动气针法治疗肱骨外上髁炎的临床研究
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摘要
研究目的:
透过随机分组的方法观察动气针法和局部针法治疗肱骨外上髁炎的疗效差异并探讨其机理
研究意义:
肱骨外上髁炎又称网球肘,为临床常见的骨伤病症之一。笔者在收集了大量的临床研究文献后发现目前针对此症的治疗方法虽然疗效不差,然亦发现以下的问题:
1)对于受伤局部组织的状态却缺乏论述。而临床上也未见医者依照肱骨外上髁炎患者局部组织损伤的程度来讨论适当的治疗手段。
2)研究方法多系自身对照,与其它疗法进行比较则较少见。
3)疗效评估标准较为简单,不易针对不同组别进行交叉分析。
动气针法为一结合针刺与运动的治疗方式。其具有以下特点:
1)动气针法具有”简””便””廉”的特色而易于在门诊量大的台湾使用。
2)治疗过程中除针灸外,另结合运动模式对局部肌肉进行再训练,强化软组织,从而降低复发的可能性。
根据笔者临床应用的体会对於肱骨外上髁炎患者,动气针法确能达到相当的疗效,然而再进一步的对相关的文献加以收集整理,发现有关的资料实在少之又少,只见零星的医案报告。本课题从针灸和导引术的发展历史出发,进而讨论动气针法的发展和临床应用。在临床研究方面,除传统自身对照的疗效评估模式外,另采用分组比较方法,将所有受试者分为局部针刺和动气针法两种治疗模式。并依病程的长短分为急性和慢性两大组,来比较两种治疗模式疗效之差异,期望对临床治疗有一定的指导作用。
研究方法:
将临床收集到的案例先区分为急性组和慢性组,再将每大组依随机分配原则细分为局部针刺和动气针法两小组,每小组各取30例。并以『患者评分的侧外上髁炎前臂评价问卷』为疗效诊断标准,于治疗前及治疗3周后各进行一次的疗效评估,最后比较两者疗效的差异。
结果:
本文研究结果发现,治疗后各组患者疼痛主项积分、功能主项积分及总积分均有不同程度降低,且均有统计学意义(P＜0.05)。提示局部针刺法与动气针法对急慢性肱骨外上髁炎均有一定的治疗作用。
最後一次治疗後疼痛主项积分、功能主项积分及总积分在局部针刺慢性组与动气针法慢性组比较差异无统计学意义(P＞0.05)。局部针刺急性组与动气针法急性组最後一次治疗後各项积分之间有显著性差异(P＜0.05)。提示动气针法治疗急性肱骨外上髁炎的疗效较好,优于局部针刺法。
讨论:
1)动气针法可以在发挥针刺疏通经络、调和气血、平衡阴阳的作用基础上,即时有效地配合现代运动疗法,疏通关节不利、解除肌肉痉挛,从而发挥动气针法对肱骨外上髁炎的综合治疗作用。本文研究结果也证实对於急性肱骨外上髁炎患者应采用动气针法治疗。另外,对于慢性肱骨外上髁炎患者因其病程较长,局部肌肉组织粘连退化较为严重,故局部针刺和动气针法两者在疗效上并无不同。
2)透过本研究我们可以发现在急性期阶段就即时的采用动气针法来治疗其效果是较好的。然而因为本地区医疗生态的特点及临床患者的治疗需要,本次研究追踪时间并不够长。因此我们无法了解各组在结束疗程一段时间后其病症复发或再度恶化的情况,这是往后学者们可以再于研究讨论的。
We conducted a prospective randomized study about the treatment effect difference about lateral humeral epicondylitis which was treated by the Dong-Gi acupuncture and local acupuncture. The treatment effect was evaluated based on the clinical observation. The lateral epicondylitis , also termed as tennis elbow ,is one of the most common disease in the traditional Chinese medicine trauma clinic. Although the effect of various treatment modality did not have significant difference, there were shortcommings such as:
1. The long term recurrence rate was neglected by the tradition conservative methods.
2. Research methods always self-control, lack of objectivity, and didn't compaired with other therapies.
3. Diagnostic criteria of efficacy are more straightforward, can not be cross-analysis of different groups than the right.
Dong-Gi acupuncture is a combination of acupuncture and exercise which wasn't widely applied in the ordinary Chinese medicine clinic, was frequently used in clinics.but there were fewer studys talking about this. In this study we try to compare the effect of the Dong-Gi acupuncture technique with Local acupuncture, and try to prove that Dong-Gi acupuncture is better than local acupuncture in lateral humeral epicondylitis problem.
Study methods:
The patient was divided as chronic and acute lateral epicondylitis groups. Each group was then randomized to Dong-Gi and local acupuncture groups. Each group included 30 patients. The questionnaire of lateral epicondylitis was used to evaluate the treatment result. The difference between pre-treatment and post-treatment was evaluated.
