薄氏腹针治疗腰椎间盘突出症的临床研究
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摘要
背景：
腰椎间盘突出症是临床的常见病、多发病,约占下腰痛患者的20%左右。本病是因椎间盘变性,纤维环破裂,髓核突出刺激或压迫神经根、马尾神经所表现的一种综合征,腰4-5、腰5-骶1间隙发病率最高,临床以腰背痛和下肢放射痛为典型症状,多见于25-55岁。
治疗腰椎间盘突出症的方法包括保守治疗和手术治疗,以保守治疗为主,80%的病人可经硬膜外注射、牵引、针灸、推拿等西医或中医保守治疗方法得到症状缓解,甚至痊愈。针灸作为中医学的重要组成部分,因其简、便、廉、效等特点,已在临床上广泛运用。随着社会的不断发展,人们的物质精神需求也越高,在疾病的治疗过程中,不但希望能治愈,更希望预后能有高的生活质量。我们发现腹针疗法因其安全、无痛、高效、快捷、适应证广等优点脱颖而出,深受大家喜欢。
但是,腰椎间盘突出症的治疗效果还不十分满意,其复发率也在逐年增加,故临床上还在继续寻找治疗本病的优化方案。
基于此,本课题开展了薄氏腹针治疗腰椎间盘突出症的临床研究,主要探讨腹针疗法治疗本病的临床疗效和生存质量改善情况,为腹针治疗腰椎间盘突出症的有效性提供了临床证据,为非手术治疗腰椎间盘突出症优化方案的制定提供了选择依据。
目的：
1.通过文献研究,系统归纳总结西医学和中医学对腰椎间盘突出症(腰痛)疾病范畴、流行病学特征、病理生理学机制、病因病机、临床诊断和治疗的研究概况。
2.通过开展薄氏腹针治疗腰椎间盘突出症的临床研究,分别采用薄氏腹针疗法和以督脉、足太阳膀胱经腧穴为主的常规针刺疗法两种针刺方案治疗腰椎间盘突出症患者,观察两者临床疗效的差异。
3.观察两种治疗方案对腰椎间盘突出症相关临床症状、体征的改善情况。
4.观察两种治疗方案对腰椎间盘突出症疼痛症状的改善情况。
5.观察两种治疗方案对患者生存质量的改善情况。
6.为临床防治腰椎间盘突出症提供指导和参考,探索一种简、便、廉、效的优化治疗方案。
方法：
1.文献研究：通过检索中国期刊全文数据库(CNKI,包库)、维普中文期刊数据库(VIP)、万方学术期刊全文数据库(含中华医学会期刊)以及pubmed等中外数据库,收集相关文献,归纳总结中医、西医对腰椎间盘突出症的认识、研究及诊疗进展。
2.临床研究：严格按照诊断标准、纳入标准和排除标准收集腰椎间盘突出症病例70例,随机分为2组,每组35例。治疗组运用薄氏腹针疗法,穴位组合以水分、气海、关元为主穴,并随症加减；对照组采用常规针刺治疗,以督脉和足太阳膀胱经腧穴为主,如委中、脊中、腰阳关、肾俞、大肠俞等,配合局部阿是穴,并随症加减。每日1次,连续治疗6次为1个疗程,2个疗程之间间隔1天,观察周期为3个疗程。分别于治疗前和治疗后1、2、3周采用日本骨伤学会(JOA)下腰痛评分表、简化的麦吉儿疼痛问卷表(SF-MPQ)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)进行客观地综合测评,所得数据由专人处理,并用SPSS13.0统计软件分析。
结果：
1.基线指标比较结果：治疗组和对照组患者在性别构成、年龄和病程方面没有显著差异(P>0.05),两组间具有可比性。
2.JOA下腰痛评分结果：
(1)主观症状评分比较：组内比较得知,治疗后各时间点,每组患者的腰痛、下肢痛及麻木、步行功能评分均显著优于治疗前(P<0.05)。组间比较得知,两组患者治疗前各主观症状评分均没有显著差异(P>0.05)；治疗后1、2周,治疗组腰疼、步行能力评分均显著高于对照组(P<0.05),而两者的下肢疼痛、麻木评分没有显著差异(P>0.05)；治疗后3周治疗组患者腰痛、下肢疼痛及麻木评分显著优于对照组(P<0.05),而两组步行能力大部分患者的评分为3分(最高分),但没有显著差异(P>0.05)。
(2)体征评分比较：组内比较得知,治疗后1、2、3周,治疗组患者的感觉障碍、运动障碍、直腿抬高情况均较治疗前有显著改善(P<0.05)；对照组治疗后1周,各体征与治疗前相比无显著差异,但治疗后2、3周,各体征评分均较治疗前有显著改善(P<0.05)。组间比较得知,治疗前、治疗后1、2、3周治疗组患者的各体征评分均显著高于对照组(P<0.05)；进一步统计发现,治疗组治疗后2、3周感觉障碍的改善程度均明显高于对照组(P<0.05),其它各指标的改善程度在两组患者之间无显著差异。
(3)日常生活评分比较：组内比较得知,治疗后1、2、3周,每组患者各项日常生活评分均有一定程度的改善,显著优于治疗前(P<0.001)。组间比较得知,治疗前治疗组洗漱、坐1h评分显著高于对照组(P<0.05),其它项两组间无显著差异；治疗后1、2、3周,治疗组的洗漱、身体前倾、举持重物等日常生活评分均显著高于对照组(P<0.05),而卧位翻身、站立、坐1h评分两组间均无显著差异；治疗后1周治疗组的行走评分显著高于对照组(P<0.05),但治疗后2周,该项评分在两组之间已无显著差异。
(4)膀胱功能评分比较：70例患者治疗前以及治疗后1、2、3周膀胱功能评分均为0分,说明纳入的患者中无膀胱功能障碍者,同时说明这两种治疗方法均对膀胱功能没有影响。
