BAI NGHIEN Cl)U •
Danh gia ket qua dieu trj viem quanh khdp vai the don thuan cua bai thuoc TKl ket hop xoa bop bam huyet
EFFECTIVENESS OF TKl TRADITIONAL MEDICINE PLUS ACUPRESSURE POINTS AND MASSAGE IN TREATMENT PERIARTHRITIS OF THE SHOULDER
Hoang Huy^n Charpi, Huynh Quang Huy^, Dgu Xuan C^nM ' H o c v i l n Y D u o c hoc c6 t r u v e n Viet Nam
^ B d m d n Chan J o a n hinh anh - D a i hoc Y khoa P h a m Ngoc Thach
^Hoc vien Y Duoc hoc Co t r u y e n Viet Nam
TOiMTAT
Muc tiiu: xdc djnh hiiu qud cua bdi thudc TKl kit hdp xoa bop bdm huyet dHu tri viim quanh khdp vai thiddn thudn.
B6i tUdng, phUdngphdp: 60 binh nhdn diidc chdn dodn viem quanh khdp vai the ddn thudn theo tiiu chudn ctia Botssier 1992. Nghien ciiu thUc kin tiii Benh viin Tui Tinh, tii thdng 10/2017 din thdng 6/2018.
Thiit ke nghien cifu ldm sdng ddi chiCng ngdu nhien. Doi tUdng dUdc ngdu nhien chia thdnh 2 nhdm: nhdm NC (n=30): dieu tri bang "TKl" kit hdp XBBH; nhdm chiing (n^30): dieu tri bangXBBH. So sdnh kit qud diiu tri d 2 nhdm sau 21 ngdy dieu tri. Cdc chi Ueu ddnh gid: diim dau VAS, tdm vdn dgng cua khdp, dii'm Costant vd Murley, tinh chat viim trin siiu dm.
Kit qua: Sau 21 ngdy diiu trt, dii'm dau VAS dNNC cdi thiin cdf nghia dNNC (p<0,00l) vd khdngkhdc biit so vdi NBC) tdm van ddng khdp cdi thiin cd f nghia dNNC (gdp, duoi, dang, xoay trong, xoay ngodi) vd nhieu hdn so vdi NBC. Diem Constant & Murley thay doi cdf nghia thong ki dNNC vd mUc cdi thien nhiiu hdn so vdi NBC. Cdc ddu hiiu tren sieu dm khdp vai dNNC cd cdi thiin ro ret so vdi NBC. Hiiu qud diiu tri chung dNNC Id 96,7% hinh nhdn dgt tdt; 3,3% binh nhdn cd ket qud khd. Cd 1 trUdnghap binh nhdn xu&thien dau bung thUdng vi d ngdy thii 6 sau diiu tri vd 1 binh nhdn xudt hiin budn ndn d ngdy thii 7 sau diiu tri. Tuy nhien, triiu chiing ndy hit ngay khi binh nhdn uong thudc sau dn no.
Kit lugn: Bdt thudc TKl kit hdp xoa bop bdm huyet cd hieu qud trongdii'u tri viim quanh khdp vai thiddn thudn khi so sdnh vdi biin phdp XBBH ddn thudn.
Ngay nhan bdi 8/1/2019 Ngayphanbiin 11/1/2019 Ngay chdp nhdn dang 11/1/2019
1 8 I TAP C H I Y D U O C C O TRUYEN V I E T N A M L-t>l>Wtl;ii:^*JiBl
J-
ABSTRACT
Objectives: To determine the effectiveness of TKl traditional medicineplus acupressure points and massage in treatment periarthritis ofthe shoulder.
Methods: 60 patients in Tue Tinh hospital who were diagnosed periarthritis ofthe shoulder according to the Boissier 1992 criteria during October 2017 and June 2018. This is a case-control study. Patients were enrolled into 2 groups: the case group which was treated with TKl traditional medicine plus acupressure points and massage (n=30); the control group which was treated with acupressure points and massage (n=30). Comparision the result between 2 groups after 21 days of treatment with the criteria includes VAS pain score, range of joint motion. Constant and Murley points, and inflammatory properties on ultrasound.
