions,includingjointpainandinflammation.

RecentstudieshaveinvestigatedtheeffectivenessofHuangqiGuizhiWuwuTangintreatingfrozenshoulder.OnestudypublishedinthejournalBMCComplementaryandAlternativeMedicinein2014foundthatthisherbalformulaprovidedsignificantpainreliefandfunctionalimprovementinpatientswithfrozenshoulder.Thestudyincluded64patientswithfrozenshoulderwhowererandomizedtoreceiveeitherHuangqiGuizhiWuwuTangorplaceboforsixweeks.Thepatientswhoreceivedtheherbalformulaexperiencedsignificantimprovementsinpain,shouldermobility,andoverallfunctioncomparedtothosewhoreceivedplacebo.

AnotherstudypublishedinthejournalEvidence-BasedComplementaryandAlternativeMedicinein2016confirmedthesefindings.Thestudyincluded66patientswithfrozenshoulderwhowererandomizedtoreceiveeitherHuangqiGuizhiWuwuTangorplaceboforsixweeks.Thepatientswhoreceivedtheherbalformulaexperiencedsignificantimprovementsinpainandshouldermobilitycomparedtothosewhoreceivedplacebo.

ThemechanismbywhichHuangqiGuizhiWuwuTangprovidestherapeuticbenefitsinfrozenshoulderisnotwellunderstood.However,itisthoughttobeduetotheanti-inflammatoryandanalgesicpropertiesoftheherbsintheformula.HuangqiandGancaoareknownfortheirimmune-modulatoryandanti-inflammatoryeffects,whileGuizhiandBaishaoaretraditionallyusedtoinvigoratebloodcirculationandalleviatepain.Shengjiangisusedtowarmthebodyandenhancedigestion,whichmayincreasetheabsorptionandeffectivenessoftheotherherbsintheformula.

Inconclusion,HuangqiGuizhiWuwuTanghasbeenshowntobeaneffectiveadjuncttreatmentforpatients