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Article(id=1322928198224314744, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.006, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340261273, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340261273, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340261273, creator=13701087609, updateTime=1793340261273, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=33, endPage=37, ext={EN=ArticleExt(id=1322928198429835641, articleId=1322928198224314744, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Acupuncture Combined with Neuromuscular Electrical Stimulation on Shoulder Joint Function and Nerve Function after Arthroscopic Rotator Cuff Repair, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the effects of acupuncture combined with neuromuscular electrical stimulation on shoulder joint function and nerve function after arthroscopic rotator cuff repair.

Method

A hundred and fifty patients who visited the Affiliated Hospital of Henan University due to shoulder joint injury from December 2021 to December 2023 were selected as the research subjects.They were randomly divided into a control group and an observation group using a random number table method.The control group received neuromuscular electrical stimulation treatment，while the observation group received acupuncture combined with neuromuscular electrical stimulation.The excellent rate，adverse reactions，pain level，shoulder joint range of motion，shoulder joint function and nerve function were compared between the two groups at different time points before and after intervention.

Result

The total effective rate of the observation group（96.00%，72/75）was significantly better than that of the control group（86.67%，65/75）（P<0.05）.At week 2，4 and 6 of intervention，the visual analogue scale（VAS）score of the shoulder joint in the observation group was significantly reduced（P<0.05，P<0.01）.After the intervention was completed，the active flexion angle and lateral rotation angle of the shoulder joint in the observation group were significantly increased compared to those in the control group（P<0.01），and the National Institutes of Health Stroke Scale（NIHSS）score of the observation group was significantly down regulated，while the American Shoulder and Elbow Surgeons’Form（ASES）score was significantly up regulated（P<0.01）.After 3 months of intervention，the 36-Item Short-Form（SF-36）score of the observation group patients was significantly up-regulated compared to that of the control group（P<0.01）.The incidence of adverse reactions in the observation group（12.00%，9/75）showed no significant difference compared to that in the control group（10.67%，8/75）（P>0.05）.

Conclusion

Acupuncture combined with neuromuscular electrical stimulation can significantly alleviate the postoperative pain in ARCR，expand the range of motion of the shoulder joint，promote the joint function recovery，improve the neurological function，reduce the shoulder muscle atrophy and enhance the quality of life.

, authors=Taifu HOU1, Hengbin YIN2, Qionghui ZHU2, Liling CHEN3, Yiqiang WEI3, authorsList=Taifu HOU, Hengbin YIN, Qionghui ZHU, Liling CHEN, Yiqiang WEI, authorCompany=null, correspAuthors=Yiqiang WEI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322928199939785096, articleId=1322928198224314744, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

观察针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响。

方法

选择2021年12月—2023年12月因肩关节损伤就诊于河南大学附属医院的150例患者作为研究对象，采用随机数字表法平均分为对照组和观察组，其中对照组采用神经肌肉电刺激治疗，观察组同时联合针刺。比较两组的优良率、不良反应以及干预前、后不同时间点疼痛程度、肩关节活动范围、肩关节功能和神经功能。

结果

观察组的总有效率（96.00%，72/75）显著优于对照组（86.67%，65/75）（P<0.05）。干预2、4、6周时，观察组患者的肩关节视觉模拟评分（Visual analogue scale，VAS）显著下调（P<0.05，P<0.01）。干预完成后，观察组患者的肩关节主动前屈角度和体侧外旋角度相较于对照组显著增加（P<0.01），且观察组患者的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分显著下调，而美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分显著上调（P<0.01）。干预完成后3个月，观察组患者的简明健康状况调查问卷（Medical outcomes study 36-item short-form health survey，SF-36）评分相较于对照组显著上调（P<0.01）。观察组患者不良反应发生率（12.00%，9/75）相较于对照组（10.67%，8/75）差异无统计学意义（P>0.05）。

结论

针刺联合神经肌肉电刺激治疗能够显著缓解关节镜下肩袖修复术（Arthroscopic rotator cuff repair，ARCR）术后疼痛，扩大肩关节活动范围并促进关节功能的恢复，同时还可改善患者神经功能，减少肩关节肌肉萎缩，提升患者生活质量。