Results: After 21 days of treatment, VAS pain score was reduced significantly in case group and simillar to control group; the range of joint motion was better in case group than those in control group. Constant & Murley point changed signicantly in case group more than that in control group. Inftammatory properties on ultrasound was improved more in case group than in control group. The overall outcome showed 96.7% cases of good, 3.3%
cases of rather good. One patient has abdominal pain on the 6th day and another patient has nausea symptom on the 7th day after treatment. However, all symptoms has disappeared when patients get medicine after meal.
Conclusion: TKl traditional medicineplus acupressure points and massage is better in treatment periarthritis of the shoulder than in case of using acupressure points and massage only.
DAT VANDE
Viem quanh khdp vai la benh kha phd biln trong sd cac benh khdp thifdng gip tai cac Phdng Kham Khoa khdp, Khoa Ddng y va Khoa Phuc hdi chflc nang [1,2]. Tuy benh khdng anh hi(dng trflc tilp den tinh mang, nhifng nd thifdng keo dai nhieu thing, tham chi hang nim, gay dau ddn va han chi van ddng, anh hfldng den smh boat hang ngay va kha nang lam vile cua ngfldi benh [3].
Trong thflc te Iam sang viec dieu tri viem quanh khdp vai bang ndi khoa, Y hpc hien dai ehu yeu thifdng sfl dung thudc khang viem, gian cd, giam dau (nonsteroid, steroid va cac din xuat...). Cac thudc nay thifdng cd cic tic dung phu nhu suy giim sflc dl khing cua cd the, loang xfldng, viem loet da day, tdn thfldng gan, thin... lam benh nhin khdng the sfl dung dai ngay dfldc hoje khdng thi sfldungthudcdifdc[4].
Tren thflc t l dieu tri lam sang, ehung tdi nhan thay bai thudc "TKl" da difdc sfl dung nhieu tren
lam sang va cd hieu qua chdng viem giam dau rat tdt, va flng dung dilu tri VQKV cd hieu qua rat cao.
Tuy nhien, chifa cd tic gii nio nghien cflu phifdng phap dilu tn viem quanh khdp vai bang bai thudc
"TKl" hoac sfl dung bai thudc "TKl" ket hdp xoa bdp bam huyet de tri heu VQKV
Tfl dd chung tdi thflc hien de tai nham muc tieu: xae dinh hilu qui cua bai thudc TKl ket h i ^ xoa bdp bim huyet dieu tri viem quanh khdp vai the ddn thuan.
DOI TUDNG VA PHUDNG PHAP NGHIEN CUU
Ddi tfldng
Benh nhin dfldc chan doan vilm quanh khc^
vai the ddn thuan theo tieu chuan cua Boissier M.C.(1992)[5]:
Lim sang: Dau vai d cic mfle dp khac nhau.
Han che van ddng khdp vai vdi nhieu mfle dp tfl it den nhieu.
Can lam sang: Sieu im khdp vai cd hinh anh:
TAP CHIY DUOC CO TRUYEN VIET NAM M 19
BAI NGHIEN CU'U .
viem gin cd trin gai, vilm gin mu cac edxoay, viem gan cd nhi dau.
Nghiin cflu thflc hiln tai Benh viln Tue Tmh.
Thdigian: tfl thang 10/2017 den thang6/2018.
Phfldng phap nghien cflu
Thiet ke nghien cflu: thfl nghiem lam sang ddi chflng ngiu nhien (case - control study): Ddi tifdng nghiin eflu dUiJc ngau nhiin chia thanh 2 nhdm sao cho cd sfl tfldng ddng vl tudi, gidi va mfle dp tdn thfldng (bdc thim dl chia nhdm):
Nhdm 1 (nhdm NC, 30 benh nhan): dieu tri bang "TK 1" ket hdp XBBH.
iSThdm 2 (nhdm chiing, 30 benh nhan): dieu tri VQKV bang XBBH.
Theo ddi, lifdng gia va so sanh ket qua dieu tri
Bdng l.Su thay doi diem dau VAS sau 21 ngdy diiu tri
d 2 nhdm nay sau 21 ngay dieu tri, tfl do thiy dfldc hilu qui cua bai thudc "TKl" trong dilu tri viem quanh khdp vai the ddn thuan.
