经膀胱经腧穴透刺关节突关节温针灸治疗腰椎关节突关节源性腰痛的临床研究
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摘要
目的:观察经膀胱经腧穴透刺关节突关节温针灸治疗腰椎关节突关节源性腰痛的临床疗效和安全性。方法:将72例符合要求的腰椎关节突关节源性腰痛患者随机分为2组,每组36例。直刺组在患者L4、L5、S1椎体双侧上关节突与相应横突根部的交界点实施温针灸治疗,透刺组采用经双侧气海俞、大肠俞、关元俞向L4、L5、S1椎体同侧上关节突与相应横突根部交界点透刺温针灸治疗。2组的温针灸治疗均每天1次,10次为1个疗程,间隔7 d后进行下一疗程治疗,共治疗2个疗程。采用视觉模拟量表(visual analogue scale,VAS)评定患者的腰部疼痛情况,采用BCS-400背力计测定患者的腰背伸力,采用Oswestry功能障碍指数(Oswestry disability index,ODI)问卷表评定腰痛对患者日常生活的影响,同时观察患者试验期间的不良反应发生情况。结果:2组患者均完成试验,试验过程中均未出现不良反应。治疗前2组患者的腰痛VAS评分比较,差异无统计学意义(t=0.081,P=0.936);治疗结束后2组患者的腰痛VAS评分均较治疗前降低[(6.62±1.50)分,(3.18±1.09)分,t=7.635,P=0.000;(6.71±1.59)分,(2.10±1.13)分,t=12.875,P=0.001];治疗结束后直刺组的评分高于透刺组(t=5.473,P=0.008)。治疗前2组患者的腰背伸力比较,差异无统计学意义(t=0.253,P=0.880);治疗结束后2组患者的腰背伸力均较治疗前增大[(58.02±3.67)N,(64.64±5.23)N,t=11.771,P=0.000;(57.89±5.77)N,(67.17±4.46)N,t=8.005,P=0.000];治疗结束后直刺组的腰背伸力低于透刺组(t=-3.751,P=0.000)。治疗前2组患者的ODI比较,差异无统计学意义(t=1.240,P=0.287);治疗结束后2组患者的ODI均较治疗前降低[(68.45±13.67)%,(17.64±11.23)%,t=15.332,P=0.000;(69.19±12.77)%,(13.17±10.46)%,t=17.653,P=0.000];治疗结束后直刺组的ODI高于透刺组(t=-4.369,P=0.001)。结论:经膀胱经腧穴透刺关节突关节温针灸治疗和关节突关节温针灸治疗均能有效缓解腰椎关节突关节源性腰痛患者的腰部疼痛、增强患者的腰背伸力、改善腰部功能,且均有较高的安全性,但前者的疗效更好。
Objective:To observe the clinical curative effects and safety of acupuncture at zygapophysial joint with warmed needle that reaches there by penetrating acupoint of bladder meridian for treatment of low back pain originated from lumbar zygapophysial joints.Methods:Seventy-two patients with low back pain originated from lumbar zygapophysial joints enrolled in the study were randomly divided into straight acupuncture group and penetrating acupuncture group,36 cases in each group.The patients in straight acupuncture group were treated with acupuncture with warmed needles at the junction points of bilateral superior articular processes of L_4-S_1and corresponding roots of transverse processes,while the patients in penetrating acupuncture group were treated with acupuncture at the junction points of ipsilateral superior articular processes of L_4-S_1and corresponding roots of transverse processes with warmed needles that reached there by penetrating bilateral acupoints of Qihaishu(BL24),Dachangshu(BL25)and Guanyuanshu(BL26).The needle warming therapy was performed on patients once a day for 2 courses of treatment,10 times for each course with a 7-day rest-insertion between courses.The low back pain,the low back tensility and the effect of low back pain on daily living were evaluated by using visual analogue scale(VAS),BCS-400 back strength dynamometer and Oswestry disability index(ODI)questionnaires respectively,meanwhile,the adverse reactions were observed.Results:The clinical trial was finished successfully in all patients,and no adverse reactions were found in the 2 groups during the clinical trial.There was no statistical difference in the low back pain VAS scores between the 2 groups before the treatment(t=0.081,P=0.936).The low back pain VAS scores decreased after the end of the treatment compared to pretreatment in the 2 groups(6.62+/-1.50 vs 3.18+/-1.09 points,t=7.635,P=0.000;6.71+/-1.59 vs 2.10+/-1.13 points,t=12.875,P=0.001).The low back pain VAS scores were higher in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=5.473,P=0.008).There was no statistical difference in the low back tensility between the 2 groups before the treatment(t=0.253,P=0.880).The low back tensility increased after the end of the treatment compared to pretreatment in the 2 groups(58.02+/-3.67 vs64.64+/-5.23 N,t=11.771,P=0.000;57.89+/-5.77 vs 67.17+/-4.46 N,t=8.005,P=0.000).The low back tensility was lower in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=-3.751,P=0.000).There was no statistical difference in the ODI between the 2 groups before the treatment(t=1.240,P=0.287).The ODI decreased after the end of the treatment compared to pretreatment in the 2 groups(68.45+/-13.67 vs 17.64+/-11.23%,t=15.332,P=0.000;69.19+/-12.77vs 13.17+/-10.46%,t=17.653,P=0.000).The ODI was higher in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=-4.369,P=0.001).Conclusion:Both acupuncture at zygapophysial joint with warmed needle that reaches there by penetrating acupoint of bladder meridian and straight acupuncture at zygapophysial joint with warmed needle can effectively relieve low back pain,enhance low back tensility and improve low back function in patients with low back pain originated from lumbar zygapophysial joints,and they have high safety,however,the former surpasses the latter in curative effect.
