透灸配合针刺治疗肩凝症的临床对照观察
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摘要
目的:比较透灸配合针刺与单纯针刺治疗肩凝症的临床疗效,分析透灸配合针刺对肩凝症的治疗效果。方法:将60例肩凝症患者随机分为透灸针刺组与单纯针刺组,每组30例。穴取肩髃、肩贞、肩髎、阳陵泉、条口透承山、阿是穴,透灸针刺组用透灸配合针刺治疗,单纯针刺组仅用针刺治疗,每次40～50min,每天1次,每周5次为1个疗程。比较治疗前和治疗2个疗程后患者的视觉模拟量尺(VAS)评分、肩关节功能(Constant-Murley)总积分及各项积分。结果:两组患者治疗后VAS评分均较治疗前降低(P<0.05);两组患者治疗后的Constant-Murley各项积分(日常功能活动、关节活动度、疼痛积分、肌力)、Constant-Murley总积分均较治疗前升高(P<0.05)。治疗后组间比较,透灸针刺组总有效率高于单纯针刺组(P<0.05);透灸针刺组VAS评分低于单纯针刺组(P<0.05),Constant-Murley总积分以及日常功能活动、关节活动度、疼痛积分高于单纯针刺组(P<0.05)。结论:透灸配合针刺治疗肩凝症的综合疗效优于单纯针刺,透灸针刺组通过改善肩凝症患者日常功能活动、关节活动度,减轻患者疼痛而提高治疗效果。
Objective To compare the clinical therapeutic effect of intensive moxibustion plus acupuncture and simple acupuncture therapy in the treatment of frozen shoulder so as to provide a reference for clinical practice.Methods A total of60 patients with frozen shoulder were randomly divided into intensive moxibustion plus acupuncture group and simple acupuncture group(n=30 per group).Acupoints Jianyu(LI15),Jianzhen(SI9),Jianliao(TE14),Tiaokou(ST38),Chengshan(BL57)and Ashi points(Extra)were punctured with filiform needles which were manipulated till the patients experienced feelings of soreness and distension in the local region,followed by retaining the needles for 40 min.For patients of the moxibustion plus acupuncture group,after acupuncture,an ignited moxa-stick segment was applied to the affected shoulder for 40-50 min.After the treatment,all patients were ordered to make a shoulder exercise(anteflexion,rear protraction,abduction and upthrow movements,etc.).The visual analogue scale(VAS)was used to assess the pain severity,and the Constant-Murley shoulder assessment scale(the total score is 100 points,including 15 points in pain severity and 20 points in daily living activities,40 points in joint motion range,and25 points in myodynamia)used to assess the functional state of the shoulder,and the"Standards for Diagnosis and Therapeutic Effect Evaluation of Diseases of Traditional Chinese Medicine"(1994)were employed to evaluate the therapeutic effect.Results Following the treatment,intra-group comparison showed that the VAS score was significantly reduced in both groups in comparison with their own pre-treatment(P<0.05),and the total scores of Constant-Murley scale,the scores of activities of daily living and active motion range,as well as the scores of pain integration and myodynamia,were all considerably increased in the two groups in comparison with their own pre-treatment(all P<0.05).The therapeutic effect of the moxibustion plus acupuncture was significantly superior to that of the simple acupuncture in reducing VAS score and increasing total score of Constant-Murley scale,and scores of activities of daily living and active motion range,as well as the scores of pain integration(P<0.05).Of the two 29 cases in the moxibustion plus acupuncture and simple acupuncture groups,19(65.52%)and 10(34.48%)were cured,8(27.58%)and 12(41.38%)experienced improvement,2(6.90%)and 7(24.14%)were failed,with the effective rate being 93.10%and 75.86%,respectively.The therapeutic effective rate of the moxibustion plus acupuncture was evidently higher than that of the simple acupuncture(P<0.05).Conclusion The therapeutic effect of intensive moxibustion plus acupuncture is superior to that of simple acupuncture in improving symptoms of frozen shoulder in patients.
