浮针治疗骨质疏松性胸椎压缩骨折术后遗留肋间痛疗效分析
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摘要
目的部分骨质疏松性椎体压缩骨折患者术后仍会遗留肋间痛,严重影响手术疗效。浮针是一种特殊的针刺疗法,在治疗疼痛方面有着立竿见影的效果,但未见该技术运用在椎体压缩骨折术后遗留肋间痛方面的报道。本研究旨在观察浮针疗法治疗胸椎压缩性骨折术后遗留肋间痛的有效性及安全性。方法收集2014年1月至2017年6月获得完整随访的23例老年骨质疏松性胸椎压缩骨折术后遗留肋间痛患者资料,所有患者均为在接受经皮灌注骨水泥椎体强化术治疗后肋间痛减轻不明显,接受浮针疗法进一步治疗。记录连续3次浮针治疗前、治疗后1 d、3个月、12个月的视觉模拟评分值(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index, ODI)值、针刺皮下血肿、血气胸等相关并发症情况。结果所有患者均完成连续3次的浮针治疗,VAS评分值分别为7.1±0.8(治疗前)、3.2±0.6(治疗后1 d)、2.8±0.7(治疗后3个月)、3.1±0.8(治疗后12个月),与治疗前比较,治疗后VAS评分值均显著性降低(P<0.05)。ODI值分别为42.6±2.3(治疗前)、27.9±4.2(治疗后1 d)、23.2±8.3(治疗后3个月)、28.2±1.3(治疗后12个月),与治疗前比较,术后ODI值均显著下降(P<0.05),所有患者均未发生针刺后血肿、血气胸等胸腔脏器损伤的并发症。结论浮针疗法可有效治疗骨质疏松性胸椎压缩骨折术后遗留肋间痛,可以获得即刻的止痛效果,改善患者生活质量,安全性较高,值得临床推广使用。
Objective Osteoporotic thoracic compression fractures is a serious complication of osteoporosis in the aged, and percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) are the effective treatment. Some patients with osteoporotic vertebral compression fractures still have intercostal pain after surgery, which seriously affects the curative effect. Fu~'s Subcutaneous Needling is a special acupuncture treatment that has an immediate effect in treating pain, but there have been no reports of the use of this technique for residual intercostal pain after vertebral compression fracture. The purpose of this study was to evaluate the efficacy and safety of Fu~'s Subcutaneous Needling(FSN) in the treatment of residual intercostal pain after thoracic compression fractures. Methods From January 2014 to June 2017, 23 osteoporotic thoracic compression fracture patients with postoperative costal pain and who had undergone FSN with complete follow-up were reviewed retrospectively. All patients underwent percutaneous vertebroplasty, but pain relief was not obvious. They then received further treatment with Fu~'s Subcutaneous Needling. One needle or two needles applied for each patient. Visual analogue scale(VAS) and Oswestry Disability Index(ODI) of all patients were measured pre-needling and 1 day, 3 months and 12 months post-needling. Complications such as subcutaneous hematoma and Chemothorax were recorded. Results All the patients had three consecutive FSN treatments. The VAS was significant decreased: 7.1±0.8(pre-needling) to 3.2±0.6(1 d), 2.8±0.7(3 m), 3.1±0.8(12 m), P<0.05; the ODI was significant decreased: 42.6±2.3(pre-needling) to 27.9±4.2(1 d), 23.2±8.3(3 m), 28.2±1.3(12 m), P<0.05, and there was no complication. Conclusion The FSN can effectively treat costal pain related to osteoporotic thoracic compression fractures with high safety, can relieve the pain and improved the quality of life. The FSN are worthy of clinical application.