, authors=侯太甫1, 殷恒斌2, 朱琼慧2, 陈利玲3, 魏贻强3, authorsList=侯太甫, 殷恒斌, 朱琼慧, 陈利玲, 魏贻强, authorCompany=null, correspAuthors=魏贻强, authorNote=

侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

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魏贻强（1970-），男，河南鹤壁人，主任中医师，学士，研究方向：中医内科疾病、急慢性疼痛的针灸康复治疗。E-mail：。
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侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

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侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

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组别例数性别/（例）年龄/（岁，）病程/（d，）病变部位/（例）
男女左侧右侧
对照组75413453.19±6.3721.78±3.793540
观察组75433252.89±7.6322.56±3.823738
t/χ2值0.3820.6150.6130.241
P值0.5170.4960.5170.753
), ArticleFig(id=1322928202385064376, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表1, caption=

两组肩关节损伤患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/（例）年龄/（岁，）病程/（d，）病变部位/（例）
男女左侧右侧
对照组75413453.19±6.3721.78±3.793540
观察组75433252.89±7.6322.56±3.823738
t/χ2值0.3820.6150.6130.241
P值0.5170.4960.5170.753
), ArticleFig(id=1322928202460561849, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数优良差总有效
对照组7545（60.00）20（26.67）10（13.33）65（86.67）
观察组7549（65.33）23（30.67）3（4.00）72（96.00）
χ2值4.225
P值0.041
), ArticleFig(id=1322928202531865018, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表2, caption=

两组肩关节损伤患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数优良差总有效
对照组7545（60.00）20（26.67）10（13.33）65（86.67）
观察组7549（65.33）23（30.67）3（4.00）72（96.00）
χ2值4.225
P值0.041
), ArticleFig(id=1322928202594779579, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数干预前干预1周干预2周干预4周干预6周
对照组757.35±1.126.55±0.975.40±1.254.85±1.633.80±0.93
观察组757.74±1.195.91±1.514.75±1.273.15±1.002.47±0.39
t值-0.8651.5782.1673.054-5.375
P值0.1650.0610.0450.0030.000
), ArticleFig(id=1322928202666082748, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表3, caption=

两组肩关节损伤患者肩关节疼痛程度比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数干预前干预1周干预2周干预4周干预6周
对照组757.35±1.126.55±0.975.40±1.254.85±1.633.80±0.93
观察组757.74±1.195.91±1.514.75±1.273.15±1.002.47±0.39
t值-0.8651.5782.1673.054-5.375
P值0.1650.0610.0450.0030.000
), ArticleFig(id=1322928202741580221, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主动前屈角度体侧外旋角度
干预前干预后干预前干预后
对照组75109.40±2.77139.35±2.7931.51±2.5836.97±3.32
观察组75110.30±3.09154.60±3.5130.89±2.6644.71±3.27
t值-0.6436.1890.7125.767
P值0.5060.0000.4810.000
), ArticleFig(id=1322928202812883390, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表4, caption=

两组肩关节损伤患者肩关节功能比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主动前屈角度体侧外旋角度
干预前干预后干预前干预后
对照组75109.40±2.77139.35±2.7931.51±2.5836.97±3.32
观察组75110.30±3.09154.60±3.5130.89±2.6644.71±3.27
t值-0.6436.1890.7125.767
P值0.5060.0000.4810.000
), ArticleFig(id=1322928202884186559, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数NIHSS评分ASES评分
干预前干预后干预前干预后
对照组758.81±1.793.91±0.6265.14±4.8675.72±4.67
观察组758.91±1.692.29±0.7864.82±3.7789.21±4.59
t值0.7434.4790.5746.079
P值0.4510.0000.5610.000
), ArticleFig(id=1322928202972266944, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表5, caption=

两组肩关节损伤患者神经功能和肩关节功能比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数NIHSS评分ASES评分
干预前干预后干预前干预后
对照组758.81±1.793.91±0.6265.14±4.8675.72±4.67
观察组758.91±1.692.29±0.7864.82±3.7789.21±4.59
t值0.7434.4790.5746.079
P值0.4510.0000.5610.000
), ArticleFig(id=1322928203039375809, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数干预前干预完成后干预完成后3个月
对照组7553.35±4.1664.55±5.9875.40±6.25
观察组7552.75±5.1966.95±5.5184.75±6.27
t值-0.8622.5787.162
P值0.1650.0560.000
), ArticleFig(id=1322928203102290370, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928198224314744, language=CN, label=表6, caption=

