温针灸联合麦肯基疗法治疗海军舰艇官兵腰椎间盘突出症的疗效观察
|
摘要
目的探讨应用温针灸联合麦肯基疗法治疗海军舰艇官兵腰椎间盘突出症的临床疗效。方法选取2015年2月至2017年2月于海军军医大学附属长海医院就诊的患腰椎间盘突出症的海军舰艇官兵105例为研究对象,所有研究对象按随机数表法随机分为温针灸组、麦肯基组、联合治疗组,每组各35例。温针灸组采用温针灸疗法,麦肯基组采用麦肯基疗法,联合治疗组采用温针灸联合麦肯基疗法。采用视觉模拟评分法(visual analogue scale,VAS)、改良的MacNab疗效评定标准对3组患者治疗前、治疗1个月后临床症状改善评分及疗效进行分析比较,治疗结束6个月后对各组患者腰痛复发情况进行随访调查。结果治疗1个月后,联合治疗组VAS评分(1.74±0.82)分较温针灸组(3.57±1.75)分、麦肯基组(3.80±1.35)分明显降低,差异有统计学意义(P<0.05)。治疗1个月后,联合治疗组优良率(88.57%)明显高于温针灸组(74.29%)、麦肯基组(62.86%),差异有统计学意义(P<0.05)。治疗6个月后,随访取得联系的共100人,联合治疗组复发率(11.76%)明显低于温针灸组(39.40%)、麦肯基组(33.33%),差异有统计学意义(P<0.05)结论温针灸联合麦肯基疗法治疗腰椎间盘突出症的疗效明显优于温针灸、麦肯基疗法,该方法提高了治疗优良率、降低了复发率,值得在海军舰艇官兵中推广。
Objective To investigate the therapeutic effects of warm acupuncture combined with McKenzie therapy on prolapse of lumbar intervertebral disc among naval afloat personnel.Methods One hundred and five afloat naval patients with prolapse of lumbar intervertebral disc, who received medical care in Changhai Hospital from February, 2015 to February, 2017, were enrolled as study subjects. The patients were randomly divided into the warm acupuncture group, the McKenzie therapy group and the combination therapy group, each consisting of 35 patients. The warm acupuncture group was treated with warm acupuncture, the McKenzie therapy group received McKenzie therapy, and the combination therapy group was treated with warm acupuncture combined with McKenzie therapy. Visual analogue scale(VAS) and modified MacNab evaluation criteria were used to evaluate and compare improvement of clinical symptoms and therapeutic efficacy in the patients of the 3 groups, before therapy and one month after therapy. Six months after treatment, the rate of recurrence of lower back pain was investigated through medical follow-ups.Results After one month of treatment, the VAS scores(1.74±0.82) for the combination therapy group were obviously lower than those for the warm acupuncture group(3.57±1.75)and the McKenzie therapy group(3.80±1.35). Statistical significance could be noticed when comparisons were made between them(P<0.05).Excellent rate of the combination therapy group was 88.57%, which was significantly higher than those of the warm acupuncture group and the McKenzie therapy group, with statistical significance(P<0.05). Six months after treatment, the recurrent rates of lower back pain among 100 patients with medical follow-up were respectively 39.40%, 33.33% and 11.76%. The recurrent rates of warm acupuncture combined with McKenzie therapy(11.76%)was obviously lower than that of simple warm acupuncture therapy(39.40%) and McKenzie therapy(33.33%), also with statistical significance(P<0.05).Conclusion Clinical efficacy of warm acupuncture combed with McKenzie therapy in the treatment of prolapse of lumbar intervertebral disc is obviously superior to simple warm acupuncture and McKenzie therapy. This treatment method has the advantages of increasing excellent rate and reducing recurrence rate, which is worth popularization among naval afloat personnel.
