| 摘要: |
| [目的] 观察联合治疗法对冻结肩（FS）模型大鼠肩关节活动度改善和关节囊积液中肿瘤坏死因子（TNF）-α等炎症因子及转化生长因子（TGF）-β蛋白的表达水平，探讨速刺肩胛下肌激痛点法治疗肩周炎的机制。[方法] 选取12周龄雄性SD大鼠，通过手术固定法建立FS模型，随机分为空白组、模型组、传统针刺组、速刺激痛点组及联合治疗组。干预后，检测各组大鼠肩关节活动度（外展角、外旋角）；采用苏木精-伊红（HE）染色观察不同组大鼠肩关节形态变化，通过酶联免疫吸附实验（ELISA）法测定关节囊积液中TNF-α等炎症因子水平，通过Western Blot（蛋白质印迹法）检测大鼠肩关节组织TGF-β蛋白的表达水平。[结果] 与空白组相比，模型组的肩周炎大鼠患侧关节活动度显著受限（P<0.000 1），连续应用不同治疗方案后，肩周炎大鼠的关节活动度均有不同程度的改善，其中以联合治疗组的疗效最为显著。HE染色结果显示，显微镜下模型组出现肌腱纤维结构明显紊乱，滑膜组织增厚、毛细血管增多、炎性细胞浸润等病理变化。干预后，传统针刺组，速刺激痛点组，联合治疗组对组织形态学病变显著改善，尤其是联合治疗组上述情况明显好转。与空白组相比，模型组大鼠肩关节腔液相关炎症因子TNF-α、白细胞介素（IL）-1α/β、TGF-β水平显著升高P<0.001），与模型组相比，治疗组的炎症因子水平均显著降低，具有显著统计学差异。而且，与传统针刺组及速刺激痛点组相比，联合治疗组的炎症因子TNFa、IL-1a/β及TGF-β水平进一步降低（P<0.05）。与空白组相比，模型组大鼠TGF-β蛋白水平显著升高（P<0.001），与模型组相比，治疗组的TGF-β蛋白水平均显著降低，具有显著统计学差异。而且，与传统针刺组及速刺激痛点组相比，联合治疗组的TGF-β蛋白水平进一步降低（P<0.05）。[结论] 联合治疗组可有效提高肩周炎大鼠模型的关节活动度，改善肩周炎大鼠模型的病理状态，降低TNF-α等炎症因子及TGF-β蛋白的表达水平，对肩周炎大鼠模型具有良好的治疗效果。 |
| 关键词: 速刺激痛点 冻结肩 关节活动度 组织形态学 细胞因子 |
| DOI：10.11656/j.issn.1673-9043.2026.08.10 |
| 分类号:R684.3;R245.31 |
| 基金项目:天津市卫生健康委员会中西结合科研项目（2023151）。 |
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| Effects of Rapid Acupuncture at Trigger Points of Subscapularis Combined with Traditional Acupuncture on Local Morphology，Inflammatory Levels and Related Proteins in Rats with Scapulohumeral Periarthritis |
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YAN Chao1, XU Nuo2, WANG Aidi1, SONG Yanqi1, LIU Baoshan1
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1.Tianjin Medical University General Hospital, Tianjin 300193, China;2.Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
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| Abstract: |
| [Objective] To observe the improvement of shoulder joint range of motion and the expression levels of inflammatory factors（TNF-α，IL-1α/β）and TGF-β protein in joint capsule effusion of frozen shoulder（FS）model rats treated with combined therapy，and to explore the mechanism of rapid needling at trigger points of the subscapularis muscle in the treatment of FS. [Methods] Twelve week old male SD rats were selected，and FS models were established by surgical immobilization. The rats were randomly divided into a blank group，a model group，a traditional acupuncture group，a rapid trigger point needling group，and a combined treatment group. After intervention，the shoulder joint range of motion（abduction angle，external rotation angle） was measured. HE staining was used to observe morphological changes of the shoulder joint. The levels of inflammatory factors such as TNF-α in joint capsule effusion were determined by ELISA. The expression level of TGF-β protein in rat shoulder joint tissues was detected by Western blot. [Results] Compared with the blank group，the affected shoulder joint range of motion of rats in the model group was significantly restricted（P<0.000 1）. After continuous application of different treatment regimens，the joint range of motion improved to varying degrees，with the most significant efficacy observed in the combined treatment group. HE staining results showed that the model group exhibited obvious disorganization of tendon fiber structure，synovial tissue thickening，increased capillaries，and inflammatory cell infiltration. After intervention，all treatment groups showed significant improvement in histopathological changes，especially in the combined treatment group. Compared with the blank group，the levels of inflammatory factors TNFα，IL1α/β，and TGFβ in shoulder joint cavity fluid of rats in the model group were significantly elevated（P<0.001）. Compared with the model group，the levels of inflammatory factors in the treatment groups were significantly reduced. Moreover，compared with the traditional acupuncture group and rapid trigger point needling group，the levels of TNF-α，IL-1α/β，and TGF-β in the combined treatment group were further reduced（P<0.05）. Compared with the blank group，the TGF-β protein level in the model group was significantly elevated（P<0.001）. Compared with the model group，the TGF-β protein levels in the treatment groups were significantly reduced，with the combined treatment group showing the most significant reduction（P<0.05）. [Conclusion] The combined treatment can effectively improve the joint range of motion and pathological state of FS model rats，and reduce the expression levels of inflammatory factors such as TNF-α and TGF-β protein，demonstrating good therapeutic effects on the rat model of frozen shoulder. |
| Key words: rapid needling at trigger point frozen shoulder joint range of motion histomorphology cytokines |
