寰枢椎脱位针刺哑门穴安全深度的研究
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摘要
目的:比较寰枢椎脱位(AAD)患者与解剖结构正常者的哑门穴直刺和斜刺的安全深度。方法:选取寰枢椎脱位患者177例(AAD组)和排除AAD且解剖结构正常的207例患者(正常组)。所有入组患者体型均为适中型。对其行颈椎MRI平扫,在矢状位像上测量哑门穴直刺和斜刺安全深度。结果:AAD组安全深度:男性直刺(45.33±5.17)mm,斜刺(48.58±4.41)mm,女性直刺(44.17±7.80)mm,斜刺(47.49±7.32)mm;正常组安全深度:男性直刺(47.72±5.06)mm,斜刺(42.69±5.53)mm,女性直刺(44.63±5.85)mm,斜刺(39.88±6.18)mm。AAD组男性和女性的斜刺安全深度大于直刺安全深度(P<0.01),正常组男性和女性的斜刺安全深度小于直刺安全深度(P<0.01);AAD组直刺与斜刺安全深度男性与女性比较,差异无统计学意义(P>0.05),正常组直刺和斜刺安全深度男性大于女性(P<0.01);男性AAD组直刺安全深度小于正常组直刺安全深度(P<0.01);男性AAD组斜刺安全深度大于正常组斜刺安全深度(P<0.01);女性AAD组直刺安全深度与正常组直刺安全深度比较,差异无统计学意义(P>0.05);女性AAD组斜刺安全深度大于正常组斜刺安全深度(P<0.01)。结论:寰枢椎脱位状态下的哑门穴针刺安全深度发生了明显的改变,临床上进行针刺时应小于其安全深度。
Objective To explore and compare the safety depths of perpendicular and oblique acupuncture at Yamen(GV 15) in patients with atlantoaxial dislocation(AAD) and healthy volunteers. Methods One bundred and seventy-seven patients with atlantoaxial dislocation were selected as an AAD group, and 207 patients without atlantoaxial dislocation and with normal anatomical structure were selected as a normal group. All participants were moderately sized. The MRI scanning of the cervical vertebra was performed, and the safety depth of perpendicular and oblique acupuncture at Yamen(GV 15) was calculated on the sagittal image. Results In the AAD group, the safety depth of men was(45.33±5.17) mm for perpendicular acupuncture and(48.58±4.41) mm for oblique acupuncture; the safety depth of women was(44.17±7.80) mm for perpendicular acupuncture and(47.49±7.32) mm for oblique acupuncture. In the normal group, the safety depth of men was(47.72±5.06) mm for perpendicular acupuncture and(42.69±5.53) mm for oblique acupuncture; the safety depth of women was(44.63±5.85) mm for perpendicular acupuncture and(39.88±6.18) mm for oblique acupuncture. The safety depth of men and women for oblique acupuncture was longer than that for perpendicular acupuncture in the AAD group(P<0.01); the safety depth of men and women for oblique acupuncture was shorter than that for perpendicular acupuncture in the normal group(P<0.01). The safety depth of perpendicular and oblique acupuncture between men and women was not significant in the AAD group(P>0.05); the safety depth of perpendicular and oblique acupuncture for men was longer than that for women in the normal group(P<0.01). For men, the safety depth of perpendicular acupuncture in the AAD group was shorter than that in the normal group(P<0.01), while the safety depth of oblique acupuncture in the AAD group was longer than that in the normal group(P<0.01). For women, the safety depth of perpendicular acupuncture in the AAD group was similar with that in the normal group(P>0.05), while the safety depth of oblique acupuncture in the AAD group was longer than that in the normal group(P<0.01). Conclusion The safe depth of acupuncture at Yamen(GV 15) has significantly changed under AAD, so during the clinical acupuncture the needle insertion should be less than its safe depth.
Objective To explore and compare the safety depths of perpendicular and oblique acupuncture at Yamen(GV 15) in patients with atlantoaxial dislocation(AAD) and healthy volunteers. Methods One bundred and seventy-seven patients with atlantoaxial dislocation were selected as an AAD group, and 207 patients without atlantoaxial dislocation and with normal anatomical structure were selected as a normal group. All participants were moderately sized. The MRI scanning of the cervical vertebra was performed, and the safety depth of perpendicular and oblique acupuncture at Yamen(GV 15) was calculated on the sagittal image. Results In the AAD group, the safety depth of men was(45.33±5.17) mm for perpendicular acupuncture and(48.58±4.41) mm for oblique acupuncture; the safety depth of women was(44.17±7.80) mm for perpendicular acupuncture and(47.49±7.32) mm for oblique acupuncture. In the normal group, the safety depth of men was(47.72±5.06) mm for perpendicular acupuncture and(42.69±5.53) mm for oblique acupuncture; the safety depth of women was(44.63±5.85) mm for perpendicular acupuncture and(39.88±6.18) mm for oblique acupuncture. The safety depth of men and women for oblique acupuncture was longer than that for perpendicular acupuncture in the AAD group(P<0.01); the safety depth of men and women for oblique acupuncture was shorter than that for perpendicular acupuncture in the normal group(P<0.01). The safety depth of perpendicular and oblique acupuncture between men and women was not significant in the AAD group(P>0.05); the safety depth of perpendicular and oblique acupuncture for men was longer than that for women in the normal group(P<0.01). For men, the safety depth of perpendicular acupuncture in the AAD group was shorter than that in the normal group(P<0.01), while the safety depth of oblique acupuncture in the AAD group was longer than that in the normal group(P<0.01). For women, the safety depth of perpendicular acupuncture in the AAD group was similar with that in the normal group(P>0.05), while the safety depth of oblique acupuncture in the AAD group was longer than that in the normal group(P<0.01). Conclusion The safe depth of acupuncture at Yamen(GV 15) has significantly changed under AAD, so during the clinical acupuncture the needle insertion should be less than its safe depth.