Objective To investigate the therapeutic effects of warm acupuncture combined with McKenzie therapy on prolapse of lumbar intervertebral disc among naval afloat personnel.Methods One hundred and five afloat naval patients with prolapse of lumbar intervertebral disc, who received medical care in Changhai Hospital from February, 2015 to February, 2017, were enrolled as study subjects. The patients were randomly divided into the warm acupuncture group, the McKenzie therapy group and the combination therapy group, each consisting of 35 patients. The warm acupuncture group was treated with warm acupuncture, the McKenzie therapy group received McKenzie therapy, and the combination therapy group was treated with warm acupuncture combined with McKenzie therapy. Visual analogue scale(VAS) and modified MacNab evaluation criteria were used to evaluate and compare improvement of clinical symptoms and therapeutic efficacy in the patients of the 3 groups, before therapy and one month after therapy. Six months after treatment, the rate of recurrence of lower back pain was investigated through medical follow-ups.Results After one month of treatment, the VAS scores(1.74±0.82) for the combination therapy group were obviously lower than those for the warm acupuncture group(3.57±1.75)and the McKenzie therapy group(3.80±1.35). Statistical significance could be noticed when comparisons were made between them(P<0.05).Excellent rate of the combination therapy group was 88.57%, which was significantly higher than those of the warm acupuncture group and the McKenzie therapy group, with statistical significance(P<0.05). Six months after treatment, the recurrent rates of lower back pain among 100 patients with medical follow-up were respectively 39.40%, 33.33% and 11.76%. The recurrent rates of warm acupuncture combined with McKenzie therapy(11.76%)was obviously lower than that of simple warm acupuncture therapy(39.40%) and McKenzie therapy(33.33%), also with statistical significance(P<0.05).Conclusion Clinical efficacy of warm acupuncture combed with McKenzie therapy in the treatment of prolapse of lumbar intervertebral disc is obviously superior to simple warm acupuncture and McKenzie therapy. This treatment method has the advantages of increasing excellent rate and reducing recurrence rate, which is worth popularization among naval afloat personnel.
引文
[1] 王蔚文.临床疾病诊断与疗效判断标准实用全书[M].北京:人民卫生出版社,2010:396.
[2] Robin M, Craig K.7 Steps to a pain-free life[M].New York:Penguin Putnam Inc,2000:98-111.
[3] 于清丽. 温针灸结合推拿治疗腰间盘突出症疗效观察[J]. 辽宁中医杂志, 2008, 35(4):594-595.DOI:10.3969/j.issn.1000-1719.2008.04.071.
[4] 萧伟成. 麦肯基疗法自我治疗腰椎间盘突出症疗效分析[J]. 中国医药指南, 2013(12):222-223.DOI:10.3969/j.issn.1671-8194.2013.12.170.
[5] Ari V, Taina P, Tarja K, et al. How to ask about patient satisfaction: the visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale[J]. J Adv Nurs,2016,72(4):946-957.DOI:10.1111/jan.12875.
[6] Macnab I. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients[J]. J Bone Joint Surg: Am Vol.1971,53(5):891-903.
[7] Onofri E, Salesi M, Massoni F, et al. Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships[J]. La Clinica Terapeutica,2012,163(5):e365-e371.DOI:10.1586/ERI.12.88.
[8] 李国,宫峰,钱海平,等.椎间孔镜微创治疗舰艇官兵腰椎间盘突出症的疗效观察[J].中华航海医学与高气压医学杂志,2017,24(2):100-102.DOI:10.3760/cma.j.issn.1009-6906.2017.02.005.
[9] 任东风,谭小云,吴闻文,等.海军某部舰艇官兵腰痛流行病学调查[J].中国骨与关节杂志,2014,(4):251-253.DOI:10.3969/j.issn.2095-252X.2014.04.002.
[10] 郭会卿.针刺腰夹脊穴治疗腰椎间盘突出症的疗效观察[J].针灸临床杂志,2006,22(11):14-15. DOI:10.3969/j.issn.1005-0779.2006.11.010.
[11] 宋明霞,沈友虎,胡长顺.温针灸治疗腰椎间盘突出症临床疗效观察[J].中国中医急症,2016,25(2):326-328. DOI:10.3969/j.issn.1004-745X.2016.02.048.
[12] 魏宏强.麦肯基疗法配合针灸推拿治疗腰椎间盘突出症伴横突综合征的临床疗效观察[J].中国医药指南,2013, 26(1):80-81.DOI:10.3969/j.issn.1671-8194.2013.26.053.
[13] Hasanpour-Dehkordi A, Dehghani A, Solati K. A comparison of the effects of pilates and McKenzie training on pain and general health in men with chronic low back pain: a randomized trial[J]. Indian J Palliative Care, 2017, 23(1):36.DOI:10.4103/0973-1075.197945.
