新易筋疗法治疗胸椎小关节紊乱的临床研究
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摘要
背景
胸椎小关节紊乱(thoracic facet joint disorders, TFJD)主要是指由于各种原因导致的胸椎关节突关节和肋椎关节的错位,牵拉软组织刺激神经而产生以胸背痛为主症的病证,一般多发于上中胸段,运动员多见。胸椎小关节由胸椎后关节和肋椎关节组成,从理论上讲,胸椎的连接比较稳定,并且活动度小,一般不易引起损伤。由于胸椎周围的软组织比较薄弱,长时间使用电脑、伏案或保持单一姿势特别是对于运动员来讲,需长期进行某一个训练动作使脊柱的韧带过度疲劳而变松弛、椎体间的活动度增大,可产生脊柱小关节偏离正常位置造成错位,从而引起临床症状。由于错位只发生在脊柱关节面之间,所以通常情况下X线无法显示紊乱情况。胸椎小关节紊乱是临床的常见病,其发病率正呈现出年轻化、快速增长的趋势。随着电脑的不断普及,人们的工作生活方式的改变,胸椎小关节紊乱将逐渐成为现代生活中最为常见的疾病之一,并且将给个人及社会带来巨大负担和压力。因此,研究如何治疗胸椎小关节紊乱具有重要的意义。
目前,国内外对于胸椎小关节紊乱的治疗尚无公认的、确切的治疗方法。西医治疗主要以对症治疗为主,主要给予止痛剂缓解疼痛,如阿司匹林、消炎痛等药物,并辅以扩张血管药、解筋类药物、神经营养和条件药物、物理治疗等,严重者可给予局部注射盐酸普鲁卡因、强的松龙等。这些治疗方法虽能暂时缓解疼痛,但疗效都不甚显著,容易复发。
祖国医学认为,胸椎小关节紊乱,属于中医学“胸痛”、“背痛”范畴,也属于“骨错缝、筋出槽”范畴。“骨错缝,筋出槽”是中医特有的名词,它既属于病名,又属于病机变化。“骨错缝”一方面是指骨关节之间,由于不同的损失,使正常的解剖结构发生了微小错缝。这种改变的半脱位很轻,所以在线摄片上目前还不能得到反映。但解剖结构病理改变以后,影响到生理机能,故出现肿胀疼痛；另一方面是指比较严重的骨缝发生参差不齐或半脱位,在X线摄片上可以显示,肿胀疼痛也比较显著。“筋出槽”是指受损伤时,肌键等软组织发生滑脱或解剖位置有变化,从而影响活动功能,甚者出现较剧烈的疼痛,影响正常的工作和生活。因此,祖国医学中的针灸推拿治疗胸椎小关节紊乱具有独特的优势,现主要形成了以推拿手法为主,针灸、拔罐、外敷、针刀、中药等相结合的综合治疗方法,并取得了一定的疗效。
近年来,原林教授通过对人体筋膜结缔组织进行标记和三维重建,并进一步对人体非特异性结缔组织的生物进化和发育生物学进行追踪溯源,提出了“筋膜学理论”。它认为人体是由两个系统组成,即由全身非特异性筋膜结缔组织支架构成的支持与储备系统和被该支架支持和包绕的功能细胞构成的功能系统。其中全身的筋膜结缔组织支架构成了中医经络的物质基础,“穴位”是指在人体的结缔组织聚集处进行针刺操作时能够产生较强生物学信息的部位。全身各处“穴位”与“非穴位”没有质的区别而只有所含生物信息量的差异,即全身各处都是“穴位”。通过针刺穴位,对局部结缔组织进行机械牵拉刺激可产生较强的生物学信息(如局部细胞组织的牵拉刺激和损伤刺激信息、感觉神经信息、细胞释放的活性物质等),而且这种刺激越强所产生的生物学信息量也越大,从而起到对人体机体修复作用。因此,筋膜学认为通过对筋膜结缔组织高强度的刺激可对机体病变起到修复作用。