两组肩关节损伤患者生活质量比较

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组别例数干预前干预完成后干预完成后3个月
对照组7553.35±4.1664.55±5.9875.40±6.25
观察组7552.75±5.1966.95±5.5184.75±6.27
t值-0.8622.5787.162
P值0.1650.0560.000
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组别例数关节僵硬关节肿胀皮肤破溃切口感染总发生
对照组753（4.00）5（6.67）0（0.00）1（1.33）9（12.00）
观察组752（2.67）3（4.00）1（1.33）2（2.67）8（10.67）
χ2值0.211
P值0.632
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两组肩关节损伤患者不良反应比较

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组别例数关节僵硬关节肿胀皮肤破溃切口感染总发生
对照组753（4.00）5（6.67）0（0.00）1（1.33）9（12.00）
观察组752（2.67）3（4.00）1（1.33）2（2.67）8（10.67）
χ2值0.211
P值0.632
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针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响
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侯太甫 1 , 殷恒斌 2 , 朱琼慧 2 , 陈利玲 3 , 魏贻强 3
中华中医药学刊 | 国家项目点击 2025,43(10): 33-37
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中华中医药学刊 |国家项目点击 2025 , 43 (10) : 33 -37
针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响
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侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

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侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

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侯太甫1, 殷恒斌2, 朱琼慧2, 陈利玲3, 魏贻强3
作者信息
  • 1.河南大学，河南 开封 475001
  • 2.固始县中医院，河南 固始 465200
  • 3.浚县中医院，河南 浚县 456250
通讯作者:
魏贻强（1970-），男，河南鹤壁人，主任中医师，学士，研究方向：中医内科疾病、急慢性疼痛的针灸康复治疗。E-mail：。
作者简介:

侯太甫（1978-），男，河南驻马店人，副主任医师，博士在读，研究方向：神经康复，脊髓损伤康复，骨科康复、疼痛康复。

Effect of Acupuncture Combined with Neuromuscular Electrical Stimulation on Shoulder Joint Function and Nerve Function after Arthroscopic Rotator Cuff Repair
Taifu HOU1, Hengbin YIN2, Qionghui ZHU2, Liling CHEN3, Yiqiang WEI3
Affiliations
  • 1.Henan University，Kaifeng 475001，Henan，China
  • 2.Gushi County Hospital of Traditional Chinese Medicine，Gushi 465200，Henan，China
  • 3.Junxian Hospital of Traditional Chinese Medicine，Junxian 456250，Henan，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.006
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摘要
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目的

观察针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响。

方法

选择2021年12月—2023年12月因肩关节损伤就诊于河南大学附属医院的150例患者作为研究对象，采用随机数字表法平均分为对照组和观察组，其中对照组采用神经肌肉电刺激治疗，观察组同时联合针刺。比较两组的优良率、不良反应以及干预前、后不同时间点疼痛程度、肩关节活动范围、肩关节功能和神经功能。

结果

观察组的总有效率（96.00%，72/75）显著优于对照组（86.67%，65/75）（P<0.05）。干预2、4、6周时，观察组患者的肩关节视觉模拟评分（Visual analogue scale，VAS）显著下调（P<0.05，P<0.01）。干预完成后，观察组患者的肩关节主动前屈角度和体侧外旋角度相较于对照组显著增加（P<0.01），且观察组患者的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分显著下调，而美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分显著上调（P<0.01）。干预完成后3个月，观察组患者的简明健康状况调查问卷（Medical outcomes study 36-item short-form health survey，SF-36）评分相较于对照组显著上调（P<0.01）。观察组患者不良反应发生率（12.00%，9/75）相较于对照组（10.67%，8/75）差异无统计学意义（P>0.05）。

结论

针刺联合神经肌肉电刺激治疗能够显著缓解关节镜下肩袖修复术（Arthroscopic rotator cuff repair，ARCR）术后疼痛，扩大肩关节活动范围并促进关节功能的恢复，同时还可改善患者神经功能，减少肩关节肌肉萎缩，提升患者生活质量。

针刺  /  神经肌肉电刺激  /  关节镜  /  肩袖修复后  /  肩关节功能  /  神经功能
Objective

To observe the effects of acupuncture combined with neuromuscular electrical stimulation on shoulder joint function and nerve function after arthroscopic rotator cuff repair.