(5)JOA,总分比较：组内比较得知,治疗后1、2、3周两组患者JOA各项总评分与治疗前比较均存在显著差异(P<0.05)；进一步计算发现,随时间延长,各总评分显著上升(P<0.05)。组间比较得知,治疗前治疗组患者的体征总分和JOA,总评分均显著高于对照组(P<0.001),两组患者主观症状总分以及日常生活总分没有显著差异(P>0.05)；治疗后1、2、3周治疗组的主观症状总分、体征总分、日常生活总分和JOA,总分均显著高于对照组(P<0.05)。
3.临床疗效比较结果：
临床疗效根据JOA评分计算,治疗后1周一2周治疗组的有效率显著高于对照组(P<0.05),但治疗后3周两组患者的有效率没有显著差异(P>0.05)。进一步将疗效分成四个等级统计后发现,治疗组的疗效在治疗后1、2周均显著优于对照组(P<0.05),治疗2周后开始患者的有效率已达100%,治疗3周后治疗组患者的痊愈率达到77.1%,较对照组高28.5%,治疗组总的疗效优于对照组(P<0.05)。
4. SF-MPQ评分结果：
组内比较得知,每组患者治疗后1、2、3周各指标评分均有显著改善,且随时间延长,评分显著下降(P<0.05)。组间比较得知,治疗前两组患者各评分均没有显著差异(P>0.05)；治疗后1周,治疗组的PRI感觉评分、PRI总分和VAS评分均显著低于对照组,而两组的PRI情感评分、PPI评分没有显著差异；治疗后2周,两组患者除PRI情感评分之外,其它评分治疗组均显著低于对照组(P<0.05)；治疗后3周,治疗组所有指标评分均显著低于对照组(P<0.05)。
5. WHOQOL-BREF评分结果：
组内比较得知,除了对照组治疗后1周社会领域评分和治疗前相比没有显著差异,每组患者治疗后三个时间点的总的生存质量、总的健康状况生理、心理、社会、环境领域评分以及总评分均显著高于治疗前(P<0.05)；治疗后三个时间点之间,除了治疗组和对照组治疗后3周环境领域评分和治疗后2周相比没有显著差异,其他各个指标任何两个时间点之间均有显著差异,且随着疗程的延长,各项评分均显著增大(P<0.05)。组间比较得知,治疗前两组患者各项评分均无显著差异(P>0.05)；治疗后1、2周治疗组患者各项评分及总评分均显著高于对照组(P<0.05)；治疗后3周,除环境领域评分没差异之外,治疗组总的生存质量、总的健康状况、生理、心理、社会领域以及总评分均显著高于对照组(P<0.05)。
6.不良反应发生情况：
治疗组和对照组均发生不良事件,如进针感痛、出针出血、血肿、弯针、晕针等,治疗组的不良事件少于对照组。
结论：
本课题以腰椎间盘突出症患者作为研究对象,采用薄氏腹针治疗,并与常规针刺治疗作为对照,采用JOA下腰痛评分表、SF-MPQ、WHOQOL-BREF和不良反应的发生情况进行客观地综合测评,观察腹针疗法治疗本病的临床疗效和生存质量改善情况。
通过数据处理、分析可知：第一,腹针治疗和常规针刺治疗均能有效改善腰椎间盘突出症患者的临床症状和体征以及患者的生存质量；第二,腹针治疗的总改善率明显优于常规针刺治疗,在治疗2周后即出现100%的有效率,在治疗3周后所有患者疗效明显甚至治愈,且不良事件发生少,未出现晕针等较严重的不良反应；第三,腹针治疗的患者在治疗3周后,总的生存质量情况显著高于常规针刺的患者。表明薄氏腹针是一种值得临床推广应用的治疗方法。
本课题仍存在一些不足之处：第一,穴位定位(尤其是腹穴定位)、针刺手法差异、量表评价等方面应进一步规范化；第二,今后的研究中应扩大样本量；第三,进一步行重复、随机、对照研究；第四,探讨腹针疗法作用机制。
Background:
The lumbar intervertebral disc herniation that is definded as a kind of syndroma associated with nerve root and cauda equina compressed by the lumbar disc degeneration, the annulus fibrosis disruption and the nucleus pulposus herniation is a frequent source of low back pain, approximately as many as20%of people. The most common site of disc herniation is at the L4-5and L5-S1interspace. The tipical symptom of this disorder is the patient's back pain often localized to the lower back and gluteal area and the backleg pain which radiates down the leg, particularly below the level of the knee. The group most commonly affected is adults aged25-55years.