[14] Waqqar S, Shakilurrehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain[J]. Pakistan J Med Sci, 2016, 32(2):476-479.DOI:10.12669/pjms.322.9127.
[15] Gulsah K, Sevgi H. The effect of low back pain on the daily activities of patients with lumbar disc herniation: a Turkish military hospital experience.[J].J Am Associ Neurosci Nur,2012,44(2):98-104.DOI:10.1097/JNN.0b013e3182478e57.
[16] Garcia AN, Costa LDCM, Hancock MJ, et al. Efficacy of the McKenzie method in patients with chronic nonspecific low back pain: a protocol of randomized placebo-controlled trial[J]. Physical Therapy, 2015, 95(2):267-273.DOI:10.2522/ptj.20140208.
[2] Robin M, Craig K.7 Steps to a pain-free life[M].New York:Penguin Putnam Inc,2000:98-111.
[3] 于清丽. 温针灸结合推拿治疗腰间盘突出症疗效观察[J]. 辽宁中医杂志, 2008, 35(4):594-595.DOI:10.3969/j.issn.1000-1719.2008.04.071.
[4] 萧伟成. 麦肯基疗法自我治疗腰椎间盘突出症疗效分析[J]. 中国医药指南, 2013(12):222-223.DOI:10.3969/j.issn.1671-8194.2013.12.170.
[5] Ari V, Taina P, Tarja K, et al. How to ask about patient satisfaction: the visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale[J]. J Adv Nurs,2016,72(4):946-957.DOI:10.1111/jan.12875.
[6] Macnab I. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients[J]. J Bone Joint Surg: Am Vol.1971,53(5):891-903.
[7] Onofri E, Salesi M, Massoni F, et al. Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships[J]. La Clinica Terapeutica,2012,163(5):e365-e371.DOI:10.1586/ERI.12.88.
[8] 李国,宫峰,钱海平,等.椎间孔镜微创治疗舰艇官兵腰椎间盘突出症的疗效观察[J].中华航海医学与高气压医学杂志,2017,24(2):100-102.DOI:10.3760/cma.j.issn.1009-6906.2017.02.005.
[9] 任东风,谭小云,吴闻文,等.海军某部舰艇官兵腰痛流行病学调查[J].中国骨与关节杂志,2014,(4):251-253.DOI:10.3969/j.issn.2095-252X.2014.04.002.
[10] 郭会卿.针刺腰夹脊穴治疗腰椎间盘突出症的疗效观察[J].针灸临床杂志,2006,22(11):14-15. DOI:10.3969/j.issn.1005-0779.2006.11.010.
[11] 宋明霞,沈友虎,胡长顺.温针灸治疗腰椎间盘突出症临床疗效观察[J].中国中医急症,2016,25(2):326-328. DOI:10.3969/j.issn.1004-745X.2016.02.048.
[12] 魏宏强.麦肯基疗法配合针灸推拿治疗腰椎间盘突出症伴横突综合征的临床疗效观察[J].中国医药指南,2013, 26(1):80-81.DOI:10.3969/j.issn.1671-8194.2013.26.053.
[13] Hasanpour-Dehkordi A, Dehghani A, Solati K. A comparison of the effects of pilates and McKenzie training on pain and general health in men with chronic low back pain: a randomized trial[J]. Indian J Palliative Care, 2017, 23(1):36.DOI:10.4103/0973-1075.197945.
[14] Waqqar S, Shakilurrehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain[J]. Pakistan J Med Sci, 2016, 32(2):476-479.DOI:10.12669/pjms.322.9127.
[15] Gulsah K, Sevgi H. The effect of low back pain on the daily activities of patients with lumbar disc herniation: a Turkish military hospital experience.[J].J Am Associ Neurosci Nur,2012,44(2):98-104.DOI:10.1097/JNN.0b013e3182478e57.
[16] Garcia AN, Costa LDCM, Hancock MJ, et al. Efficacy of the McKenzie method in patients with chronic nonspecific low back pain: a protocol of randomized placebo-controlled trial[J]. Physical Therapy, 2015, 95(2):267-273.DOI:10.2522/ptj.20140208.