Objective To compare the clinical therapeutic effect of intensive moxibustion plus acupuncture and simple acupuncture therapy in the treatment of frozen shoulder so as to provide a reference for clinical practice.Methods A total of60 patients with frozen shoulder were randomly divided into intensive moxibustion plus acupuncture group and simple acupuncture group(n=30 per group).Acupoints Jianyu(LI15),Jianzhen(SI9),Jianliao(TE14),Tiaokou(ST38),Chengshan(BL57)and Ashi points(Extra)were punctured with filiform needles which were manipulated till the patients experienced feelings of soreness and distension in the local region,followed by retaining the needles for 40 min.For patients of the moxibustion plus acupuncture group,after acupuncture,an ignited moxa-stick segment was applied to the affected shoulder for 40-50 min.After the treatment,all patients were ordered to make a shoulder exercise(anteflexion,rear protraction,abduction and upthrow movements,etc.).The visual analogue scale(VAS)was used to assess the pain severity,and the Constant-Murley shoulder assessment scale(the total score is 100 points,including 15 points in pain severity and 20 points in daily living activities,40 points in joint motion range,and25 points in myodynamia)used to assess the functional state of the shoulder,and the"Standards for Diagnosis and Therapeutic Effect Evaluation of Diseases of Traditional Chinese Medicine"(1994)were employed to evaluate the therapeutic effect.Results Following the treatment,intra-group comparison showed that the VAS score was significantly reduced in both groups in comparison with their own pre-treatment(P<0.05),and the total scores of Constant-Murley scale,the scores of activities of daily living and active motion range,as well as the scores of pain integration and myodynamia,were all considerably increased in the two groups in comparison with their own pre-treatment(all P<0.05).The therapeutic effect of the moxibustion plus acupuncture was significantly superior to that of the simple acupuncture in reducing VAS score and increasing total score of Constant-Murley scale,and scores of activities of daily living and active motion range,as well as the scores of pain integration(P<0.05).Of the two 29 cases in the moxibustion plus acupuncture and simple acupuncture groups,19(65.52%)and 10(34.48%)were cured,8(27.58%)and 12(41.38%)experienced improvement,2(6.90%)and 7(24.14%)were failed,with the effective rate being 93.10%and 75.86%,respectively.The therapeutic effective rate of the moxibustion plus acupuncture was evidently higher than that of the simple acupuncture(P<0.05).Conclusion The therapeutic effect of intensive moxibustion plus acupuncture is superior to that of simple acupuncture in improving symptoms of frozen shoulder in patients.
引文
[1]MILGROM C,NOVACK V,WEIL Y,et al.Risk factors for idiopathic frozen shoulder[J].Isr Med Assoc J,2008,10(5):361-364.
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[3]GALATZ L M.肩肘外科学[M].北京:北京大学医学出版社,2012:510-512.
[4]苏志强,曹健,周美启.近3年针灸治疗肩关节周围炎研究进展[J].安徽中医学院学报,2008,27(4):61-64.
[5]王荣,张哲.肩周炎的常规针灸治疗近况[J].内蒙古中医药,2008,27(4):33-35.
[6]髙树中.针灸治疗学[M].上海:上海科学技术出版社,2009:30-31.
[7]张君涛,王平,杨光,等.三种外治法治疗肩凝症90例临床观察[J].中医杂志,2012,53(7):574-577.
[8]张世民,李海丰,黄轶刚.骨折分类与功能评定[M].北京:人民军医出版社,2008:301-302.
[9]高丹,韩正,杨芳.针灸治疗肩周炎机理探讨[J].中国中医药现代远程教育,2018,16(3):122-123.
[10]谭忻风.肩三针结合辨证配穴治疗肩周炎48例临床观察[J].湖南中医杂志,2016,32(8):110-111.
[11]郭庆广.针刺条口透承山穴治疗肩周炎128例[J].中医临床研究,2016,8(8):32-34.
[12]唐照亮,宋小鸽,章复清,等.艾灸对关节炎大鼠抗炎消肿作用及细胞因子、自由基影响[J].安徽中医学院学报,2001,20(5):34-37.
[13]唐照亮,宋小鸽,侯正明,等.艾灸抗炎作用对炎症介质影响的实验研究[J].针刺研究,1999,24(3):212-215.
[14]罗磊,胡玲,宋小鸽,等.艾灸对类风湿关节炎模型大鼠跖关节中细胞因子的影响[J].环球中医药,2011,4(6):416-419.