There are two kinds of therapeutic methods for patients with the lumbar intervertebral disc herniation. One is surgical treatment, the other is conservative treatment. As many as80%of patients have resolution of their symptoms with conservative treatment, such as epidural injection, lumbar traction, acupuncture and moxibustion, manipulation and so on. Acupuncture and moxibustion as an important part of traditional Chinese medicine(TCM) has won worldwide popularity for its advantages of simplicity, convenience, low cost and efficacy. With the development of social, material and spiritual needs of people is getting higher and higher. Everybody wants not only a good healing, but the good quality of life(QOL). We find that abdominal acupuncture is widely used in clinical because it is safe, painleess, efficient, suitable and so forth.
But the treatment of the lumbar intervertebral disc herniation is not so satisfied, and the recurrence rate is high, so scholars is trying their best to find a better therapeutic regimen.
Based on this, we have studied on the lumbar intervertebral disc herniation patients treated with abdominal acupuncture to observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.
Objective:
1. To sum up all the literatures about the lumbar intervertebral disc herniation to analyse its category, epidemiological characterstics, pathophysiological mechanisms, pathogenesis, clinical diagnosis and treatment both of Western medicine and TCM.
2. To investigate the clinical effect via comparing and analysing abdominal acupuncture and routine acupuncture treating the lumbar intervertebral disc herniation.
3. To observe the improvement of symptoms and signs of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.
4. To observe the improvement of back pain or backleg pain of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.
5. To observe the improvement of the QOL of the lumbar intervertebral disc herniation patients via comparing and analysing abdominal acupuncture and routine acupuncture.
6. To find a better therapeutic regimen for treating the lumbar intervertebral disc herniation in clinic.
Methods:
1. Literature research: Sift out literatures about the lumbar intervertebral disc herniation through searching several databases, such as the CJFD, the VIP, the pubmed and so on. And conclude the development of this disorders in both Western medicine and TCM.
2. Clinical research:70cases of lumbar intervertebral disc herniation patients gathering strictly according to the inclusion criteria and the exclusion criteria were randomly divided into2groups. One was the treatment group including35patients taking abdominal acupuncture, the other was the control group, also including35patients taking routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF before and after the treatment of1,2and3weeks. All data analyses were performed using SPSS13.0.
Results:
1. the result of the two groups'baseline index:
There were no significant differences from the gender composition, aging and course of disease between the two groups (P>0.05), so other indexes of the two groups could be compared.
2. the result of JOA scores:
(1) the result of symptoms scores of JOA:After the treatment of1,2and3weeks, the two groups'symptoms scores, including back pain score, backleg pain and numbness score and walking function score were significantly improved versus before treatment (P<0.05). Before treating, there were no significant differences from symptoms scores between the two groups (P>0.05). After1and2weeks, the scores about back pain and walking function of the treatment group were significantly improved versus the control group (P<0.05), except the backleg pain and numbness score. After3weeks'treatment, the scores about back pain and backleg pain and numbness were significantly improved versus the control group (P<0.05), except the walking function score which was almost arrived at the high score (3point) in the two groups (P>0.05).
(2) the result of signs scores of JOA:After the treatment of1,2and3weeks, the treatment group's signs scores, including sensory disturbance score, dyskinesia score and straight leg raising test score were significantly improved versus before treatment (P<0.05); the control group was failed to find any statistical superiority of any signs scores until treating2and3weeks. Not only before but after every week's treatment, the scores of all the signs of the treatment group were significantly improved versus the control group (P<0.05). Only the sensory disturbance score of the treatment group at2and3weeks was significantly improved versus the other group through further computing (P<0.05).
