针刺联合水针治疗第3腰椎横突综合征临床疗效观察
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摘要
目的:观察针刺联合水针与单纯针刺治疗第3腰椎横突综合征的临床疗效差异。方法:将100例患者随机分为观察组和对照组,每组50例。对照组予常规针刺治疗,穴取委中、阿是穴、夹脊(L2～L4)、肾俞,每日治疗1次,每周治疗6d,连续治疗2周;观察组在对照组基础上,予5号注射针头松解剥离第3腰椎横突及关节突上压痛点,松解剥离后注射丹参注射液,每处1 mL,每7天注射1次,治疗2周。分别于治疗前、治疗后、随访半年观察两组患者视觉模拟评分(VAS)、日本骨科协会(JOA)评分和功能障碍指数(ODI)评分,并比较两组临床疗效。结果:观察组完成48例,脱落2例;对照组完成47例,脱落3例。两组治疗总有效率分别为91.7%(44/48)、76.6%(36/47),差异有统计学意义(P<0.05)。两组治疗后和随访半年后,VAS评分、ODI评分均较治疗前下降,JOA评分较治疗前升高(均P<0.05),且观察组VAS评分、ODI评分均低于对照组(均P<0.05),JOA评分高于对照组(P<0.05)。结论:针刺联合水针治疗第3腰椎横突综合征疗效较好,能显著改善患者腰椎功能,且疼痛症状明显缓解,优于常规针刺治疗。
Objective To observe the clinical efficacy differences between acupuncture combined with hydro-acupuncture and acupuncture alone for transverse processes syndrome of the third lumbar vertebra. Methods One hundred patients were randomly divided into an observation group and a control group, 50 cases in each one. The patients in the control group were treated with regular acupuncture at Weizhong(BL 40), ashi points, Jiaji(L2～L4) and Shenshu(BL 23); the acupuncture was given once a day, six treatments per week for consecutive 2 weeks. Based on the acupuncture treatment in the control group, in the observation group the No.5 injection needle was applied to relieve the tenderness points on the transverse process and articular process of the third lumbar vertebra, followed by hydro-acupuncture with Danshen injection(1 mL per point, 7 days per injection for 2 weeks). The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scale and Oswestry disability index(ODI) were observed before treatment, after treatment and during six-month follow-up visit in the two groups. In addition, the clinical efficacy was compared between the two groups. Results Forty-eight patients completed treatment and 2 patients dropped off in the observation group, while 47 patients completed treatment and 3 patients dropped off in the control group. The total effective rate was 91.7%(44/48) in the observation group, which was significantly superior to 76.6%(36/47) in the control group(P<0.05). Compared before treatment, the VAS and ODI in the two groups were reduced after treatment and during six-month follow-up visit, while the JOA was increased(all P<0.05);the VAS and ODI in the observation group was lower than that in the control group, while JOA in the observation group was higher than that in the control group(all P<0.05). Conclusion Acupuncture combined with hydro-acupuncture are effective for transverse processes syndrome of the third lumbar vertebra, and could significantly improve lumbar function and relieve the pain symptoms, which is superior to regular acupuncture.
