体外冲击波联合经皮神经电刺激治疗肩关节挛缩患者的疗效分析

Efficacy of Extracorporeal Shock Wave Therapy Combined with Transcutaneous Electrical Nerve Stimulation in Patients with Shoulder Contracture

摘要: 目的：探讨体外冲击波治疗(extracorporeal shock wave therapy, ESWT)联合经皮神经电刺激(transcutaneous electrical nerve stimulation, TENS)治疗肩关节挛缩患者的临床疗效，并观察治疗前后疼痛、肩关节功能及活动度的改善效果。方法：回顾性分析2024年1月至2025年8月于安徽医科大学第二附属医院康复医学科接受康复治疗的肩关节挛缩患者90例，分为TENS组(n = 30)、ESWT组(n = 30)与联合治疗组(n = 30)。三组均接受常规康复治疗与自我功能锻炼，TENS组另外给予经皮神经电刺激治疗，ESWT组另外给予体外冲击波治疗，联合治疗组给予ESWT联合TENS治疗，干预周期均为2周。于治疗前后，分别评估并比较三组患者的肩关节关节活动度，疼痛视觉模拟评分(VAS)，Constant-Murley评分及巴氏指数等。结果：三组患者基线资料比较差异均无统计学意义(均P > 0.05)。治疗后各组VAS较治疗前下降，Constant-Murley评分、巴氏指数及各方向ROM均较治疗前改善；其中联合组在治疗2周时VAS下降幅度、Constant-Murley评分提升幅度及前屈/外展ROM改善幅度均优于ESWT组和TENS组，差异有统计学意义(均P < 0.05)；ESWT组与TENS组比较，在Constant-Murley评分和部分ROM改善方面优于TENS组(P < 0.05)。结论：体外冲击波联合经皮神经电刺激可较单一干预更显著地缓解肩关节挛缩患者的疼痛、改善肩关节功能及活动度。该联合治疗方案安全可行，对于肩关节挛缩患者的功能康复具有积极的促进作用，具备临床推广应用价值。

Abstract: Objective: This paper aims to investigate the clinical efficacy of extracorporeal shock wave therapy (ESWT) combined with transcutaneous electrical nerve stimulation (TENS) in patients with shoulder contracture, and to evaluate changes in pain, shoulder function, and range of motion before and after treatment. Methods: A retrospective analysis was conducted on 90 patients with shoulder contracture who underwent rehabilitation treatment in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Anhui Medical University, between January 2024 and August 2025. The patients were allocated to a TENS group (n = 30), an ESWT group (n = 30), and a combined treatment group (n = 30). All three groups received conventional rehabilitation therapy and self-directed functional exercise. In addition, the TENS group received transcutaneous electrical nerve stimulation, the ESWT group received extracorporeal shock wave therapy, and the combined treatment group received ESWT combined with TENS. The intervention period was 2 weeks in all groups. Before and after treatment, shoulder range of motion (ROM), visual analogue scale (VAS) score for pain, Constant-Murley score, and Barthel Index were assessed and compared among the three groups. Results: There were no statistically significant differences in baseline characteristics among the three groups (all P > 0.05). After treatment, VAS scores decreased in all groups compared with pretreatment levels, whereas Constant-Murley scores, Barthel Index scores, and ROM in all directions improved relative to baseline. At 2 weeks, the combined treatment group showed greater reductions in VAS scores, greater increases in Constant-Murley scores, and greater improvements in flexion and abduction ROM than both the ESWT group and the TENS group, with statistically significant differences (all P < 0.05). Compared with the TENS group, the ESWT group demonstrated superior improvement in Constant-Murley scores and selected ROM parameters (P < 0.05). Conclusion: ESWT combined with TENS was more effective than either intervention alone in relieving pain and improving shoulder function and ROM in patients with shoulder contracture. This combined treatment is safe and feasible, has a positive effect on functional rehabilitation in patients with shoulder contracture, and may have good potential for clinical application.