(3) the result of normal activities scores of JOA:After the treatment of1,2and3weeks, the two groups'normal activities scores, including rolling over from supine position score, standing score, washing face and brushing teeth score, leaning forward score, sitting for1hour score, lifting heavy object score and walking score was significantly improved versus before treatment (P<0.001). Before treating, the normal activities scores only about washing face and brushing teeth and sitting for1hour of the treatment group were significantly improved versus the control group (P <0.05). After1,2and3weeks'treating, only washing face and brushing teeth score, leaning forward score and lifting heavy object score were significantly improved versus the control group (P<0.05), besides the walking score was significantly improved after1week but not2weeks or3ones.
(4) the result of bladder function score of JOA:There was no bladder dysfunction berore or after treating in the two groups. That was to say neither abdominal acupuncture nor routine one would cause bladder dysfunction.
(5) the result of the total JOA scores:After the treatment of1,2and3weeks, the two groups'total JOA scores including symptoms scores, signs scores, normal activities scores and bladder function score were significantly improved versus before treatment (P<0.05). What's more, with time going, the total JOA scores becomed higher and higher. Before treating, signs scores and the total JOA scores of the treatment group were significantly improved versus the control group (P<0.001), except symptoms scores and normal activities scores. After1,2and3weeks' treating, the total JOA scores of the treatment group were significantly improved versus the other one (P<0.05).
3. the result of the clinical effect:
The total effective rate of the treatment group at1st and2nd week were significantly higher versus the control group(P<0.05). But at3rd week, there is no significant differences between them. By further computing, we known that the clinical effect at1st and2nd week were significantly improved versus the control group(P<0.05). After2weeks'treating, the total effective rate of the treatment group was arriving at100%with the total cure rate of77.1%which was28.5%higher than that of the control group after3weeks'treating.
4. the result of the short-form of McGill pain questionnaire (SF-MPQ) scores:
After the treatment of1,2and3weeks, the two groups'SF-MPQ scores were significantly improved versus before treatment (P<0.05). What's more, with time going, SF-MPQ scores becomed lower and lower. Before treating, there were no significant differences from SF-MPQ scores between the two groups (P>0.05). After1week, the sense score of the pain rating index (PRI), the PRI score and the visual analogue scale(VAS) score, excluding emotion score of PRI and the present pain Intenstty (PPI) score, of the treatment group were significantly lower than that of the control group (P<0.05). After2weeks, almost all SF-MPQ scores were significantly lower than that of the control group (P<0.05), except emotion score of PRI. Until3weeks later, all SF-MPQ scores of the treatment group were significantly lower than that of the control group (P<0.05).
5. the result of the QOL scores:
After the treatment of1,2and3weeks, the two groups'QOL scores, including the whole QOL score, the whole health status score, physiology score, psychology score and environ score were significantly improved versus before treatment (P<0.05), except communication score. By further computing, there were significant differences from almost all the QOL scores between two time points (P<0.05) which were becoming higher and higher with time going, but not the environ score at3rd week versus2nd week.
Before treating, there were no significant differences from QOL scores between the two groups (P>0.05). After1and2weeks' treating, all the QOL scores of the treatment were significantly higher than that of the control group (P<0.05). After3weeks, excluding environ score, other scores of the treatment were significantly higher than that of the control group too(P<0.05).
6. the result of the adverse reactions:
There were some adverse reactions, such as pain when needling, bleeding when removing the needles, haematoma, banding needle or feeling faints when needling both in the two groups, but there were less adverse reactions of the treatment group than that of the control group.
Conclusions:
In the study, we take into lumbar intervertebral disc herniation patients treating with abdominal acupuncture, comparing with other patients who received routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF. To observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.
According to the data analyses, firstly, we have found that both abdominal acupuncture and routine acupunture can effectively improve the clinical effect of the patients with the lumbar intervertebral disc herniation. Secondly, there is a more telling advantage about total effect of abdominal acupuncture than that of routine acupuncture, while after2weeks, the total effective rate of abdominal acupuncture was arriving at100%; after3weeks, the total cure rate of77.1%of abdominal acupuncture was28.5%higher than that of routine acupuncture. Thirdly, the QOL of the abdominal group is better than the other one. Finaly, there are less adverse reactions of abdominal acupuncture. Overall, abdominal acupuncture is one of treatment which is worth clinical using.
But there are still some weakness in our clinical research, for example, the position of points, the way of needling, the selecting of measuring scale and questionnaire. In the future, we could mending our weakness above, enlarge the sample size and take a further study on mechanism of abdominal acupuncture treating the lumbar intervertebral disc herniation.