Method

A hundred and fifty patients who visited the Affiliated Hospital of Henan University due to shoulder joint injury from December 2021 to December 2023 were selected as the research subjects.They were randomly divided into a control group and an observation group using a random number table method.The control group received neuromuscular electrical stimulation treatment，while the observation group received acupuncture combined with neuromuscular electrical stimulation.The excellent rate，adverse reactions，pain level，shoulder joint range of motion，shoulder joint function and nerve function were compared between the two groups at different time points before and after intervention.

Result

The total effective rate of the observation group（96.00%，72/75）was significantly better than that of the control group（86.67%，65/75）（P<0.05）.At week 2，4 and 6 of intervention，the visual analogue scale（VAS）score of the shoulder joint in the observation group was significantly reduced（P<0.05，P<0.01）.After the intervention was completed，the active flexion angle and lateral rotation angle of the shoulder joint in the observation group were significantly increased compared to those in the control group（P<0.01），and the National Institutes of Health Stroke Scale（NIHSS）score of the observation group was significantly down regulated，while the American Shoulder and Elbow Surgeons’Form（ASES）score was significantly up regulated（P<0.01）.After 3 months of intervention，the 36-Item Short-Form（SF-36）score of the observation group patients was significantly up-regulated compared to that of the control group（P<0.01）.The incidence of adverse reactions in the observation group（12.00%，9/75）showed no significant difference compared to that in the control group（10.67%，8/75）（P>0.05）.

Conclusion

Acupuncture combined with neuromuscular electrical stimulation can significantly alleviate the postoperative pain in ARCR，expand the range of motion of the shoulder joint，promote the joint function recovery，improve the neurological function，reduce the shoulder muscle atrophy and enhance the quality of life.

