读医学网

纽约（路透健康新闻）一项新的研究显示，一种肩部的负向运动和伸展运动养生法可能为肩峰下肩部疼痛提供长期治疗并降低手术需求。在一项包含95个患者的试验中，随访一年后，随机分入对照组的患者有63%进行了手术，而锻炼组只有24%。

林雪平大学（林雪平，瑞典）此项研究的领导者Hanna Hallgren在一封邮件中告诉路透健康新闻，这种养生法应该成为肩峰下疼痛的一线治疗方法。“在一年的随访中，疗效最好的患者出自特殊锻炼组，没有进行任何手术；这表明这个项目具有很大的研究价值，”Hallgren说。

研究者们于6月26日在《英国运动医学杂志》（BJSM）的网上发表了他们的发现。这套养生法包括六项动作练习，2012年Hallgren和他的研究团队在《英国运动医学杂志》上发表的的一篇论文对其进行了阐述。

其中包括两项肩袖反向偏心运动，三项反向收缩运动（稳固肩胛骨），及一项肩后伸展运动。患者将整套动作分成三小节练习，每天两遍。持续八周后，缩减至每天一遍，再持续四周。对照组进行除此养生法之外的其它动作练习。

每位参加了此研究的患者，一年随访结束后病情均有好转，甚至那些接受了手术的也不例外。这表明，关节镜肩峰下减压术联合术后理疗可成功治疗那些对特殊运动练习无效的患者。

研究发现，那些临床基线评分较低或肩袖完全撕裂的患者选择手术的可能性更大。与部分撕裂和毫无撕裂相比，肩袖完全撕裂引起的手术风险的优势比为5.5（95%置信区间（CI）：1.1-28.6；p=0.04）。

“在原始治疗法中增加偏心运动练习看来是有道理的。在美国，大部分患者在手术之前都会测试凝血酶原时间，为什么不在养生法中加入偏心运动练习呢？”Richard Radnovich博士说。Richard Radnovich博士是爱达荷博伊西损伤护理医学中心的医师和运动损伤专家，没有参与这项研究。

然而，Radnovich博士说，鉴于研究的样本量比较小、入试的每位患者都有好转且治疗仅由一位治疗师实施，对于研究结果的解释应当谨慎。

Exercise for Subacromial Impingement Syndrome May Reduce Need forSurgery

NEWYORK (Reuters Health) - A regimen of negative shoulder movements and stretchingmay offer a long-term treatment for chronic subacromial shoulder pain andreduce the need for surgery, a new study suggests.

Ina trial of 95 patients, 63% of those randomized to the control group hadsurgery by one year of follow up, compared to 24% in the exercise group.

Theregimen should be the first line of treatment in subacromial pain, HannaHallgren, who led the study at Link?ping University in Link?ping, Sweden, toldReuters Health in an email.

Themost satisfied patients at the one-year follow up (were) the patients that hadbeen in the specific exercise group without any surgery and this is reflectingthat there is a lot to gain with this program, Hallgren says.

Theresearchers published their findings online June 26 in the British Journal ofSports Medicine.

Theregimen includes six exercises, which Hallgren and the research team describedin a 2012 paper in the British Journal of Medicine. (See here:http://bit.ly/VUvz0t.)

Thereare two negative-motion, eccentric exercises of the rotator cuff, threecontracting and negative-motion exercises to stabilize the scapula, and astretch for the posterior shoulder.

Patientsperformed the movements in three short sets twice daily for eight weeks. Thenthey backed off to once daily exercises for four more weeks.

Thecontrol group performed other exercises that were not a part of this regimen.

Everyoneinvolved in the study saw some improvement by year s end, even those who chosesurgery.

Thisshows that arthroscopic subacromial decompression together with postoperativephysiotherapy is a successful treatment for those patients not responding tothe specific exercises, Hallgren says.

Patientswith lower clinical scores at baseline or a full-thickness tear of the rotatorcuff were more likely to opt for surgery, the study found. A full-thicknesstear was significantly associated with an odds ratio for surgery risk of 5.5(95% CI: 1.1 to 28.6; p=0.04) compared to partial-thickness tears and no tearat all.

Addingeccentric exercises to an initial therapy regimen seems reasonable. Mostpatients in the US will get a trial of PT before considering surgery, why notadd eccentric exercises to that regimen? says Dr. Richard Radnovich, aphysician and sports injury specialist at Injury Care Medical Center in Boise,Idaho, who was not involved in this research.

Careshould be taken with interpretation of the results, however, given that thesample size was small, everyone enrolled improved and the therapy wasadministered by a single therapist, Dr. Radnovich said.