Cae chi tieu dinh gia: diem dau VAS, tam van dpng cua khc^, Costant & Murley.
Xfl ly sd heu bang phin mIm SPSS 20.0. So sanh eac gia tri trung binh tai mdi thdi diem (trflde va sau dieu tri) gifla 2 nhdm dpc lip (nhdm NC va nhdm chflng) bing test phi tham sd Mann Whitney U.
KET QUA
60 benh nhin viem quanh k h ^ vai the ddn thuan, trong do 20 nam, 40 nfl. Cd sfl tfldng ddng ve tudi vi gicft gifla 2 nhdm.
Nhom
N N C n = 30 N D C n = 30
P N N C NRC
D , ( X ± S D )
5,37 + 0,56 5,23 ±0,43
>0,05
D „ ( X ± S D )
0,80 ±0,96 1,23 + 0,82
<0,0S
Hieu s6 diem
• ' . - I ' l l 4,57 ±0,82 4,00 ±0,87
<0,05
" D O - D I O
<0,00I
<0,001
Nhdn xet: Sau 21 ngay dieu tri, dil'm dau VAS d NNC cii thiin CO y nghia d NNC(p<0,001) vi khdng khac bilt so vdi NDC
Bdng 2. Sii thay doi tdm van ddng khdp vai sau 21 ngdy diiu tri
Nliom
NNC n=30
Gap Duoi Dang Khep Xoay trong Xoay ngoai
D , ( X ± S D ) 75,33 ±19,95 31,00 + 9,32 75,17± 19,14 44,00 ±3,81 60,34 ±14,57 42,59± 13,00
D j , ( X ± S D ) 154,33 ±25,21
45,00 + 0,00 144,33 + 37,39
45,00 ±0,00 69,66 + 4,98 ' 82,07 ±13,20
Hi^u sodium
" i i - D . 79,00 + 25,07
14,00±9,32 69,17 ±34,39
1,00±3,81 9,31 ±14,06 39,48+12,13
PDI,.D.
<0,001
<0,001
<0,00I
>0,0S
<0,01
<0,001
20 1 TAP CHlY DUqC CO TRUYEN VIET NAM H5BI
J'
N D C n=30
PNNC-NDC
Gap Du6i Dang Khep Xoay trong Xoay ngoai Gap Duoi Dang Kliep Xoay trong Xoay ngoai
78,67 ±15,59 39,17 + 8,31 7750 ±22,54 41,21 ±6,90 59,50 ±13,02 54,50 ±12,55
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
148,50 ±34,27 44,83 ±6,09 148,83±34,18
43,45 ±4,65 67,67 ±4,30 83,50 ±7,67
<0,01
<0,05
<0,05
<0,05
<0,05
<0,0S
69,83 ±26,96 5,67 ±8,88 71,33 ±23,71
2,24 ±5,28 8,17±9,69 29,00 ±9,59
<0,001
<0,05
<0,001
>0,05
<0,05
<0,01
Nhgn xet: Sau 21 ngiy dilu tri, tam van ddng khdp cai thien cd y nghia d NNC (gap, dudi, dang, xoay trong, xoay ngoai) va nhieu hdn so vdi NDC.
Bdng 3. Su thay ddi thang diim Costant & Murley sau 21 ngdy diiu tri
Nhom
N N C n=30
N D C n . 3 0
p
Chi so dau Hoat dong hang ngay Kha nangvan dpng khdp vat Luc cua khdp vai Chi s6 dau Hoat dong hang ngay Kha nang v j n dong khdp vai Luc ciia khdp vai Chi sd dau Host dpng hang ngay Kha nang van dong khdp vai Lilc cua khdp vai
D , ( X ± S D ) 1,33 + 2,25 8,70±1,21 16,93+1,76 7,27 ±1,92 1,00 + 2,49 8,27+1,11 16,90 ±0,96 8,03 ±1,07
>0,05
>0,05
>0,05
>0,05
D j , ( X + SD) 12,1713,64 17,23 ±2,61 32,90±3,15 19,33±4,71 10,67±2,54 14,03 + 2,40 29,30 ±3,57 14,83 ±3,40
<0,05
<0,01
<0,01
<0,01
Hieu s6 diem
D„-D„
10,83±4,37 8,53 ±2,32 15,97 ±2,53 12,07 ±4,36 7,67 ±2,86 5,76 ±2,24 12,40 ±3,81 6,80 ±2,87
P n , ™
<0,001
<0,001
<0,001
<0,001
<0,001
<0,001
<0,001
<OOOI
Nhdn xet: Sau 21 ngay dieu tn, diem Constant & iVIurley thay doi ed y nghia thdng ke d NNC vi mfle cii thien nhieu hdn so vdi NDC.
