| 摘要: | 疼痛的肩關節活動受限是一種最普遍且功能受限最多的肌肉骨骼問題，經常尋求骨科治療（Wadsworth,1986）。肩關節是人類所有關節中活動度最大的關節，由複雜的軟組織所支持，一但肩關節活動失能則許多的日常生活功能亦受限。冷凍肩即屬於其中的一種肩關節受限，早在100多年前冷凍肩已被報導在許多醫療文獻中。最早冷凍肩的症狀由Duplay在1872年提出。1934年Codman描述冷凍肩是一種特殊的症狀，很難加以定義、很難治療同時很難從病理學的角度去解釋（Fareed and Gallivan, 1989）。同時Codman也指出冷凍肩是一種自癒性的症狀，不管治療或不治療患者皆能在2年內恢復。但相對的也有許多學者指出，冷凍肩的症狀一但發生，關節活動的受限問題往往持續數年之久，最長者為6年（Chen,1988;Shaffer,1992;Rene,1991）。因此患者的許多日常生活功能長久受限，同時必需經常地使用醫療資源。 傳統肌肉骨骼系統疾病的療效評估多只著重在臨床的生理變數，例如關節活動度，相對的較忽略了患者自覺的健康相關變數。然而目前的臨床研究多已將健康相關的生活品質作為重要的測量指標(Fabio,1998;Gartland,1988;Gill,1994)。本研究的目的是為了評估冷凍肩患者接受針灸治療及西醫復健治療的療效。除了客觀的疼痛指數、關節活動度(ROM)的評估，另外主觀的健康相關生活品質問卷SF-36也是本研究一項重要的評估指標。同時本研究進一步進行一般性問卷SF-36在冷凍肩單一疾病使用上信度及效度的探討。 自民國90年11月至民國91年5月，本研究於中國醫藥學院附設醫院復健部及針灸科共收集47位冷凍肩患者，平均年齡54.9歲，平均發病23.9週。其中31位接受西醫復健治療，16位接受中醫針灸治療。所有患者於初診時皆進行靜態疼痛、活動疼痛、主動及被動關節活動度以及SF-36的前測評估，後測的評估則分別於第二週治療及第四週治療後進行。 與中部五縣市一般常態民眾進行比較，本研究冷凍肩患者SF-36各次量表的分數皆明顯較低（李，民86）。另外與國外一項冷凍肩相關研究的比較，本研究的信度0.6117<Cronbach’α<0.8508與該研究相近。本研究亦證實了SF-36於冷凍肩單一疾病的使用上具有良好的校標效度與建構效度。此外本研究並未有充分證據顯示，針灸治療與復健治療之間有顯著的療效差異存在。另外在接受中醫針灸組及西醫復健組的治療後，SF-36的分數也未有顯著的改善。 本研究證實SF-36在冷凍肩單一疾病的使用上有不錯的信度及效度。不過為了有更全面性的療效評估，未來針對單一疾病的研究應該同時使用一般性及專門性的測量工具作為療效的評估。另外，本研究未有充分足夠的樣本數證實不同治療方式是否有顯著差異，未來研究可採集更多樣本數。未來研究建議可以採用針灸及復健治療合併的中西醫整合治療方式，進一步進行療效差異性的探討。; Abstract Background Painful restriction of shoulder motion is one of the most common and disabling orthopedic disorders for which patients seek treatment. Frozen shoulder is one specific shoulder restriction has reported in medical literature for over 100 years. Duplay first described the syndrome of frozen shoulder in 1872.（Wadsworth,1986） In 1934 Codman described Frozen shoulder is a class of cases which are difficult to define, difficult to treat and difficult to explain from the point of view of pathology. （Fareed &Gallivan, 1989）. Codman also stated “Even the most sever cases recover with or without treatment in about 2 years.” However, many experts described that frozen shoulder remains symptomatic and has somewhat restricted motion even many years after onset; the longest one remained for 6 years. Patient’s daily life was effected for a long while.（Chen,1988 ; Rene,1991 ; Shaffer,1992） In the past study two physiologic variables, range of motion（ROM）、pain scores were used as major outcome variables. Recently, health related quality of life was advocated as one of primary outcome variables. (Fabio,1998 ; Gartland,1988; Gill,1994) In this study we used quality of life and physiologic variables simultaneously to evaluate the outcome of patients with frozen shoulder who were treated by acupuncture or physical therapy. The appropriate of using a generic questionnaire SF-36 to measure quality of life on patients with frozen shoulder was also assessed by measuring reliability and validity in our study. Method From November 2001 to May 2002. 47 frozen shoulder patients at China Medical College Hospital were collected in this study. 31 patients were treated with physical therapy and 16 patients were treated with acupuncture. The initial evaluation included the assessments of pain at rest、pain with activity、active ROM、passive ROM and Short Form-36. These assessments were also executed two weeks and four weeks later after treated. Nonparametric statistic, Wilcoxon signed rank test and Mann-Whitney test was adopted to do statistic inference. Result Average age of 47 patients (male 53.2%, female 46.8%) was 54.9. The average duration was 23.9 weeks before treated. All patients had improved on pain scores、ROM and SF-36 scores after two weeks and four weeks treatment. But all scores were not statistic significance between acupuncture group and physical therapy group in these variables. Internal consistency was used to assess the reliability of SF-36 in this study（0.6117<α<0.8508）. The pain at rest and pain with activity both had negative correlation with Body Pain(BP)（from-0.29 to -0.33） |