acupuncture  /  neuromuscular electrical stimulation  /  arthroscope  /  after rotator cuff repair  /  shoulder joint function  /  neurological function
侯太甫, 殷恒斌, 朱琼慧, 陈利玲, 魏贻强. 针刺联合神经肌肉电刺激对关节镜下肩袖修复后肩关节功能和神经功能的影响. 中华中医药学刊, 2025 , 43 (10) : 33 -37 . DOI: 10.13193/j.issn.1673-7717.2025.10.006
Taifu HOU, Hengbin YIN, Qionghui ZHU, Liling CHEN, Yiqiang WEI. Effect of Acupuncture Combined with Neuromuscular Electrical Stimulation on Shoulder Joint Function and Nerve Function after Arthroscopic Rotator Cuff Repair[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 33 -37 . DOI: 10.13193/j.issn.1673-7717.2025.10.006
正文
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肩袖主要由肩胛下肌、冈上肌、冈下肌以及小圆肌等肌群组成，肩袖损伤是外科和骨科临床常见的疾病之一，该病以肩关节疼痛、活动范围降低和功能障碍等为主要临床表现，多数患者起因于跌倒时手臂外展着地所致[1-2]，临床采取保守治疗3～6个月效果不佳或无效者则推荐手术治疗[3]。若治疗不当或病情进展，长期关节功能障碍会导致冈上、下肌及三角肌萎缩，甚至导致残障[4]。关节镜下肩袖修复术（Arthroscopic rotator cuff repair，ARCR）已成为诊断和治疗肩袖损伤的常用且有效的治疗方式，术后患者肩关节疼痛及功能障碍等均改善明显[5]。但部分患者ARCR术后仍有疼痛，尤其是在术后早期。造成ARCR后关节疼痛以及不同程度功能障碍的潜在因素复杂，与患者肩袖损伤程度、撕裂类型、手术方式、年龄以及性别等多个方面相关[6-7]。术后疼痛不仅降低患者对手术的满意度，而且影响其康复进程、关节活动度及功能。为改善患者术后肩关节疼痛及关节功能，常需采取适当的康复措施进行干预。研究表明，神经肌肉电刺激能够在一定程度上预防肌肉萎缩[8]。临床实践发现，针刺不仅能够促进肢体运动功能的恢复，还能改善患者神经功能[9]。基于此，本研究通过分析针刺联合神经肌肉电刺激治疗肩袖损伤行肩关节镜修复术后患者疼痛及功能障碍的效果，并观察其对患者神经功能和生活质量的改善情况。
1　临床资料
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1.1　一般资料
选择2021年12月—2023年12月因肩关节损伤就诊于我院的150例患者作为研究对象，采用随机数字表法平均分为对照组和观察组，其中对照组采用神经肌肉电刺激治疗，观察组同时联合针刺，连续治疗5周。两组一般资料具有可比性（P>0.05）。见表1。
1.2　纳入标准
（1）符合肩袖损伤的诊断标准和关节镜下修复手术的适应证；（2）18岁≤年龄≤75岁；（3）均有肩部疼痛、肿胀和功能受限，且病变部位为单侧，并经影像学检查明确诊断；（4）既往未接受任何相关的药物及康复治疗；（5）精神及认知正常者，能够完成本研究的运动命令；（6）患者或家属签署知情同意。
1.3　排除标准
（1）存在冻结肩或其他类型无法修复的肌腱缺损以及肩关节疾病者；（2）关节内感染或关节周围有皮肤破损、感染者；（3）其他疾病引起的继发性肩关节肿痛、活动受限者；（4）合并严重的心、脑血管、肝肾、循环系统疾病或代谢异常导致不能接受肢体训练者。
2　治疗方法
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所有患者术后固定6周，其间在无痛情况下进行适当的功能锻炼：例如张力握拳、肘关节伸直、被动活动以及肩部肌肉力量训练。术后6～12周逐渐开始主动活动训练，术后12周后开始主动肌肉力量训练。
2.1　对照组
神经肌肉电刺激：患者取坐位，充分暴露治疗部位，在术侧三角肌肌腹上放置正负极电极片，启动电源后缓慢调节电流强度至患者可耐受的程度。1次/d，20 min/次，于术后第2天开始，连续治疗1周。1周后1次/周，连续治疗4周。
2.2　观察组
神经肌肉电刺激同对照组，同时联合针刺：治疗时患者取坐位，充分暴露针刺部位，常规消毒后使用一次性无菌针灸针（0.25 mm×40 mm）取穴进行针刺，包括肩贞、肩髎、肩前、肩井、曲池、手五里、肩内陵等。肩井采取斜刺，其余各穴均直刺，得气后留针30 min，用泻法，每隔10 min行针1次。术后第2天开始针刺，1次/d，10 d为1个疗程，共治疗3个疗程。针灸由同一位医师完成。