Objective To observe the clinical efficacy differences between acupuncture combined with hydro-acupuncture and acupuncture alone for transverse processes syndrome of the third lumbar vertebra. Methods One hundred patients were randomly divided into an observation group and a control group, 50 cases in each one. The patients in the control group were treated with regular acupuncture at Weizhong(BL 40), ashi points, Jiaji(L2～L4) and Shenshu(BL 23); the acupuncture was given once a day, six treatments per week for consecutive 2 weeks. Based on the acupuncture treatment in the control group, in the observation group the No.5 injection needle was applied to relieve the tenderness points on the transverse process and articular process of the third lumbar vertebra, followed by hydro-acupuncture with Danshen injection(1 mL per point, 7 days per injection for 2 weeks). The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scale and Oswestry disability index(ODI) were observed before treatment, after treatment and during six-month follow-up visit in the two groups. In addition, the clinical efficacy was compared between the two groups. Results Forty-eight patients completed treatment and 2 patients dropped off in the observation group, while 47 patients completed treatment and 3 patients dropped off in the control group. The total effective rate was 91.7%(44/48) in the observation group, which was significantly superior to 76.6%(36/47) in the control group(P<0.05). Compared before treatment, the VAS and ODI in the two groups were reduced after treatment and during six-month follow-up visit, while the JOA was increased(all P<0.05);the VAS and ODI in the observation group was lower than that in the control group, while JOA in the observation group was higher than that in the control group(all P<0.05). Conclusion Acupuncture combined with hydro-acupuncture are effective for transverse processes syndrome of the third lumbar vertebra, and could significantly improve lumbar function and relieve the pain symptoms, which is superior to regular acupuncture.
引文
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[13]范桂清,张万龙,汪芗,等.针刺对第三腰椎横突综合征的止痛作用与镇痛机制探讨[J].世界中医药,2014,9(7):931-933.
[14]黄平.退变性腰椎侧凸演变过程及相关生物力学机制的有限元分析[D].上海:第二军医大学,2013:35-38.
[15]倪朝民,赵翱.第三腰椎横突综合症与末端病关系的研究[J].颈腰痛杂志,1993,14(3):137-138.
[16]陈东煜,何俊,王翔,等.针刀经筋层松解术治疗非特异性下腰痛临床研究[J].上海中医药杂志,2012,46(6):52-54.
[17]程永.经筋实质、经筋病病机与治法探讨[J].湖南中医杂志,2011,27(5):97-99.
[2]吴海波,陈东煜.针刀为主治疗第三腰椎横突综合征研究进展[J].亚太传统医药,2017,13(3):64-67.
[3]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:216.
[4]徐恒泽.针灸学[M].北京:中国中医药出版社,2002:304-306.
[5]吴大江,徐锡明,魏显招,等.简体中文版功能评分指数在下腰痛患者中的应用及信度效度测量[J].中国骨科临床与基础研究杂志,2014,6(1):13-20.
[6]Shirado O,Doi T,Akai M,et al.An outcome measure for Japanese people with chronic low back pain:an introduction and validation study of Japan low back pain evaluation questionnaire[J].Spine,2007,32(26):3052-3059.
[7]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.
[8]王和鸣.中医伤科学[M].北京:中国中医药出版社,2002:281-282.
[9]秦书芝.三首活血化瘀方药对气滞血瘀模型大鼠红细胞膜生物学指标的研究[D].哈尔滨:黑龙江中医药大学,2014.
[10]姜雪,史磊.丹参活性成分及药理作用研究进展[J].药学研究,2017,36(3):166-169.
[11]范刚启,赵杨,符仲华.针刺方向、角度、深度与针刺镇痛的关系[J].中国针灸,2010,30(11):965-968.
[12]刘乃刚,郭长青,李晓泓,等.针刀松解法对第三腰椎横突综合征模型大鼠血管活性物质的远期影响[J].北京中医药,2012,31(10):780-782.
[13]范桂清,张万龙,汪芗,等.针刺对第三腰椎横突综合征的止痛作用与镇痛机制探讨[J].世界中医药,2014,9(7):931-933.
[14]黄平.退变性腰椎侧凸演变过程及相关生物力学机制的有限元分析[D].上海:第二军医大学,2013:35-38.
[15]倪朝民,赵翱.第三腰椎横突综合症与末端病关系的研究[J].颈腰痛杂志,1993,14(3):137-138.
[16]陈东煜,何俊,王翔,等.针刀经筋层松解术治疗非特异性下腰痛临床研究[J].上海中医药杂志,2012,46(6):52-54.
[17]程永.经筋实质、经筋病病机与治法探讨[J].湖南中医杂志,2011,27(5):97-99.