腰椎间盘突出症是临床的常见病、多发病,约占下腰痛患者的20%左右。本病是因椎间盘变性,纤维环破裂,髓核突出刺激或压迫神经根、马尾神经所表现的一种综合征,腰4-5、腰5-骶1间隙发病率最高,临床以腰背痛和下肢放射痛为典型症状,多见于25-55岁。
治疗腰椎间盘突出症的方法包括保守治疗和手术治疗,以保守治疗为主,80%的病人可经硬膜外注射、牵引、针灸、推拿等西医或中医保守治疗方法得到症状缓解,甚至痊愈。针灸作为中医学的重要组成部分,因其简、便、廉、效等特点,已在临床上广泛运用。随着社会的不断发展,人们的物质精神需求也越高,在疾病的治疗过程中,不但希望能治愈,更希望预后能有高的生活质量。我们发现腹针疗法因其安全、无痛、高效、快捷、适应证广等优点脱颖而出,深受大家喜欢。
但是,腰椎间盘突出症的治疗效果还不十分满意,其复发率也在逐年增加,故临床上还在继续寻找治疗本病的优化方案。
基于此,本课题开展了薄氏腹针治疗腰椎间盘突出症的临床研究,主要探讨腹针疗法治疗本病的临床疗效和生存质量改善情况,为腹针治疗腰椎间盘突出症的有效性提供了临床证据,为非手术治疗腰椎间盘突出症优化方案的制定提供了选择依据。
目的：
1.通过文献研究,系统归纳总结西医学和中医学对腰椎间盘突出症(腰痛)疾病范畴、流行病学特征、病理生理学机制、病因病机、临床诊断和治疗的研究概况。
2.通过开展薄氏腹针治疗腰椎间盘突出症的临床研究,分别采用薄氏腹针疗法和以督脉、足太阳膀胱经腧穴为主的常规针刺疗法两种针刺方案治疗腰椎间盘突出症患者,观察两者临床疗效的差异。
3.观察两种治疗方案对腰椎间盘突出症相关临床症状、体征的改善情况。
4.观察两种治疗方案对腰椎间盘突出症疼痛症状的改善情况。
5.观察两种治疗方案对患者生存质量的改善情况。
6.为临床防治腰椎间盘突出症提供指导和参考,探索一种简、便、廉、效的优化治疗方案。
方法：
1.文献研究：通过检索中国期刊全文数据库(CNKI,包库)、维普中文期刊数据库(VIP)、万方学术期刊全文数据库(含中华医学会期刊)以及pubmed等中外数据库,收集相关文献,归纳总结中医、西医对腰椎间盘突出症的认识、研究及诊疗进展。
2.临床研究：严格按照诊断标准、纳入标准和排除标准收集腰椎间盘突出症病例70例,随机分为2组,每组35例。治疗组运用薄氏腹针疗法,穴位组合以水分、气海、关元为主穴,并随症加减；对照组采用常规针刺治疗,以督脉和足太阳膀胱经腧穴为主,如委中、脊中、腰阳关、肾俞、大肠俞等,配合局部阿是穴,并随症加减。每日1次,连续治疗6次为1个疗程,2个疗程之间间隔1天,观察周期为3个疗程。分别于治疗前和治疗后1、2、3周采用日本骨伤学会(JOA)下腰痛评分表、简化的麦吉儿疼痛问卷表(SF-MPQ)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)进行客观地综合测评,所得数据由专人处理,并用SPSS13.0统计软件分析。
结果：
1.基线指标比较结果：治疗组和对照组患者在性别构成、年龄和病程方面没有显著差异(P>0.05),两组间具有可比性。
2.JOA下腰痛评分结果：
(1)主观症状评分比较：组内比较得知,治疗后各时间点,每组患者的腰痛、下肢痛及麻木、步行功能评分均显著优于治疗前(P<0.05)。组间比较得知,两组患者治疗前各主观症状评分均没有显著差异(P>0.05)；治疗后1、2周,治疗组腰疼、步行能力评分均显著高于对照组(P<0.05),而两者的下肢疼痛、麻木评分没有显著差异(P>0.05)；治疗后3周治疗组患者腰痛、下肢疼痛及麻木评分显著优于对照组(P<0.05),而两组步行能力大部分患者的评分为3分(最高分),但没有显著差异(P>0.05)。
(2)体征评分比较：组内比较得知,治疗后1、2、3周,治疗组患者的感觉障碍、运动障碍、直腿抬高情况均较治疗前有显著改善(P<0.05)；对照组治疗后1周,各体征与治疗前相比无显著差异,但治疗后2、3周,各体征评分均较治疗前有显著改善(P<0.05)。组间比较得知,治疗前、治疗后1、2、3周治疗组患者的各体征评分均显著高于对照组(P<0.05)；进一步统计发现,治疗组治疗后2、3周感觉障碍的改善程度均明显高于对照组(P<0.05),其它各指标的改善程度在两组患者之间无显著差异。
(3)日常生活评分比较：组内比较得知,治疗后1、2、3周,每组患者各项日常生活评分均有一定程度的改善,显著优于治疗前(P<0.001)。组间比较得知,治疗前治疗组洗漱、坐1h评分显著高于对照组(P<0.05),其它项两组间无显著差异；治疗后1、2、3周,治疗组的洗漱、身体前倾、举持重物等日常生活评分均显著高于对照组(P<0.05),而卧位翻身、站立、坐1h评分两组间均无显著差异；治疗后1周治疗组的行走评分显著高于对照组(P<0.05),但治疗后2周,该项评分在两组之间已无显著差异。
(4)膀胱功能评分比较：70例患者治疗前以及治疗后1、2、3周膀胱功能评分均为0分,说明纳入的患者中无膀胱功能障碍者,同时说明这两种治疗方法均对膀胱功能没有影响。