Objective:To observe the clinical curative effects and safety of acupuncture at zygapophysial joint with warmed needle that reaches there by penetrating acupoint of bladder meridian for treatment of low back pain originated from lumbar zygapophysial joints.Methods:Seventy-two patients with low back pain originated from lumbar zygapophysial joints enrolled in the study were randomly divided into straight acupuncture group and penetrating acupuncture group,36 cases in each group.The patients in straight acupuncture group were treated with acupuncture with warmed needles at the junction points of bilateral superior articular processes of L_4-S_1and corresponding roots of transverse processes,while the patients in penetrating acupuncture group were treated with acupuncture at the junction points of ipsilateral superior articular processes of L_4-S_1and corresponding roots of transverse processes with warmed needles that reached there by penetrating bilateral acupoints of Qihaishu(BL24),Dachangshu(BL25)and Guanyuanshu(BL26).The needle warming therapy was performed on patients once a day for 2 courses of treatment,10 times for each course with a 7-day rest-insertion between courses.The low back pain,the low back tensility and the effect of low back pain on daily living were evaluated by using visual analogue scale(VAS),BCS-400 back strength dynamometer and Oswestry disability index(ODI)questionnaires respectively,meanwhile,the adverse reactions were observed.Results:The clinical trial was finished successfully in all patients,and no adverse reactions were found in the 2 groups during the clinical trial.There was no statistical difference in the low back pain VAS scores between the 2 groups before the treatment(t=0.081,P=0.936).The low back pain VAS scores decreased after the end of the treatment compared to pretreatment in the 2 groups(6.62+/-1.50 vs 3.18+/-1.09 points,t=7.635,P=0.000;6.71+/-1.59 vs 2.10+/-1.13 points,t=12.875,P=0.001).The low back pain VAS scores were higher in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=5.473,P=0.008).There was no statistical difference in the low back tensility between the 2 groups before the treatment(t=0.253,P=0.880).The low back tensility increased after the end of the treatment compared to pretreatment in the 2 groups(58.02+/-3.67 vs64.64+/-5.23 N,t=11.771,P=0.000;57.89+/-5.77 vs 67.17+/-4.46 N,t=8.005,P=0.000).The low back tensility was lower in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=-3.751,P=0.000).There was no statistical difference in the ODI between the 2 groups before the treatment(t=1.240,P=0.287).The ODI decreased after the end of the treatment compared to pretreatment in the 2 groups(68.45+/-13.67 vs 17.64+/-11.23%,t=15.332,P=0.000;69.19+/-12.77vs 13.17+/-10.46%,t=17.653,P=0.000).The ODI was higher in straight acupuncture group compared to penetrating acupuncture group after the end of the treatment(t=-4.369,P=0.001).Conclusion:Both acupuncture at zygapophysial joint with warmed needle that reaches there by penetrating acupoint of bladder meridian and straight acupuncture at zygapophysial joint with warmed needle can effectively relieve low back pain,enhance low back tensility and improve low back function in patients with low back pain originated from lumbar zygapophysial joints,and they have high safety,however,the former surpasses the latter in curative effect.
引文
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[6]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
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[11]周惠钧.温针灸艾条点燃位置对针体及周围温度影响的研究[J].中国针灸,2014,34(7):675-677.
[12]张家立,王东洋,伍亮,等.射频消融术联合臭氧注射治疗腰椎关节突关节源性腰痛的临床疗效研究[J].中国全科医学,2016,19(5):585-588.
[13]程珂,魏建子,沈雪勇.不同材质针灸针温针灸的温度特性研究[J].中华中医药学刊,2011,29(4):703-707.
