胸椎介入的治療方式對於肩峰下疼痛症候群之療效：系統性回顧與統合分析

The Effect of Thoracic Management in Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis

陳欣逸(Shin-I Chen) ； 程騰寬(Teng-Kuan Cheng) ； 蘇勢棠(Shih-Tang Su) ； 李雪楨(Hsuei-Chen Lee) ； 施怡芬(Yi-Fen Shih)

《物理治療》 47卷3期 (2022/09) Pp. 176-188

https://doi.org/10.6215/FJPT.202209_47(3).0002

摘要

背景與目的：肩峰下疼痛症候群（subacromial pain syndrome, SPS）具有很高的盛行率，其症狀出現在肩峰周圍，且會出現肩胛骨運動學的變化。過去研究觀察到這類疼痛常見於胸椎排列不正的個案，許多研究因此嘗試由胸椎介入治療來減輕肩峰下疼痛。本研究目的以系統性回顧與統合分析探討胸椎介入方式對SPS的治療效果。方法：搜尋Cochrane、PubMed、PEDro三種電子資料庫，納入刊登日期至2021年3月之前的隨機分配試驗研究，並使用PEDro量表和Cochrane文獻回顧小組制定之質性分析來評估文獻的品質與證據等級，以Comprehensive Meta-Analysis V.2軟體進行統合分析，統計顯著差異水平定為0.05。結果：共有11篇研究納入統合分析。比較胸椎矯治技術（manipulation）及虛假胸椎矯治技術的立即效果及2天後效果，在2天後疼痛減輕效果（p = 0.04）與改善肩胛骨上轉的立即效果（p ＜ 0.01）有顯著差異，然而對於疼痛與肩胛骨內轉、後傾的立即效果及2天後功能表現的效果則沒有顯著差異；胸椎徒手治療結合運動治療與單獨運動治療相比，於改善功能表現改善（p = 0.04）、肩關節屈曲（p = 0.025）及外轉角度（p = 0.03）上皆達到顯著差異，有額外附加效果，但是對於疼痛、肩關節內轉及外展角度的改變則沒有顯著差異。結論：胸椎介入方式可減輕SPS的疼痛、改善肩關節功能表現及肩胛骨運動學、增加關節活動度。

關鍵字

胸椎徒手治療 ； 肩峰下疼痛症候群 ； 系統性回顧 ； 統合分析

並列摘要

Background and Purpose: Chronic shoulder pain, such as subacromial pain syndrome (SPS), has a high prevalence, and it is characterized by symptoms localized around the acromion and abnormal scapular kinematics. Studies have revealed that subacromial pain was observed in people with thoracic malalignment. Therefore, the intervention targeted at the thoracic spine has been suggested. The purpose of the study was to systematically review and critically appraise the literature on the effectiveness of thoracic management in people with SPS. Methods: We searched databases from Cochrane, PubMed, and PEDro for randomized controlled trials published prior to March 2021. The quality of eligible studies was evaluated using the PEDro scale and the qualitative analysis from Cochrane collaboration review group for Evidence-Based Medicine. Meta-analysis was performed using the Comprehensive Meta-analysis V.2. The significance level was set at 0.05. Results: Eleven randomized controlled trials were included. Comparing the immediate effects and 2 days effects of thoracic manipulation to sham manipulation, thoracic manipulation was superior to sham manipulation in the 2-day effect on pain reduction (p = 0.04) and the immediate effect on scapular upward rotation (p ＜ 0.01). However, there was no group difference either in the immediate effect on pain, scapular internal rotation, and posterior tilt or in the 2-day effect on shoulder function. Comparing thoracic combined management, which consists of thoracic manual therapy and exercise, to exercise alone, thoracic combined management has additional effects in the short-term effect on function (p = 0.04) and increasing range of motion (ROM) of shoulder flexion (p = 0.025) and external rotation (p = 0.03), but no significant difference in changes of pain, shoulder internal rotation and abduction ROM. Conclusions: Our findings suggested that thoracic management could be used in pain reduction, shoulder function and scapular kinematics improvement, and increasing shoulder ROM in people with SPS.

並列關鍵字

Thoracic manual therapy ； Subacromial pain syndrome ； Systematic review ； Meta-analysis