(5)JOA,总分比较：组内比较得知,治疗后1、2、3周两组患者JOA各项总评分与治疗前比较均存在显著差异(P<0.05)；进一步计算发现,随时间延长,各总评分显著上升(P<0.05)。组间比较得知,治疗前治疗组患者的体征总分和JOA,总评分均显著高于对照组(P<0.001),两组患者主观症状总分以及日常生活总分没有显著差异(P>0.05)；治疗后1、2、3周治疗组的主观症状总分、体征总分、日常生活总分和JOA,总分均显著高于对照组(P<0.05)。
3.临床疗效比较结果：
临床疗效根据JOA评分计算,治疗后1周一2周治疗组的有效率显著高于对照组(P<0.05),但治疗后3周两组患者的有效率没有显著差异(P>0.05)。进一步将疗效分成四个等级统计后发现,治疗组的疗效在治疗后1、2周均显著优于对照组(P<0.05),治疗2周后开始患者的有效率已达100%,治疗3周后治疗组患者的痊愈率达到77.1%,较对照组高28.5%,治疗组总的疗效优于对照组(P<0.05)。
4. SF-MPQ评分结果：
组内比较得知,每组患者治疗后1、2、3周各指标评分均有显著改善,且随时间延长,评分显著下降(P<0.05)。组间比较得知,治疗前两组患者各评分均没有显著差异(P>0.05)；治疗后1周,治疗组的PRI感觉评分、PRI总分和VAS评分均显著低于对照组,而两组的PRI情感评分、PPI评分没有显著差异；治疗后2周,两组患者除PRI情感评分之外,其它评分治疗组均显著低于对照组(P<0.05)；治疗后3周,治疗组所有指标评分均显著低于对照组(P<0.05)。
5. WHOQOL-BREF评分结果：
组内比较得知,除了对照组治疗后1周社会领域评分和治疗前相比没有显著差异,每组患者治疗后三个时间点的总的生存质量、总的健康状况生理、心理、社会、环境领域评分以及总评分均显著高于治疗前(P<0.05)；治疗后三个时间点之间,除了治疗组和对照组治疗后3周环境领域评分和治疗后2周相比没有显著差异,其他各个指标任何两个时间点之间均有显著差异,且随着疗程的延长,各项评分均显著增大(P<0.05)。组间比较得知,治疗前两组患者各项评分均无显著差异(P>0.05)；治疗后1、2周治疗组患者各项评分及总评分均显著高于对照组(P<0.05)；治疗后3周,除环境领域评分没差异之外,治疗组总的生存质量、总的健康状况、生理、心理、社会领域以及总评分均显著高于对照组(P<0.05)。
6.不良反应发生情况：
治疗组和对照组均发生不良事件,如进针感痛、出针出血、血肿、弯针、晕针等,治疗组的不良事件少于对照组。
结论：
本课题以腰椎间盘突出症患者作为研究对象,采用薄氏腹针治疗,并与常规针刺治疗作为对照,采用JOA下腰痛评分表、SF-MPQ、WHOQOL-BREF和不良反应的发生情况进行客观地综合测评,观察腹针疗法治疗本病的临床疗效和生存质量改善情况。
通过数据处理、分析可知：第一,腹针治疗和常规针刺治疗均能有效改善腰椎间盘突出症患者的临床症状和体征以及患者的生存质量；第二,腹针治疗的总改善率明显优于常规针刺治疗,在治疗2周后即出现100%的有效率,在治疗3周后所有患者疗效明显甚至治愈,且不良事件发生少,未出现晕针等较严重的不良反应；第三,腹针治疗的患者在治疗3周后,总的生存质量情况显著高于常规针刺的患者。表明薄氏腹针是一种值得临床推广应用的治疗方法。
本课题仍存在一些不足之处：第一,穴位定位(尤其是腹穴定位)、针刺手法差异、量表评价等方面应进一步规范化；第二,今后的研究中应扩大样本量；第三,进一步行重复、随机、对照研究；第四,探讨腹针疗法作用机制。
Background:
The lumbar intervertebral disc herniation that is definded as a kind of syndroma associated with nerve root and cauda equina compressed by the lumbar disc degeneration, the annulus fibrosis disruption and the nucleus pulposus herniation is a frequent source of low back pain, approximately as many as20%of people. The most common site of disc herniation is at the L4-5and L5-S1interspace. The tipical symptom of this disorder is the patient's back pain often localized to the lower back and gluteal area and the backleg pain which radiates down the leg, particularly below the level of the knee. The group most commonly affected is adults aged25-55years.