TAP CHI Y DUOC C 6 TRUYEN VIET NAM l3&l»Mtl;li:LAJilll I 2 1
BAI N G H I E N CLTU
Si/ thay iii diu him mem quanh khip vai trin sieu am kh&p vai sau 10 vd 21 ngay dilu tri
Viem gan cd nhi dau
Viem bap hoat dich dudi mom cung gai
Viera gan cd tren gai
Canxi hda gan cd tren gai
Viem gan cd dudi gai
Viem gan cp dudi vai D,
"lo D„
POOD.D PDODU
Da D » D„
PDOUIO P K I D I O
Dj D,, D„
PDHDJO PDO-DIO
D„
D „ Dj,
PD..DIO POODIO
D, D „ D„
PlMDlO Pnomo D, D,.
D „
PDO-DIO PDO-DIO
N N C n = 30 n 18 16 10
%
60,0 53,3 33,3
>o,os
<0,05 21 19 10
70,0 63,3 33,3
>0,05
<o,os 15 15 8
50,0 50,0 26,6
>0,05
<0,05 20 18 12
66,7 60,0 40,0
>0,0S
<0,05 21 17 8
70,0 56,7 26-7
>o,os
<0,05 20 16 8
66,7 53,3 26,7
>0,05
<0,05
N D C n = 30 n 20 18 16
%
66,7 60,0 53,3
>0,05
<0,05 22 20 20
70,3 66,7 66,7
>0,05
>0,05 15 IS 13
50,0 50,0 33,3
>0,05
>0,0S 18 18
60,0 60,0 16 [ 53,3
>0,OS
>0,05 19 17 IS
63,3 56,7 50,0
>0,05
>0,05 21
18 16
70,0 60,0 53,3
>0,05
>0,05
P
5.0,05
>0,05
<0,05
>0,05
>0,05
<0,05
>0,05
>0,05
<0,05
>0,05
>0,05
<0,05
>0,05
>0,05
<0,05
>0,05
>0,05
<0,05
22 i TAP CHfY DUOC C 6 TRUY6N VICT NAM lj.l.H«l;li;tiiJilB
J-
Tdn thupng khdp cung ddn
Dj 0 , 0
D„
PDODIO PDHDIO
16 12 8
57,3 40,0 26,7
>0,0S
<0,05
15 14 12
50 46,7 40,0
>0,05
>0,05
>0,05
>0,05
<0,05
Nhdn xet: Sau 10 ngay dieu tri cae dau hilu tren silu im khdp vai d NNC cd eai thien nhifng sfl thay ddi khdng ed y nghia thdng ke. Sau 21 ngay cae dau hieu nay cai thien rd ret va mfle cii thien cao hdn NDC cd y nghia thdng ke vdi p<0,05.
BdngS. Hiiu qud diiu tri chung sau 21 ngdy
Hieu qua chung
Tdt Kha Trung binh
Kem
N N C n = 30 n 29 1 0 0
%
96,7 3,3 0 0
N D C n = 30 n 26 3 1 0
%
86,7 10,0 3,3 0
P
<0,05
Nhdn xet: Sau 21 ngiy dieu tri, hilu qua dilu tri chung d ISJNC li 96,7% benh nhin dat tdt; 3,3% benh nhan cd ket qua kha. Ti le benh nhan tdt d I'CNC nhieu hdn cd y nghia so vdi NDC (96,7% so vdi 86,7%, p<0,05).
Bdng 6. Tdc di^ng khdng mong muon cua thudc TKl trong thdigian diiu tri
Bilu hi^n lam sang Buon non
Ndn Dau bung
San ngiia Dl ngoai Met nidi
n 1 0 1 0
%
3,3 0 3,3 0 0 0
Ngay xuat hien D_
D .