Objective Osteoporotic thoracic compression fractures is a serious complication of osteoporosis in the aged, and percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) are the effective treatment. Some patients with osteoporotic vertebral compression fractures still have intercostal pain after surgery, which seriously affects the curative effect. Fu~'s Subcutaneous Needling is a special acupuncture treatment that has an immediate effect in treating pain, but there have been no reports of the use of this technique for residual intercostal pain after vertebral compression fracture. The purpose of this study was to evaluate the efficacy and safety of Fu~'s Subcutaneous Needling(FSN) in the treatment of residual intercostal pain after thoracic compression fractures. Methods From January 2014 to June 2017, 23 osteoporotic thoracic compression fracture patients with postoperative costal pain and who had undergone FSN with complete follow-up were reviewed retrospectively. All patients underwent percutaneous vertebroplasty, but pain relief was not obvious. They then received further treatment with Fu~'s Subcutaneous Needling. One needle or two needles applied for each patient. Visual analogue scale(VAS) and Oswestry Disability Index(ODI) of all patients were measured pre-needling and 1 day, 3 months and 12 months post-needling. Complications such as subcutaneous hematoma and Chemothorax were recorded. Results All the patients had three consecutive FSN treatments. The VAS was significant decreased: 7.1±0.8(pre-needling) to 3.2±0.6(1 d), 2.8±0.7(3 m), 3.1±0.8(12 m), P<0.05; the ODI was significant decreased: 42.6±2.3(pre-needling) to 27.9±4.2(1 d), 23.2±8.3(3 m), 28.2±1.3(12 m), P<0.05, and there was no complication. Conclusion The FSN can effectively treat costal pain related to osteoporotic thoracic compression fractures with high safety, can relieve the pain and improved the quality of life. The FSN are worthy of clinical application.
引文
[1] Lad SP, Patil CG, Lad EM, et al. National trends in vertebral augmentation procedures for the treatment of vertebral compression fractures[J]. Surg Neurol, 2009, 71(5): 580-584.
[2] Walters S, Chan S, Goh L, et al. The Prevalence of Frailty in Patients Admitted to Hospital with VertebralFragility Fractures[J]. Curr Rheumatol Rev, 2016, 12(3):244-247.
[3] Hazzard MA, Huang KT, Toche UN, et al. Comparison of Vertebroplasty, Kyphoplasty, and Nonsurgical Management of Vertebral Compression Fractures and Impact on US Healthcare Resource Utilization[J]. Asian Spine J, 2014, 8(5): 605-614.
[4] 梁绛槟,张智海,王冉东,等.椎体后凸成形术在上中胸椎骨质疏松压缩性骨折治疗中的临床应用研究[J].中国骨质疏松杂志, 2013, 19(7).718-720.
[5] 万成福,于雪,宋涛. 胸脊神经射频热凝治疗胸椎压缩骨折后肋间神经痛的临床观察[J]. 中国医师杂志, 2016, 18(6): 888-889.
[6] 刘明莹,孙忠人,张秦宏.浮针治疗痛证研究进展[J].辽宁中医杂志, 2014, 41(1): 182-183.
[7] 中华医学会骨科学分会骨质疏松学组,骨质疏松性骨折诊疗指南[J].中华骨科杂志, 2017,37(1): 1-10.
[8] Roland M, Fairbank J, The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire[J]. Spine, 2000, 25(24): 3115-3124.
[9] Huskisson EC. Measurement of pain[J]. Lancet, 1974, 2(7889): 1127-1131.
[10] Cauley JA. Osteoporosis: fracture epidemiology update 2016[J]. Curr Opin Rheumatol, 2017. 29(2): 150-156.
[11] 陈世忠, 刘永皑,王耿.经皮穿刺椎体成形术治疗胸椎压缩骨折并胁肋疼痛[J]. 中医正骨, 2010, 22(8): 43-44.
[12] 任广军,仇发美,苏晋,等. 经皮单侧椎体成形术治疗骨质疏松性椎体严重骨折并肋间神经痛[J]. 中国老年学杂志, 2014, 34(15): 4369-4370.
[13] O'Connor RC, Andary MT, Russo RB, et al., Thoracic radiculopathy[J]. Phys Med Rehabil Clin N Am, 2002, 13(3): 623-644.
[14] Kraan GA, Hoogland PV, Wuisman PI. Extra foraminal ligament attachments of the thoracic spinal nerves in humans[J]. Eur Spine J, 2009, 18(4): 490-498.
[15] Jinkins JR, Whittemore AR,Bradley WG. The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion[J]. AJR Am J Roentgenol, 1989, 152(6): 1277-1289.