There are two kinds of therapeutic methods for patients with the lumbar intervertebral disc herniation. One is surgical treatment, the other is conservative treatment. As many as80%of patients have resolution of their symptoms with conservative treatment, such as epidural injection, lumbar traction, acupuncture and moxibustion, manipulation and so on. Acupuncture and moxibustion as an important part of traditional Chinese medicine(TCM) has won worldwide popularity for its advantages of simplicity, convenience, low cost and efficacy. With the development of social, material and spiritual needs of people is getting higher and higher. Everybody wants not only a good healing, but the good quality of life(QOL). We find that abdominal acupuncture is widely used in clinical because it is safe, painleess, efficient, suitable and so forth.
But the treatment of the lumbar intervertebral disc herniation is not so satisfied, and the recurrence rate is high, so scholars is trying their best to find a better therapeutic regimen.
Based on this, we have studied on the lumbar intervertebral disc herniation patients treated with abdominal acupuncture to observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.
Objective:
1. To sum up all the literatures about the lumbar intervertebral disc herniation to analyse its category, epidemiological characterstics, pathophysiological mechanisms, pathogenesis, clinical diagnosis and treatment both of Western medicine and TCM.
2. To investigate the clinical effect via comparing and analysing abdominal acupuncture and routine acupuncture treating the lumbar intervertebral disc herniation.
3. To observe the improvement of symptoms and signs of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.
4. To observe the improvement of back pain or backleg pain of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.
5. To observe the improvement of the QOL of the lumbar intervertebral disc herniation patients via comparing and analysing abdominal acupuncture and routine acupuncture.
6. To find a better therapeutic regimen for treating the lumbar intervertebral disc herniation in clinic.
Methods:
1. Literature research: Sift out literatures about the lumbar intervertebral disc herniation through searching several databases, such as the CJFD, the VIP, the pubmed and so on. And conclude the development of this disorders in both Western medicine and TCM.
2. Clinical research:70cases of lumbar intervertebral disc herniation patients gathering strictly according to the inclusion criteria and the exclusion criteria were randomly divided into2groups. One was the treatment group including35patients taking abdominal acupuncture, the other was the control group, also including35patients taking routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF before and after the treatment of1,2and3weeks. All data analyses were performed using SPSS13.0.
Results:
1. the result of the two groups'baseline index:
There were no significant differences from the gender composition, aging and course of disease between the two groups (P>0.05), so other indexes of the two groups could be compared.
2. the result of JOA scores:
(1) the result of symptoms scores of JOA:After the treatment of1,2and3weeks, the two groups'symptoms scores, including back pain score, backleg pain and numbness score and walking function score were significantly improved versus before treatment (P<0.05). Before treating, there were no significant differences from symptoms scores between the two groups (P>0.05). After1and2weeks, the scores about back pain and walking function of the treatment group were significantly improved versus the control group (P<0.05), except the backleg pain and numbness score. After3weeks'treatment, the scores about back pain and backleg pain and numbness were significantly improved versus the control group (P<0.05), except the walking function score which was almost arrived at the high score (3point) in the two groups (P>0.05).
(2) the result of signs scores of JOA:After the treatment of1,2and3weeks, the treatment group's signs scores, including sensory disturbance score, dyskinesia score and straight leg raising test score were significantly improved versus before treatment (P<0.05); the control group was failed to find any statistical superiority of any signs scores until treating2and3weeks. Not only before but after every week's treatment, the scores of all the signs of the treatment group were significantly improved versus the control group (P<0.05). Only the sensory disturbance score of the treatment group at2and3weeks was significantly improved versus the other group through further computing (P<0.05).