0 0
Htfdngxuftri/Ketqua Upng thu6c sau an/HSt buon npn
Uong thudc sau an/Het dau
Mian xet: trong 21 ngiy dilu trj bang TKl ket hdp XBBH, nghiin cflu ghi nhin cd 1 tnfdng hdp benh nhan xueit hien dau biing thUdng vi d ngiy thfl 6 sau dieu tri va 1 benh nhin xuat hien budn ndn d ngay thfl 7 sau dilu tri. Tuy nhiin, trieu chflng nay het ngay khi benh nhan udng thude sau an no.
BAN LUAN
Sau 21 ngiy dilu tri, dilm dau VAS d NNC cai thien cd y nghia d NNC(p<0,00l) va khdng khac biet so vdi NDC.
Kit qua nghien cflu cua chung tdi ciing tfldng tfl nhfl cua Park KD (2012) nghien cflu d 23 benh
TAP CHI Y DUOC CO TRUYiN VIET NAM m 23
BAI NGHIEN COU
nhan tiem nong khdp vai dfldi hudng din cua sieu im tic dung giam dau dfldc nhin thiy d tat ca benh nhin. Tai thdi diem tnfdc nong VAS la 6,2 ± 0,9 diem, sau nong 2 tuan diem VAS giim rd ret cdn 2.8 ± 0.5 diem, sau nong 6 tuin VAS cdn Iai 2,2 ± 0,4 diem [6]. Nghien cflu cuaJH Bae (2014) tiem nong khdp vai cho 27 benh nhin dfldi hifdng dan cua silu am, tai thdi dilm tnfdc nong VAS li 6,30
± 0,38 diem, sau nong 1 tuan dil'm VAS giam rd ret cdn 2,81 ± 1,81 dilm, sau nong 5 tuin dilm VAS la 2,15 ± 1,89 dil'm, tilp tuc cii thien sau 9 tuin VAS cdn 1,81 ±1,84 diem [7].
Cd sfl khac biet cd y nghia thdng kl gifla NNC vi ND C d tim van ddng xoay ngoai va dang.
Sau 20 ngay dieu tri, kit qua sfl thay ddi tam van ddng gap, dang, khep, xoay trong, xoay ngoai deu cdy nghia thdng ke vdi p <0,05.
Cd sd khac bilt cd y nghia thdng ke sau 21 ngay dieu tri d benh nhin NNC vi NDC d ca 3 tam van ddng cd ban la dang, xoay trong va xoay ngoai.
Ket qua nghien cflu eua ehung tdi cung cflng khdng khic biet nhilu vdi kit qui nghien cflu cua cac tac giaJ.H Bae (2014) [7] cdng bd tren tdng sd 54 benh nhan VQKV chia thanh 2 nhdm: Nhdm tilm nong khdp vai dfldi hfldng din cua X quang va nhdm tiem nong khdp vai dUdi hifdng dan cua silu am. 0 27 benh nhan tilm nong khdp vai dfldi hifdng din cua sieu im cii thien gdc van ddng dang ke sau nong 1 tuan, ddng tac gap tang 21,67 do, sau 5 tuan ting 30,19 do. Park KD (2012) [6]
tiem nong khdp vai difdi hfldng din cua silu am 23 benh nhan, sau nong 2 tuan ddng tac gap ting 30 do, sau 6 tuin ting 34,34 dp.
Sau 21 ngay dilu tri, dilm Constant & Murley thay ddi cd y nghia thdng ke vdi p <0,01.
Ve ket qua sieu am khdp vai sau dilu tri: cic dau hilu niy cai thien rd ret va mfle eai thien cao hdn NDC cd y nghia thdng kl vdi p<0,05.
Viem quanh khdp vai thfldng bieu hien vilm cic gan do qua trinh thoai hda vdi tang bach eau ii toan, thoai hda chit nhay... Khi silu am, 6 tdn thifdng viem giam im khu tni die trflng khdng ddng nhat [8].
Vdi hda thfldng xuit hien nhdm cd chdp xoay.