[15]陈增辉,王立新.针灸治疗类风湿关节炎40例[J].长春中医药大学学报,2009,25(2):247.
[16]李真真,吕洁丽,张来宾,等.艾叶的化学成分及药理作用研究进展[J].国际药学研究杂志,2016,43(6):1059-1066.
[17]陈日新,康明非.一种新类型的疾病反应点---热敏点及其临床意义[J].江西中医学院学报,2006,18(2):29-30.
[18]康明非,陈日新,付勇.热敏点灸治疗膝关节骨性关节炎的临床疗效研究[J].江西中医学院学报,2006,18(2):27-28.
[19]高希言.透灸法应用探讨[J].中国针灸,2013,33(S1):54-55.
[20]尚秀葵.长时间温和灸治疗胃肠病临证举要[J].上海针灸杂志,2004,23(3):22-23.
[21]张英,刘又香.不同灸治时程对阳虚小鼠免疫功能影响的比较[J].湖北中医杂志,1998,20(2):53-55.
[22]顾一煌,金宏柱,吴云川,等.不同艾灸量对运动后血清肌酸激酶影响的实验研究[J].南京中医药大学学报,2006,22(6):373-375.
[2]BUNKER T D,ANTHONY P P.The pathology of frozen shoulder.A Dupuytren-like disease[J].J Bone Joint Surg Br,1995,77(5):677-683.
[3]GALATZ L M.肩肘外科学[M].北京:北京大学医学出版社,2012:510-512.
[4]苏志强,曹健,周美启.近3年针灸治疗肩关节周围炎研究进展[J].安徽中医学院学报,2008,27(4):61-64.
[5]王荣,张哲.肩周炎的常规针灸治疗近况[J].内蒙古中医药,2008,27(4):33-35.
[6]髙树中.针灸治疗学[M].上海:上海科学技术出版社,2009:30-31.
[7]张君涛,王平,杨光,等.三种外治法治疗肩凝症90例临床观察[J].中医杂志,2012,53(7):574-577.
[8]张世民,李海丰,黄轶刚.骨折分类与功能评定[M].北京:人民军医出版社,2008:301-302.
[9]高丹,韩正,杨芳.针灸治疗肩周炎机理探讨[J].中国中医药现代远程教育,2018,16(3):122-123.
[10]谭忻风.肩三针结合辨证配穴治疗肩周炎48例临床观察[J].湖南中医杂志,2016,32(8):110-111.
[11]郭庆广.针刺条口透承山穴治疗肩周炎128例[J].中医临床研究,2016,8(8):32-34.
[12]唐照亮,宋小鸽,章复清,等.艾灸对关节炎大鼠抗炎消肿作用及细胞因子、自由基影响[J].安徽中医学院学报,2001,20(5):34-37.
[13]唐照亮,宋小鸽,侯正明,等.艾灸抗炎作用对炎症介质影响的实验研究[J].针刺研究,1999,24(3):212-215.
[14]罗磊,胡玲,宋小鸽,等.艾灸对类风湿关节炎模型大鼠跖关节中细胞因子的影响[J].环球中医药,2011,4(6):416-419.
[15]陈增辉,王立新.针灸治疗类风湿关节炎40例[J].长春中医药大学学报,2009,25(2):247.
[16]李真真,吕洁丽,张来宾,等.艾叶的化学成分及药理作用研究进展[J].国际药学研究杂志,2016,43(6):1059-1066.
[17]陈日新,康明非.一种新类型的疾病反应点---热敏点及其临床意义[J].江西中医学院学报,2006,18(2):29-30.
[18]康明非,陈日新,付勇.热敏点灸治疗膝关节骨性关节炎的临床疗效研究[J].江西中医学院学报,2006,18(2):27-28.
[19]高希言.透灸法应用探讨[J].中国针灸,2013,33(S1):54-55.
[20]尚秀葵.长时间温和灸治疗胃肠病临证举要[J].上海针灸杂志,2004,23(3):22-23.
[21]张英,刘又香.不同灸治时程对阳虚小鼠免疫功能影响的比较[J].湖北中医杂志,1998,20(2):53-55.
[22]顾一煌,金宏柱,吴云川,等.不同艾灸量对运动后血清肌酸激酶影响的实验研究[J].南京中医药大学学报,2006,22(6):373-375.