[16] 李卓洲, 李其虎,卢文.小针刀联合整脊治疗胸腰椎压缩性骨折术后疼痛[J]. 颈腰痛杂志, 2018,39(1): 119-120.
[17] 杨江霞,符仲华.浅析浮针的理论与临床研究[J].西部中医药, 2015,28(6): 156-158.
[18] 范刚启,符仲华,曹树平,等. 浮针疗法及其对针灸学发展的启示[J].中国针灸, 2005,25(10): 733-736.
[19] 邓亚典, 杨勇,陈曦. 补阳还五汤口服联合浮针疗法治疗腰椎间盘突出症椎间孔镜术后残余神经症状[J]. 中医正骨, 2017,29(10): 64-65,68.
[2] Walters S, Chan S, Goh L, et al. The Prevalence of Frailty in Patients Admitted to Hospital with VertebralFragility Fractures[J]. Curr Rheumatol Rev, 2016, 12(3):244-247.
[3] Hazzard MA, Huang KT, Toche UN, et al. Comparison of Vertebroplasty, Kyphoplasty, and Nonsurgical Management of Vertebral Compression Fractures and Impact on US Healthcare Resource Utilization[J]. Asian Spine J, 2014, 8(5): 605-614.
[4] 梁绛槟,张智海,王冉东,等.椎体后凸成形术在上中胸椎骨质疏松压缩性骨折治疗中的临床应用研究[J].中国骨质疏松杂志, 2013, 19(7).718-720.
[5] 万成福,于雪,宋涛. 胸脊神经射频热凝治疗胸椎压缩骨折后肋间神经痛的临床观察[J]. 中国医师杂志, 2016, 18(6): 888-889.
[6] 刘明莹,孙忠人,张秦宏.浮针治疗痛证研究进展[J].辽宁中医杂志, 2014, 41(1): 182-183.
[7] 中华医学会骨科学分会骨质疏松学组,骨质疏松性骨折诊疗指南[J].中华骨科杂志, 2017,37(1): 1-10.
[8] Roland M, Fairbank J, The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire[J]. Spine, 2000, 25(24): 3115-3124.
[9] Huskisson EC. Measurement of pain[J]. Lancet, 1974, 2(7889): 1127-1131.
[10] Cauley JA. Osteoporosis: fracture epidemiology update 2016[J]. Curr Opin Rheumatol, 2017. 29(2): 150-156.
[11] 陈世忠, 刘永皑,王耿.经皮穿刺椎体成形术治疗胸椎压缩骨折并胁肋疼痛[J]. 中医正骨, 2010, 22(8): 43-44.
[12] 任广军,仇发美,苏晋,等. 经皮单侧椎体成形术治疗骨质疏松性椎体严重骨折并肋间神经痛[J]. 中国老年学杂志, 2014, 34(15): 4369-4370.
[13] O'Connor RC, Andary MT, Russo RB, et al., Thoracic radiculopathy[J]. Phys Med Rehabil Clin N Am, 2002, 13(3): 623-644.
[14] Kraan GA, Hoogland PV, Wuisman PI. Extra foraminal ligament attachments of the thoracic spinal nerves in humans[J]. Eur Spine J, 2009, 18(4): 490-498.
[15] Jinkins JR, Whittemore AR,Bradley WG. The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion[J]. AJR Am J Roentgenol, 1989, 152(6): 1277-1289.
[16] 李卓洲, 李其虎,卢文.小针刀联合整脊治疗胸腰椎压缩性骨折术后疼痛[J]. 颈腰痛杂志, 2018,39(1): 119-120.
[17] 杨江霞,符仲华.浅析浮针的理论与临床研究[J].西部中医药, 2015,28(6): 156-158.
[18] 范刚启,符仲华,曹树平,等. 浮针疗法及其对针灸学发展的启示[J].中国针灸, 2005,25(10): 733-736.
[19] 邓亚典, 杨勇,陈曦. 补阳还五汤口服联合浮针疗法治疗腰椎间盘突出症椎间孔镜术后残余神经症状[J]. 中医正骨, 2017,29(10): 64-65,68.