肌骨超声引导下阿是穴苍龟探穴针法联合中药外敷治疗气滞血瘀型冻结肩的疗效分析OA

Objective:To investigate the clinical efficacy of Ashi-point Canggui acupoint-probing needling combined with topical application of Chinese medicinal under musculoskeletal ultrasound guidance in patients with Qi stagnation and blood stasis type frozen shoulder,and to evaluate its effects on the levels of pain mediators.Methods:A retrospective cohort study was conducted.A total of 90 patients with Qi stagnation and blood stasis syndrome of frozen shoulder were assigned to the observation group and the control group,with 45 patients in each group.After propensity score matching,37 patients remained in each group.The control group was treated with conventional needling selected acupoints combined with topical application of Chinese medicinal;on which basis,the observation group was also treated with musculoskeletal ultrasound-guided precise acupuncture at Ashi points.Both groups underwent treatment for 2 weeks.The total clinical efficacy was compared between the two groups after the treatment.VAS scores,ADL scores,Constant-Murley shoulder scores,musculoskeletal ultrasound parameters,and inflammatory factor levels were compared between before and after the treatment in the two groups.A difference-in-differences(DID)analysis was performed to evaluate changes in VAS scores,ADL scores,and Constant-Murley shoulder scores.Repeated-measures analysis of variance(ANOVA)was used to analyze changes in pain mediator levels.Correlation analyses were conducted to assess the relationships between VAS scores,ADL scores,Constant-Murley scores,and pain mediator levels at different time points in both groups.Results:The total effective rate was 97.59％(36/37)in the observation group,which was significantly higher than 78.38％(29/37)in the control group(P＜0.05).The observation group exhibited significantly lower VAS score,and significantly higher ADL and Constant-murley shoulder scores than the control group after the treatment(P＜0.05).Did analysis showed there were statistical differences in VAS scores,ADL socres,and Constant-Murley scores between the two groups and ofter the treatment(P＜0.01).Regarding musculoskeletal ultrasound findings,the glenohumeral distance(GHD)was significantly lower,whereas the posterior capsule thickness(PCT)was significantly greater in the observation group than in the control group.In addition,the proportion of patients with grade R1 positive blood flow signals was significantly lower in the observation group than in the control group.The serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were significantly lower in the observation group than in the control group(P＜0.01).Repeated-measures analysis of variance demonstrated significant time effects,group effects,and time-by-group interaction effects for inflammatory factor levels(P＜0.01).Conclusion:Ashi-point Canggui acupoint-probing needling combined with topical application of Chinese medicinal effectively alleviates the inflammatory response in patients with Qi stagnation and blood stasis syndrome of frozen shoulder,reduces the release of pain mediators,relieves pain,ameliorates joint capsule fibrosis,improves shoulder abduction,and enhances overall shoulder function.