3　观察指标与统计学方法
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3.1　临床疗效
采用加州大学肩关节评分系统（University of California atLos Angeles shoulder rating scale，UCLA）对两组患者的肩关节功能进行评估，UCLA评分总分0～35分，包括关节疼痛、功能、活动范围以及肌肉力量等方面，其中得分34～35分记为优，29～33分记为良，不足29分记为差。计算并比较两组治疗后的优良率，以优良率评估临床疗效。总优良率＝（优+良）例数/总例数×100%。
3.2　肩关节疼痛程度
采用视觉模拟评分（Visual analogue scale，VAS）于干预前和干预后第1、2、4、6周对患者的疼痛程度进行评估，总分0～10分，分数与疼痛程度呈正相关。
3.3　肩关节功能
采用可穿戴关节活动度测量仪检测并比较两组患者的主动前屈角度和体侧外旋角度。采用美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分对患者肩关节的疼痛程度、稳定性、活动度以及肌肉力量等项目进行评估，总分为0～100分，分数与关节功能呈正相关。
3.4　神经功能
采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分于干预前和干预完成后对两组患者的神经损伤程度进行评估，该评分总分0～42分，包含11个维度，评分与神经损伤程度呈负相关。
3.5　生活质量
采用简明健康状况调查问卷（Medical outcomes study 36-item short-form health survey，SF-36）评分于干预前、干预完成后、干预完成后3个月对患者的生活质量进行评估，该问卷总分0～100分，分数与生活质量呈正相关。
3.6　安全性观察
观察、记录两组患者治疗期间关节僵硬、肿胀、皮肤破溃以及切口感染等不良反应发生情况。
3.7　统计学方法
采用SPSS 22.0软件对数据进行详细分析，遵循正态分布的数据，通过平均值和标准差（）进行描述，并利用独立样本t检验来对比不同组间的差异；组内的数据比较采用配对样本t检验方法；计数数据分析采用卡方检验（χ2检验）。当P<0.05时认为差异具有统计学意义。
4　疗效标准与治疗结果
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4.1　临床疗效
观察组的总有效率（96.00%）显著优于对照组（86.67%），差异具有统计学意义（P<0.05）。见表2。
4.2　肩关节疼痛程度
两组患者的肩关节VAS评分水平在干预前和干预1周差异无明显统计学意义（P>0.05）。干预2、4、6周时，与对照组比较，观察组患者的肩关节VAS评分显著下调（P<0.05，P<0.01）。见表3。
4.3　肩关节功能
干预前两组患者的肩关节活动度差异无统计学意义（P>0.05）。干预完成后，观察组患者的肩关节主动前屈角度和体侧外旋角度相较于对照组显著增加（P<0.01）。见表4。
4.4　神经功能
干预完成后，与对照组比较，观察组患者的NIHSS评分显著下调，而ASES评分显著上调（P<0.01）。见表5。
4.5　生活质量
干预完成后，观察组患者的SF-36评分相较于对照组有上调趋势，但差异无统计学意义（P>0.05）；干预完成后3个月，观察组患者的SF-36评分相较于对照组显著上调（P<0.01）。见表6。
4.6　不良反应
观察组患者不良反应发生率（12.00%）相较于对照组（10.67%）差异无统计学意义（P>0.05）。见表7。
5　讨论
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肩袖损伤作为临床常见疾病，疼痛是其主要症状，同时伴随不同程度的活动范围和功能受限，严重者会导致患者肩袖部分或全部撕裂，严重影响患者的日常工作及生活[10-11]。肩袖损伤的发生与肩关节周围肌肉组织疏松、关节囊薄弱、关节稳定性较差等因素有关[12-13]。临床上常采用保守或手术治疗等措施，但临床数据显示保守治疗通常效果欠佳，而ARCR的治疗效果相对较好。肩关节镜修复术具有创伤小、出血少以及术后恢复迅速等优势，由于存在个体差异，术后患者仍有疼痛等多种不适症状，术后通常采用康复措施[14-15]。神经肌肉电刺激通过低频电流刺激使肌肉被动收缩，缓解肌肉痉挛，改善关节功能和活动度，增强肌肉力量，预防肌肉萎缩，有效缓解疼痛，为患者提供更大的活动范围，从而提高康复训练效果[16-17]。与此同时，神经肌肉电刺激通过肢体的感觉刺激，能够促进周围神经元轴突的修复和再生，可刺激大脑功能的重组，促进神经再支配，使受到抑制的神经通路被激活，改善神经支配器官功能，从而提高患者的关节运动功能[18-19]。研究指出，ARCR术后的6周是肌肉筋骨愈合的关键时期，因此在术后6周内患者进行积极康复或给予适当治疗措施不仅能够促进患者术后恢复，还可明显降低肌肉萎缩、关节僵硬等并发症和不良反应的发生率[20-21]。
