臺灣博碩士論文加值系統

背景介紹 對於骨科及復健專家來說，治療原發性沾黏性肩關節炎(primary adhesive shoulder capsulitis)是一種進退兩難的狀況。肩關節沾黏可能造成關節僵硬而無法活動，經由手術或復健治療後，又會再次帶來疼痛，因此可能減低再次降低運動功能。本研究中，我們試圖評估是否體外震波治療(extracorporeal shockwave therapy (ESWT))能夠改善原發性沾黏性肩關節炎病患的功能性結果。

研究設計及方法 本前瞻性隨機對照研究，是單盲性的臨床研究，研究共收錄40位有原發性沾黏性肩關節炎之病患，來評估是否體外震波治療能夠比口服類固醇藥物，更能改善原發性沾黏性肩關節炎之功能性結果。 病患經由隨機分配的過程，指派到口服類固醇組(對照組)，或體外震波治療組(ESWT group)。在治療前後，分別使用Constant Shoulder Score (CSS)和Oxford Shoulder Score (OSS)評估病人的功能性結果。

結果 在研究進行的過程中，實驗組及對照組病患都出現明顯的Oxford Shoulder Score分數的進步。在兩組之間比較部分，在體外震波組(ESWT group)，Constant Shoulder Score (CSS)的總分，和CSS的關節活動度(range of motion (ROM))參數部分，從第四週開始，比口服類固醇對照組(oral steroid control group)，顯示出明顯的進步；此外，CSS中的日常活動(activity-of-daily living (ADL))參數項目，也在第六週的時候，顯示出明顯的比口服類固醇對照組進步。而在組內比較方面，對於口服類固醇對照組方面，在治療的前四週時間，疼痛比起治療前，有明顯的改善；日常活動(ADL)和關節活動度(ROM)在第四週到第12週之間，也有明顯進步。而對於體外震波組(ESWT group)，日常活動(ADL)和關節活動度(ROM)方面，從研究開始到第六週之間，有明顯的進步。

討論及結論 我們的研究結果顯示，體外震波治療(ESWT)，可以考慮作為原發性沾黏性肩關節炎的替代療法(alternative treatment)選擇。至少在原發性沾黏性肩關節炎的短期追蹤過程中，可以達到治療效果。此外，本研究中體外震波治療(ESWT)出現的副作用，都是暫時性、輕微的，並可被病患接受。

Background
The treatment of primary shoulder adhesive capsulitis is a dilemma for orthopedic rehabilitation specialists. In this study, we try to assess whether extracorporeal shockwave therapy (ESWT) improves the functional outcomes of primary adhesive capsulitis when comparing with oral steroids prescription.

Methods
In this prospective randomized single blinded controlled clinical trial, we enrolled 40 patients with primary adhesive capsulitis to assess whether extracorporeal shockwave therapy (ESWT) improves the functional outcome of primary adhesive capsulitis better than oral steroids therapy. Patients were randomized allocated into oral steroids group and ESWT group. Steroids group received 4-week prednisolone therapy; ESWT group underwent ESWT 3 times, on the 1st, 14th and 28th day. Functional outcome evaluations were performed at 0, 2, 4, 6 and 12 weeks using the constant shoulder score (CSS) and Oxford shoulder score (OSS).

Results
The results showed that total score and range of motion (ROM) of CSS improved significantly better in ESWT group than steroids group since 4th week and persisted. Activity of daily living (ADL) of CSS improved significantly better in ESWT group since 6th week. Pain and power of CSS did not improved significantly between 2 groups throughout the study. OSS of ESWT group improved significantly better from 6th week. Intra-group analyses showed steroids group had significantly improvement on pain from 0 to 4th week; ROM, ADL improved on 4th to 12th week. For ESWT group, statistical significance was noted in the total score, ADL, and ROM parameters of CSS at 0 to 6th week.

Conclusion
Our study showed that patients had functional outcome improvements no matter whether they were treated with ESWT or oral steroids, but patients who received ESWT had faster and better functional outcome improvements. For steroids group, pain was significant reduced in the early phase of the study (0-4th week); ADL and ROM improved at later phase (4th - 12th week). For ESWT group, ADL and ROM improvements were significant at the early phase of the study (0-6th week). Our results also demonstrated that ESWT can be an alternative treatment, at least in the short term, for primary adhesive capsulitis of the shoulder. In addition, all of the side effects of ESWT were transient and tolerable.

目錄Table of Contents
誌謝 i
中文摘要 ii
Abstract iv
目錄Table of Contents vii
圖目錄 List of Figures ix
表目錄List of Tables x
1. Introduction 1
1.1 Background 1
1.2 Epidemiology 4
1.3 Clinical presentation of shoulder adhesive capsulitis 6
1.4 Clinical stages of shoulder adhesive capsulitis 7
1.5 Arthroscopic appearance of the shoulder adhesive capsulitis 12
1.6 Risk factors of shoulder adhesive capsulitis 13
1.7 Images of shoulder adhesive capsulitis 14
1.8 Treatment options 17
1.9 NSAID treatment 19
1.10 Oral steroids treatment 20
1.11 Extracorporeal shock wave therapy (ESWT) 23
2. Materials and Methods 27
2.1 Study design 27
2.2 Inclusion criteria 27
2.3 Exclusion criteria 28
2.4 Demographic data 29
2.5 Post-treatment rehabilitation and education 30
2.6 Treatment protocol 32
2.7 Randomization 33
2.8 Extracorporeal Shockwave Therapy 34
2.9 Functional Outcome Evaluations 36
2.9.1 The Constant Shoulder Score 36
2.9.2 The Oxford Shoulder Score 38
2.10 Statistical Analysis 40
3. Results 42
3.1 Inter-group analyses 42
3.2 Individual parameters comparison 44
3.3 Intra-group analyses 49
3.4 Side effects of ESWT 51
4. Discussion 52
4.1 Contribution and conclusion 61
4.2 Future work 63
Disclaimer 64
References 65
Appendix 1. 一般肩關節評分表Constant Shoulder Score 72
Appendix 2. 牛津肩關節評分表Oxford Shoulder Score 76
 
圖目錄 List of Figures
Figure 1. Shoulder adhesive capsulitis (Frozen shoulder). 4
Figure 2. Shoulder Arthroscope. 13
Figure 3. Magnetic Resonance images of adhesive capsulitis. 17
Figure 4. Dupuytren's Contracture. 25
Figure 5. Patient instruction and rehabilitation demonstration sheet after ESWT. 31
Figure 6. Flowchart of study procedures. 33
Figure 7. The Extracorporeal shockwave therapy (ESWT) machine. 35
Figure 8. Functional shoulder scores after steroid treatment (oral prednisolone) and ESWT. 43
Figure 9. Improvement in parameters of CSS. 45
Figure 10. Line graph for forward flexion and abduction angles. 46
Figure 11. Bar graphs for rotation angles. 48
Figure 12. Peyronie’s Disease. 56

表目錄List of Tables
Table 1. Stages of Shoulder adhesive capsulitis [4]. 11
Table 2. Demographic data. 29
Table 3. Descriptive statistics for ROM measurements between steroid group and ESWT group. 49
Table 4. Intragroup analysis of steroid group with repeated-measures one-way analysis of variance. 50
Table 5. Intragroup analysis of ESWT group with repeated-measures one-way analysis of variance. 50

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