Cd thi' do giam oxy tai gan. Khoang 7% trfldng hflp vdi hda trong gin khong phat hi|n. Hinh anh X quang cd thi binh thudng neu vdi hda khdng tang quang ho^c dang bun [9]. Vdi hda khdng cd ting quang thifdng Uen quang din cac tnfdng hdp viem cip tinh. Trong khi do, vdi hda vdi hinh inh tang quang lien quang vdi vilm ban cap hoac man tinh.
Khao sat trin silu am cd the phat hien tdt cic the vdihdanay[lO].
Vilm gin cd nhi dau thifdng bieu hiln bang hinh anh tu dich dtfdi bao. Tu dich khdp vai phat hiln tdt tren hinh inh sieu am, trieu chflng cd thi gap trong viem quanh khdp vai [lO]
Hilu qui dilu tri chung & NNC la 96,7% benh nhan dat tdt; 3,3% benh nhan cd ket qua khi. 0 NDC, sd benh nhin dat tdt li 86,7% vi kha la 10%, trung binh cd 1 benh nhin ehiem ty le 3,3%.
Trong thdi gian dieu tri bing TKl kit hdp XBBH, nghiin cflu ghi nhan cd 1 tnfdng hdp benh nhin xuat hiln dau bung thifdng vi d ngay thfl 6 sau dieu tri va 1 benh nhan xuat hien budn ndn d ngay thfl 7 sau dieu tri. Tuy nhien, tneu chflng nay het ngay khi benh nhan udng thudc sau in no.
KET LUAN
Bai thudc TKl kit hdp xoa bdp bam huyet cd hilu qua trong dilu tri vilm quanh khdp vai the ddn thuan khi so sanh vdi bien phap XBBH ddn thuin, the hien qua cic chi so: dil'm dau VAS, tam van ddng khdp vi sfl thay ddi thang dil'm Costant
&Murleysau21 ngiy dieu tri.
24 I TAP CHI Y DUOC C 6 TRUYEN VIET NAM U»l»M4tli:kAfi1Ll
A
TAI LIEU T H A M KHAO
1. Chen Y., YangJ., WangL., Wu Y., and QuJ. (2017) [Explanation on Evidence-based Gmdelmes of Clinical Practice v^^ith Acupuncture and Moxibustion: Periarthritis of Shoulder]. Zhongguo Zhen Jiu 37(9): 991-4.
2. Juel N.G. and Natvig B. (2014) Shoulder diagnoses in secondary care, a one year cohort. BIVIC iViuseuIoskelet Disord 15: 89.
3. TrSn Ngoc An (1999) Vilm quanh khdp vai, Benh khdp, Nha xuat ban Yhoc, H i Ndi. 334 - 344.
4. Nguyen Thi Ngpc Lan (2000) Nghiin cflu tdn thUdng da diy ta trang d benh nhin mac binh khdp dieu tri diudc chdng vilm khdng steroid, Tdm tat luan an tiln si Y hoc, Tnfdng Dai hoc Y H i Ndi.
5. Boissier. iVI.C (1992) Periarthrites Seapulo - Humesrales. Conference de Rhematologie de Pari:
21-28.
6. Bo mon Y hoc cd truyen - Tnfdi^ Dai hoc Y Hi Npi (2005) Bai giang y hgc cd truyen, tip II, Nha xuat bin Y hpc. Ha Ndi.
7. Halverson L. and Maas R. (2002) Shoulder joint capsule distension (hydroplasty): a case senes of patients vfith "frozen shoulders" treated in a primary care oifiee. J Fam Pract 5l(l):61-3.
8. Jacobson J. A., Lancaster S., Prasad A., van HoIsbeeckM.T., CraigJ.G., et al. (2004) Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. Radiology 230(l):
234-42.
9. Farin P.U. (1996) Consistency of rotator-cufF calcifications. Observarions on plain radiography, sonography, computed tomography, and at needle treatment. Invest Radiol 31 (5): 300-4.
10. Royall N.A., FarrinE.,BahnerD.P., and Stawicki S.P. (2011) Ultrasound-assisted musculoskeletal procedures: Apraetical overview of currenthterature.WorldJOrthop 2(7): 57-66.
TAP CHI Y DUPC C 6 TRUYEN V1|T NAM kt^ltWJillaMTCl 25