Results:
There was statistically significance (p<0.05) about the pain , functional and total scores before and after treatment. The effect of Dong-Gi or local acupuncture on acute or chronic lateral epicondylitis was compared. The difference between chronic groups with different treating programs was not statistically significant in terms of pain, functional and total score after last treatment(p>0.05). But in acute groups, Dong-Gi group was statistically significant (p>0.05) in terms of pain, functional and total score after last treatment than Local acupuncture group. We concluded that Dong-Gi acupuncture was superior to local acupuncture for acute lateral epicondylitis.
Discussion:
Dong-Gi acupuncture in association with modern exercise has effect of In-Yen balance, Chi-Blood regulation, can be used in lateral epicondylitis. The study results revealed that the Dong-Gi acupuncture is suggested in acute lateral epicondylitis patients. Besides, there is no difference in treatment effect in chronic epicondylitis because of the longer course symptom and more severe adhesion of local muscle tissue in the later. There is no many inclusion patients in this study because the study period is short and some restriction to physicians in Taiwan. Later, many other physicians can use the Dong-Gi technique combined with other treatment methods to manage this kind of patients. In this study, we can find that using this Dong-Gi technique to treat acute patients in time will get better treatment result. However, we cannot realize if the recurrence rate in the patients receieved Dong-Gi treatment is lower than that treated with other methods or not. In concern of this point, the scholars can invest in further study in the future.
透过随机分组的方法观察动气针法和局部针法治疗肱骨外上髁炎的疗效差异并探讨其机理
研究意义:
肱骨外上髁炎又称网球肘,为临床常见的骨伤病症之一。笔者在收集了大量的临床研究文献后发现目前针对此症的治疗方法虽然疗效不差,然亦发现以下的问题:
1)对于受伤局部组织的状态却缺乏论述。而临床上也未见医者依照肱骨外上髁炎患者局部组织损伤的程度来讨论适当的治疗手段。
2)研究方法多系自身对照,与其它疗法进行比较则较少见。
3)疗效评估标准较为简单,不易针对不同组别进行交叉分析。
动气针法为一结合针刺与运动的治疗方式。其具有以下特点:
1)动气针法具有”简””便””廉”的特色而易于在门诊量大的台湾使用。
2)治疗过程中除针灸外,另结合运动模式对局部肌肉进行再训练,强化软组织,从而降低复发的可能性。
根据笔者临床应用的体会对於肱骨外上髁炎患者,动气针法确能达到相当的疗效,然而再进一步的对相关的文献加以收集整理,发现有关的资料实在少之又少,只见零星的医案报告。本课题从针灸和导引术的发展历史出发,进而讨论动气针法的发展和临床应用。在临床研究方面,除传统自身对照的疗效评估模式外,另采用分组比较方法,将所有受试者分为局部针刺和动气针法两种治疗模式。并依病程的长短分为急性和慢性两大组,来比较两种治疗模式疗效之差异,期望对临床治疗有一定的指导作用。
研究方法:
将临床收集到的案例先区分为急性组和慢性组,再将每大组依随机分配原则细分为局部针刺和动气针法两小组,每小组各取30例。并以『患者评分的侧外上髁炎前臂评价问卷』为疗效诊断标准,于治疗前及治疗3周后各进行一次的疗效评估,最后比较两者疗效的差异。
结果:
本文研究结果发现,治疗后各组患者疼痛主项积分、功能主项积分及总积分均有不同程度降低,且均有统计学意义(P＜0.05)。提示局部针刺法与动气针法对急慢性肱骨外上髁炎均有一定的治疗作用。
最後一次治疗後疼痛主项积分、功能主项积分及总积分在局部针刺慢性组与动气针法慢性组比较差异无统计学意义(P＞0.05)。局部针刺急性组与动气针法急性组最後一次治疗後各项积分之间有显著性差异(P＜0.05)。提示动气针法治疗急性肱骨外上髁炎的疗效较好,优于局部针刺法。
讨论:
1)动气针法可以在发挥针刺疏通经络、调和气血、平衡阴阳的作用基础上,即时有效地配合现代运动疗法,疏通关节不利、解除肌肉痉挛,从而发挥动气针法对肱骨外上髁炎的综合治疗作用。本文研究结果也证实对於急性肱骨外上髁炎患者应采用动气针法治疗。另外,对于慢性肱骨外上髁炎患者因其病程较长,局部肌肉组织粘连退化较为严重,故局部针刺和动气针法两者在疗效上并无不同。
2)透过本研究我们可以发现在急性期阶段就即时的采用动气针法来治疗其效果是较好的。然而因为本地区医疗生态的特点及临床患者的治疗需要,本次研究追踪时间并不够长。因此我们无法了解各组在结束疗程一段时间后其病症复发或再度恶化的情况,这是往后学者们可以再于研究讨论的。
We conducted a prospective randomized study about the treatment effect difference about lateral humeral epicondylitis which was treated by the Dong-Gi acupuncture and local acupuncture. The treatment effect was evaluated based on the clinical observation. The lateral epicondylitis , also termed as tennis elbow ,is one of the most common disease in the traditional Chinese medicine trauma clinic. Although the effect of various treatment modality did not have significant difference, there were shortcommings such as:
1. The long term recurrence rate was neglected by the tradition conservative methods.
2. Research methods always self-control, lack of objectivity, and didn't compaired with other therapies.
3. Diagnostic criteria of efficacy are more straightforward, can not be cross-analysis of different groups than the right.