中医古籍《素问·武藏生成篇》云：“诸筋者皆属于节”，《医林改错》记载：“凡肩痛……或周身疼痛，总名曰痹证”，根据肩袖损伤的临床症状，归为“肩痹”“痹证”“筋伤”以及“肩凝”等疾病范畴[22]，病因病机为肩袖损伤的内因与素体虚弱、肝血和肾精耗损、气血运行不利、肩周骨骼、肌腱、肌肉活动减少相关，骨骼筋脉失于濡养，不荣则痛；同时风寒湿邪侵袭、暴力闪挫、运动不当等又会痹阻肩部经络，气血瘀滞造成筋骨难以畅通，不通则痛，故而肩周疼痛、关节活动及功能受限[23-25]。因此中医学认为肩袖损伤的治疗应以扶正兼顾祛邪为主要原则，针灸刺激能够对肢体阻塞、麻痹的经络起到疏通作用，改善气血运行，最终发挥治疗作用[26]。在本次研究中，我们遵循穴位与病机病因原则，针刺选穴应“以痛为腧”，选取肩贞、肩髎、肩前、肩井、曲池、手五里、肩内陵等解剖部位与肩袖损伤的主要病灶有对应关系的穴位，是临床治疗肩周疼痛的常用穴位组合，阿是穴是疼痛的主要反应点，符合经筋痹证优化的取穴原则[27]。肩贞位于肩胛骨下角内侧，腋后纹头直上1寸，针刺肩贞穴可疏通肩部经络，缓解肩部疼痛，改善局部血液循环，从而促进损伤的修复。肩髎位于肩峰外侧缘前端与肱骨大结节间的凹陷中，肩髎穴的针刺通过调节肩部气血，减轻局部炎症，促进损伤组织的修复，提高肩关节的活动度。肩前位于腋前纹头直上1寸，肩胛骨喙突处，针刺肩前穴有助于改善肩关节的活动度，缓解肌肉僵硬，促进肩部功能的恢复。肩井位于肩峰顶点与第七颈椎棘突连线的中点，肩井穴的针刺通过疏通肩部气血，缓解肌肉紧张，改善局部血液循环，减轻肩部疼痛。曲池位于肘横纹外侧端，当肱骨外上髁的前缘，针刺曲池穴有助于通调上肢气血，减轻肘关节及肩关节的疼痛，提高上肢的功能。手五里位于肘横纹上3寸，桡侧。手五里穴的针刺通过调节手臂经络，缓解上肢疼痛，改善神经功能，促进肢体的康复。肩内陵位于肩胛骨内侧缘中点，约平第四胸椎。针刺肩内陵穴疏通肩胛骨内侧经络，减轻肩背部的疼痛，改善肩关节功能，促进局部组织的恢复[28-29]。有研究指出，针刺相应穴位能够增加动脉血管的弹性，改善血液黏稠和凝聚状态，从而起到改善脑部和四肢血液循环的作用[30-31]。本研究结果显示，观察组的总有效率（96.00%）显著优于对照组（86.67%）。干预2、4、6周时，观察组患者的肩关节VAS评分显著下调，观察组患者的肩关节主动前屈角度和体侧外旋角度相较于对照组显著增加。干预完成后，观察组患者的NIHSS评分显著下调，而ASES评分显著上调。干预完成后3个月，观察组患者的SF-36评分相较于对照组显著上调。观察组患者不良反应发生率（12.00%）相较于对照组（10.67%）无明显差异。可见，联合治疗能够发挥针刺的疏经活血、通络止痛功效，还可通过神经肌肉电刺激促进肌肉被动节律性收缩，恢复正常神经功能，有效改善关节功能和肌肉萎缩。
近年诸多关于针刺治疗肩袖术后相关功能及减轻术后疼痛的研究证明[32-37]，针刺联合相关治疗能够显著缓解术后疼痛，扩大肩关节活动范围并促进关节功能的恢复，同时还可改善患者神经功能，减少肩关节肌肉萎缩，提升患者生活质量，对患者术后康复有良好的促进作用。
基金
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  • 国家“十三五”重点研发计划项目子课题(2017YFD0600702-3)
文献
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参考文献 引证文献
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2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.006
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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基金
国家“十三五”重点研发计划项目子课题(2017YFD0600702-3)
作者信息
    1.河南大学，河南 开封 475001
    2.固始县中医院，河南 固始 465200
    3.浚县中医院，河南 浚县 456250

通讯作者:

魏贻强（1970-），男，河南鹤壁人，主任中医师，学士，研究方向：中医内科疾病、急慢性疼痛的针灸康复治疗。E-mail：。
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2种不同金属材料的力学参数
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species		 占总种数比例
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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