編號：DOH83-CM-058
肩部疼痛的針刺及穴位注射療效評估
林鉅超l 張永賢2 黃明德3  

1.中國醫藥學院附設醫院針灸科主治醫師
2.中國醫藥學院附設醫院針灸科主任醫師
3.台南市立醫院復健科主任

　　肩關節疼痛是一種常見的中老年人疾病，由於疼痛及肩活動受限造成 生活上極大的困擾，臨床上報告以肩部注射的效果遠優於口服藥物組 ，且副作用少。本研究依肩痛病人疼痛位置及活動受限情形，探討其 短期及中期療效。記錄經絡主觀疼痛分數及疼痛指數，並以客觀的肩 關節活動測量度為指標，分析不同經絡（大腸經、小腸經、三焦經） 的療效與經絡特性，並以雙盲測試復健對照組作為比較，以評估之。

　　篩選門診肩痛患者，發病時間在6個月之內，有肩關節周圍炎或肩部 活動受限制者，去除因重大系統性疾病或有免疫障礙及明顯感染者， 並以復健組21人做為雙盲對照測試。針灸及穴注組共128人，隨機分配 為5組（Triamcinolone穴注組23人，Xylocain穴注組23人，手陽明大 腸經針灸組31人，手太陽小腸經針灸組27人，手少陽三焦經針灸組24人）。經絡分 型組依症型分別針刺腕骨、中渚、合谷穴，穴注組(Triamcinolone 0.2mg, 及Xylocain 1％0.5ml)各均採局部痛點注射，每 次穴注以不超過三個痛點為原則。治療依第1,3,7,10,14天共記錄五 次。統計採Paired Student-t test及雙盲測試為之，並以P＜0.05為有明 顯統計意義。

研究結果如下：

  1. 大腸經LI組（肩前痛），平均年齡較大(47.8歲)，而三焦經SJ組（ 肩後痛）的年齡最小(44.3歲)，此或與不同年齡的肩關節活動性質有 關。
  2. 主觀疼痛分數總分及經絡疼痛指數評估，除LI組的疼痛指數並無明 顯緩解外，發現各組在治療前後均有明顯統計意義，此或與IL組的平 均年齡偏高有關，尚待進一步研究。
  3. 穴注組(Triamcinolone與Xylocain組)及經絡分型組其疼痛改善均 優於復健對照組，此或與經絡的特殊療效有關。
  4. 傳統經絡分型，LI組（伸展、外旋），SJ組（屈曲、外旋），SI組（ 屈曲、內旋、側舉）其肩關節活動角度改善最多且具統計意義。而穴 注組的（屈曲、內旋、側舉）肩活動改善亦甚佳。

　　肩痛依經絡分型，與復健組相較其疼痛減輕速度快，且肩關節活動角 度改善亦甚佳；若能在復健治療過程中配合施行，將有助於疼痛及活 動角度的改善，是值的推廣的治療模式。

關鍵詞：穴位注射，經絡主觀疼痛分數，肩關節活動測量 度，復健治療

DOH83-CM-058
Evaluate the effect of Acupuncture and Injection for shoulder pain patients
 Jiuh-Chau Linl, Ynng-Hsien Chang2, Ming-Derh Wang3, Jiunn-song Lin4

  1. Acupuncture department, China Medical College Hospital Supervisor Dr.
  2. Acupuncture department, China Medical College Hospital Chief director
  3. Tainan Municipal Hospital, Chief of Rehabilitation Section
  4. Tainan Municipal Hospital. Chief of Rehabilitation Section Resident Dr.

　　Shoulder pain has been a common disease of aged population. And it was found that local injection or acupoint injection is the better way of treatment. In this study 128 patients were screened for pain with ROM limitation within 6 months except that with infection and systemic disease or immune disorder. They were randomly sampled as 5 group (Injection-Triamcinolone/23 persons, Injection-Xylocain/23 persons, Acupoint injection LI meridian/31 persons, Acupoint injection SI meridian/27 persons, Acupoint injection SJ meridian/24 persons). and Rehabilitation 21 persons as double blind study group.

　　Meridian pain score and pain index were recorded as subjective factors. and shoulder ROM as objective factors. Paired student-t test is used to analyzed the data and p<0.05 regarded as with statistic significance. The result as follows.

  1. Ant. shoulder pain (LI group) with mean age 47.8 while post shoulder pain (SJ group) is 44.3.
  2. Both meridian pain score and pain Index in SJ & SI group have significant improvement, except that in LI group. It was thought to be influeneed by age factor.
  3. Acupoint injection group (Triamcinolone & Xylocain)have better pain relief in comparison with rehabilitation group.
  4. Different shoulder ROM were found with great improvement in LI group (extension/external rotation), SJ group (flexion/external rotation).SI group (flexion/internal rotaion abduction, acupoint injection group (flexion/internal rotaion abduction). Traditional meridian acupoint treatment in shoulder pain patients has been proved to be a better way in pain relief and in shoulder ROM improvement, h is suggested that meridian therapy should be put in prescription of the shoulder pain rehabilitation.

Keywords:
acupoint injection, meridian pain score, shoulder ROM, rehabilitation