(3) the result of normal activities scores of JOA:After the treatment of1,2and3weeks, the two groups'normal activities scores, including rolling over from supine position score, standing score, washing face and brushing teeth score, leaning forward score, sitting for1hour score, lifting heavy object score and walking score was significantly improved versus before treatment (P<0.001). Before treating, the normal activities scores only about washing face and brushing teeth and sitting for1hour of the treatment group were significantly improved versus the control group (P <0.05). After1,2and3weeks'treating, only washing face and brushing teeth score, leaning forward score and lifting heavy object score were significantly improved versus the control group (P<0.05), besides the walking score was significantly improved after1week but not2weeks or3ones.
(4) the result of bladder function score of JOA:There was no bladder dysfunction berore or after treating in the two groups. That was to say neither abdominal acupuncture nor routine one would cause bladder dysfunction.
(5) the result of the total JOA scores:After the treatment of1,2and3weeks, the two groups'total JOA scores including symptoms scores, signs scores, normal activities scores and bladder function score were significantly improved versus before treatment (P<0.05). What's more, with time going, the total JOA scores becomed higher and higher. Before treating, signs scores and the total JOA scores of the treatment group were significantly improved versus the control group (P<0.001), except symptoms scores and normal activities scores. After1,2and3weeks' treating, the total JOA scores of the treatment group were significantly improved versus the other one (P<0.05).
3. the result of the clinical effect:
The total effective rate of the treatment group at1st and2nd week were significantly higher versus the control group(P<0.05). But at3rd week, there is no significant differences between them. By further computing, we known that the clinical effect at1st and2nd week were significantly improved versus the control group(P<0.05). After2weeks'treating, the total effective rate of the treatment group was arriving at100%with the total cure rate of77.1%which was28.5%higher than that of the control group after3weeks'treating.
4. the result of the short-form of McGill pain questionnaire (SF-MPQ) scores:
After the treatment of1,2and3weeks, the two groups'SF-MPQ scores were significantly improved versus before treatment (P<0.05). What's more, with time going, SF-MPQ scores becomed lower and lower. Before treating, there were no significant differences from SF-MPQ scores between the two groups (P>0.05). After1week, the sense score of the pain rating index (PRI), the PRI score and the visual analogue scale(VAS) score, excluding emotion score of PRI and the present pain Intenstty (PPI) score, of the treatment group were significantly lower than that of the control group (P<0.05). After2weeks, almost all SF-MPQ scores were significantly lower than that of the control group (P<0.05), except emotion score of PRI. Until3weeks later, all SF-MPQ scores of the treatment group were significantly lower than that of the control group (P<0.05).
5. the result of the QOL scores:
After the treatment of1,2and3weeks, the two groups'QOL scores, including the whole QOL score, the whole health status score, physiology score, psychology score and environ score were significantly improved versus before treatment (P<0.05), except communication score. By further computing, there were significant differences from almost all the QOL scores between two time points (P<0.05) which were becoming higher and higher with time going, but not the environ score at3rd week versus2nd week.
Before treating, there were no significant differences from QOL scores between the two groups (P>0.05). After1and2weeks' treating, all the QOL scores of the treatment were significantly higher than that of the control group (P<0.05). After3weeks, excluding environ score, other scores of the treatment were significantly higher than that of the control group too(P<0.05).
6. the result of the adverse reactions:
There were some adverse reactions, such as pain when needling, bleeding when removing the needles, haematoma, banding needle or feeling faints when needling both in the two groups, but there were less adverse reactions of the treatment group than that of the control group.
Conclusions:
In the study, we take into lumbar intervertebral disc herniation patients treating with abdominal acupuncture, comparing with other patients who received routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF. To observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.
According to the data analyses, firstly, we have found that both abdominal acupuncture and routine acupunture can effectively improve the clinical effect of the patients with the lumbar intervertebral disc herniation. Secondly, there is a more telling advantage about total effect of abdominal acupuncture than that of routine acupuncture, while after2weeks, the total effective rate of abdominal acupuncture was arriving at100%; after3weeks, the total cure rate of77.1%of abdominal acupuncture was28.5%higher than that of routine acupuncture. Thirdly, the QOL of the abdominal group is better than the other one. Finaly, there are less adverse reactions of abdominal acupuncture. Overall, abdominal acupuncture is one of treatment which is worth clinical using.
But there are still some weakness in our clinical research, for example, the position of points, the way of needling, the selecting of measuring scale and questionnaire. In the future, we could mending our weakness above, enlarge the sample size and take a further study on mechanism of abdominal acupuncture treating the lumbar intervertebral disc herniation.
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