Dong-Gi acupuncture is a combination of acupuncture and exercise which wasn't widely applied in the ordinary Chinese medicine clinic, was frequently used in clinics.but there were fewer studys talking about this. In this study we try to compare the effect of the Dong-Gi acupuncture technique with Local acupuncture, and try to prove that Dong-Gi acupuncture is better than local acupuncture in lateral humeral epicondylitis problem.
Study methods:
The patient was divided as chronic and acute lateral epicondylitis groups. Each group was then randomized to Dong-Gi and local acupuncture groups. Each group included 30 patients. The questionnaire of lateral epicondylitis was used to evaluate the treatment result. The difference between pre-treatment and post-treatment was evaluated.
Results:
There was statistically significance (p<0.05) about the pain , functional and total scores before and after treatment. The effect of Dong-Gi or local acupuncture on acute or chronic lateral epicondylitis was compared. The difference between chronic groups with different treating programs was not statistically significant in terms of pain, functional and total score after last treatment(p>0.05). But in acute groups, Dong-Gi group was statistically significant (p>0.05) in terms of pain, functional and total score after last treatment than Local acupuncture group. We concluded that Dong-Gi acupuncture was superior to local acupuncture for acute lateral epicondylitis.
Discussion:
Dong-Gi acupuncture in association with modern exercise has effect of In-Yen balance, Chi-Blood regulation, can be used in lateral epicondylitis. The study results revealed that the Dong-Gi acupuncture is suggested in acute lateral epicondylitis patients. Besides, there is no difference in treatment effect in chronic epicondylitis because of the longer course symptom and more severe adhesion of local muscle tissue in the later. There is no many inclusion patients in this study because the study period is short and some restriction to physicians in Taiwan. Later, many other physicians can use the Dong-Gi technique combined with other treatment methods to manage this kind of patients. In this study, we can find that using this Dong-Gi technique to treat acute patients in time will get better treatment result. However, we cannot realize if the recurrence rate in the patients receieved Dong-Gi treatment is lower than that treated with other methods or not. In concern of this point, the scholars can invest in further study in the future.
引文
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58) 李辉,陈龙,针灸推拿治疗肱骨外上髁炎106例[J].中国民政医学杂志.1998,10(1):61
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62) 王丽敏,跌打丸治疗肱骨外上髁炎护理[J].航空航天医药.2001,12(3):183
63) 陈森然,毛茛外敷肱骨外上髁炎24例疗效观察[J].安徽中医学院学报.1995,(4):39
64) 朱正发,中药外敷治疗肱骨外上髁炎疗效观察[J].中国骨伤.1993,287
65) 许芝根,斑丁粉治疗肱骨外上髁炎[J].浙江中医杂志.1998,16(3):114
66) 金祖照,中药糊剂外敷治疗肱骨外上髁炎27例[J].浙江中医杂志.1999,25(5):208
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71) 黄国良.中西医结合穴位注射治疗肱骨外上髁炎[J].海军医学杂志.2002;3(23):1:80
72) 刘福成,胡彦琴.介绍一种治疗网球肘的新方法.中国骨伤.2001;4(4):44
73) Daniel T.,Jennifer D,Ingrid Z,et al.Rehabilitation for Patients with Lateral Epicondylitis:A Systematic Review[J].J Hand Ther.2004;243-266
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76) VasseljenO Jr,HφegN,Kjeldstad B,JohnssonA,Larson S.Low level laser versus placebo in the treatment of tennis elbow[J].Scan J Rehab Med.1992;24:37-42
77) Haker EHK,Lundeberg TCM.Lateral epicondylalgia:report of noneffective midlaser treatment[J].Arch Phys Med Rehabil.1991;72:984-8
78) 张平建.超短波并电脑中频治疗肱骨外上髁炎[J].中医正骨.2004;12(16):2
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81) 梁汉邦,甄志雄.等.病人评分的侧外上髁炎前臂评价问卷香港中文版的可靠性[J].Hong Kong Med J 2004;10(3):172-177.
82) 乔若愚,等.肱骨外上髁炎的病因及治疗[J].中华外科杂志.1965;13:997
83) BriggsCA,ElliottBG.Latearl epieondylitis a review of surtucters associated with tennis elbow[J].AnatClin,1985,7:14
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85) Bosworth DM.The role of oricular ligament in tennis elbow[J].J Bone Joint Surg(Am),1955;37,527
86) 崔清波,李昭铸等.肌腱病的病理改变及凋亡的研究[J].中华创伤骨科杂志,2005,8,770-772
87) Nirschl RP.Elbow tendinosis/tennis elbow[J].Clin Sports Med.1992;11:851-70.
88) Kraushaar BS,Nirschl RP.Current concept review tendinosis of the elbow(tennis elbow)[J].J Bone Joint Surg.1999;81A:259-78.