引文
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[13]唐柱生,褚鑫,丛树园,等.风府、哑门穴位针刺安全深度的磁共振成像和尸体对照研究[J].云南中医学院学报,2013,36(5):28-29.
[14]噜克.核磁共振成像[M].北京:中国医药科技出版社,2007.
[15]向澍,顾健华,张弘.指针风府、哑门穴治疗颈型颈椎病40例[J].中医外治杂志,2018(3):41-42.
[16]沈峰.试析腧穴本意[J].中国针灸,2017,37(6):621-623.
[17]赵京生.腧穴概念析[J].中国针灸,2017,37(2):149-152.
[18]王钏,刘保延,刘岩,等.针刺不良事件与针刺不良反应探析[J].中国针灸,2018,38(1):87-90.
[19]谭明生,张光铂,王文军,等.寰枢椎脱位的外科分型及其处理对策[J].中国脊柱脊髓杂志,2007,17(2):111-115.
[20]马佳佳,孟向文,郑亚超,等.关于“穴位安全针刺要素”的初步研究[J].四川中医,2017(12):15-17.
[2]谭明生.上颈椎外科学[M].北京:人民卫生出版社,2010,334.
[3]Zhang ZJ,Chen HY,Yip K,et al.The effectiveness and safety of acupuncture therapy in depressive disorders:systematic review and meta-analysis[J].J Affect Disord,2010,124(1):9-21.
[4]Chou PC,Chu HY,Lin JG.Safe needling depth of acupuncture points[J].J Altern Complement Med,2011,17(3):199-206.
[5]牟明园,孟向文,郑亚超,等.《黄帝内经》和《针灸甲乙经》中安全针刺操作要素的初步研究[J].针灸临床杂志,2017,33(8):66-68.
[6]Lu W,Rosenthal DS.Recent advances in oncology acupuncture and safety considerations in practice[J].Curr Treat Options Oncol,2010,11(3-4):141.
[7]伦新.慎用腧穴的针灸意外防治[M].北京:中国医药科技出版社,2007:201.
[8]杨占林,侯施霑,牛欣.关于风府、哑门、风池穴针刺深度的研究[J].山西中医,1985,1(1):45-47.
[9]张建华,严振国,余安胜,等.针刺意外穴位的安全深度[J].针刺研究,2000,25(3):233-235.
[10]吕秀华,赵传香.哑门穴针刺深度的研究[J].中国针灸,2002,22(7):471-472.
[11]周德育,司银楚,袁成和,等.哑门安全针刺深度与颈围等相关因素的CT测量研究[J].中国针灸,1995,15(3):41-42.
[12]唐娟,王小龙,廖兴富,等.应用MRI测量哑门和风府针刺危险深度的研究[J].重庆医学,2014(11):1317-1319.
[13]唐柱生,褚鑫,丛树园,等.风府、哑门穴位针刺安全深度的磁共振成像和尸体对照研究[J].云南中医学院学报,2013,36(5):28-29.
[14]噜克.核磁共振成像[M].北京:中国医药科技出版社,2007.
[15]向澍,顾健华,张弘.指针风府、哑门穴治疗颈型颈椎病40例[J].中医外治杂志,2018(3):41-42.
[16]沈峰.试析腧穴本意[J].中国针灸,2017,37(6):621-623.
[17]赵京生.腧穴概念析[J].中国针灸,2017,37(2):149-152.
[18]王钏,刘保延,刘岩,等.针刺不良事件与针刺不良反应探析[J].中国针灸,2018,38(1):87-90.
[19]谭明生,张光铂,王文军,等.寰枢椎脱位的外科分型及其处理对策[J].中国脊柱脊髓杂志,2007,17(2):111-115.
[20]马佳佳,孟向文,郑亚超,等.关于“穴位安全针刺要素”的初步研究[J].四川中医,2017(12):15-17.