[14]秦元,赵毅,沈雪勇,等.不同型号传统银质针温针灸在人体内的温度特性比较[J].上海针灸杂志,2014,33(3):189-191.
[15]赵毅,秦元,郑娟娟,等.银质针温针灸在人体内的温度分布特点[J].中国针灸,2012,32(9):803-806.
[16]杨洁,余思奕,杨晓明,等.穴位具有特异性作用——“973计划”经穴特异性项目概览[J].成都中医药大学学报,2015,38(2):93-96.
[17]李国艳,李霞,李淑琴,等.穴位特异性研究进展[J].上海针灸杂志,2016,35(4):383-387.
[18]马忆南.穴位特异性研究在治疗软组织损伤中的应用及存在问题分析[J].中国中医基础医学杂志,2014,20(2):225-227.
[19]HUANG ST,CHEN GY,LO HM,et al.Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[20]YOO SS,TEH EK,BLINDER RA,et al.Modulation of cerebellar activities by acupuncture stimulation:evidence from f MRI study[J].Neuroimage,2004,22(2):932-940.
[21]徐书君,符文彬.穴位特异性与针刺得气对颈椎病颈痛的疗效影响[J].中华中医药杂志,2014,29(9):3003-3007.
[2]姚玉龙,贾惊宇,吴添龙,等.椎间孔镜下脊神经内侧支消融术治疗小关节源性下腰痛疗效分析[J].中国矫形外科杂志,2015,23(7):600-604.
[3]丁伟国,顾春江,陶初华,等.腰椎脊神经后内侧支阻滞治疗关节突源性腰痛疗效观察[J].浙江中西医结合杂志,2013,23(5):361-362.
[4]詹玉林,范家伦.腰椎小关节病的诊断与治疗[J].中国矫形外科杂志,2002,10(8):822-823.
[5]MANCHUKONDA R,MANCHIKANTI KN,CASH KA,et al.Facet joint pain in chronic spinal pain:an evaluation of prevalence and false-positive rate of diagnostic blocks[J].J Spinal Disord Tech,2007,20(7):539-545.
[6]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
[7]杨勇,王雷生,张娟.经椎关节突关节温针治疗腰椎关节突关节源性腰痛[J].中医正骨,2016,28(2):67-68.
[8]陈仲,邵振海,靳安民,等.非特异性腰痛的重要原因──脊神经后支综合征[J].中华骨科杂志,1999,19(3):139-141.
[9]DEMONDION X,VIDAL C,GLAUDE E,et al.The posterior lumbar ramus:CT-anatomic correlation and propositions of new sites of infiltration[J].AJNR Am J Neuroradiol,2005,26(4):706-710.
[10]徐卫星,王健,丁伟国,等.去神经化治疗腰椎关节突关节源性腰痛的有效性与安全性研究[J].中国骨伤,2012,25(10):813-816.
[11]周惠钧.温针灸艾条点燃位置对针体及周围温度影响的研究[J].中国针灸,2014,34(7):675-677.
[12]张家立,王东洋,伍亮,等.射频消融术联合臭氧注射治疗腰椎关节突关节源性腰痛的临床疗效研究[J].中国全科医学,2016,19(5):585-588.
[13]程珂,魏建子,沈雪勇.不同材质针灸针温针灸的温度特性研究[J].中华中医药学刊,2011,29(4):703-707.
[14]秦元,赵毅,沈雪勇,等.不同型号传统银质针温针灸在人体内的温度特性比较[J].上海针灸杂志,2014,33(3):189-191.
[15]赵毅,秦元,郑娟娟,等.银质针温针灸在人体内的温度分布特点[J].中国针灸,2012,32(9):803-806.
[16]杨洁,余思奕,杨晓明,等.穴位具有特异性作用——“973计划”经穴特异性项目概览[J].成都中医药大学学报,2015,38(2):93-96.
[17]李国艳,李霞,李淑琴,等.穴位特异性研究进展[J].上海针灸杂志,2016,35(4):383-387.
[18]马忆南.穴位特异性研究在治疗软组织损伤中的应用及存在问题分析[J].中国中医基础医学杂志,2014,20(2):225-227.
[19]HUANG ST,CHEN GY,LO HM,et al.Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[20]YOO SS,TEH EK,BLINDER RA,et al.Modulation of cerebellar activities by acupuncture stimulation:evidence from f MRI study[J].Neuroimage,2004,22(2):932-940.
[21]徐书君,符文彬.穴位特异性与针刺得气对颈椎病颈痛的疗效影响[J].中华中医药杂志,2014,29(9):3003-3007.