新易筋疗法正是基于筋膜学理论,并结合“骨错缝、筋出槽”的治疗理念,提出的一种系统的标准化的治疗胸椎小关节紊乱的治疗方法。首先,通过跨关节的最大角度的牵拉、拔伸和旋转刺激关节囊囊内筋膜结缔组织及深感觉感受器；然后,通过传统针刺和浮针等方法给予病变部位周围的肌间隔筋膜结缔组织及皮神经高强度的刺激,最后,再通过手法复位使“骨复位,筋归槽”,从而达到有效治疗疾病并防止复发的目的。
本临床研究就是采用简单随机对照原则,通过与传统针刺比较,观察新易筋疗法治疗胸椎小关节紊乱的临床疗效,以探索一种新的治疗胸椎小关节紊乱的方法。
目的
通过简单随机对照临床研究,与传统针刺比较,对新易筋疗法治疗胸椎小关节紊乱的临床疗效的观察,并通过对胸椎小关节紊乱患者治疗前后的临床表现积分比较来分析新易筋疗法对患者症状、体征及生活质量的影响,以寻求一种新的更有效的治疗胸椎小关节紊乱的方法。同时也为筋膜学理论提高部分临床支持。
方法
1、本研究所有病例均来源于香港日光诊疗中心胸椎小关节紊乱患者,收集时间为2008年10月至2010年11月,共80例。采用随机对照原则,将其分为治疗组和对照组,两组各40例。
2、治疗方法
(1)治疗组：给予新易筋疗法治疗,具体操作如下：①手法推拿：患者俯卧位,医生站于患侧。外展患者患侧上肢45。后用手握住肘关节,另一只手掌跟于肩胛上角内侧,肩关节旋内后最大角度的用力牵拉、拔伸和旋转肩关节3周,然后使肩关节旋外再最大角度的用力牵拉、拔伸和旋转肩关节3周。转至患者的健侧,用手掌跟部按住患侧肩胛下角内侧,屈患侧膝关节至最大角度后用另一只胳膊抱住膝关节,先逆时针最大角度用力牵拉、拔伸和旋转髋关节3周,然后再顺时针最大角度用力牵拉、拔伸和旋转髋关节3周。再转至患者的患侧,同样方法,最大角度用力牵拉、拔伸和旋转健侧髋关节。然后用掌跟部沿着脊柱自上而下推理数次。②传统针刺：针刺部位为患侧肩胛间区和肩胛骨区压痛点处,常规消毒后,选用一次性直径为0.30mm,长度为40mm的毫针,针尖向下与皮肤呈约30。进针,施以捻转手法得气后,留针15～30 min,每隔5-10 min捻转针体数次。③浮针：针刺部位为患侧肩胛间区压痛最厉害的部位,常规消毒后,选用一次性5 ml注射器针头,针尖朝下迅速刺入皮下后,左右晃动针体数下后,留针15-20 min,每隔5-10 min晃动针体1-2次。④推拿与固定：医生站于患侧,将患侧屈肘90。后尽可能的将上肢内收使前臂后部贴于后背。先用大拇指按于患侧肩胛上角,虎口朝向健侧,另一只手握住患侧踝关节屈膝90。,最大角度的旋转膝关节。然后再分别用大拇指按住肩胛骨下角、用掌跟按于患侧肩胛间区,先后以同样方法旋转膝关节。最后用医用棉花垫与患侧肩胛间区,并用医用胶布压紧后牢固固定胶布。每次治疗后休息2天,连续治疗3次,3次为一个疗程。满一个疗程后立即对其进行评分和临床疗效评价。
(2)对照组：仅给予传统针刺治疗,未给予推拿、浮针及固定治疗,针刺部位与疗程均同治疗组。
3、评分标准
(1)视觉模拟评分(visual analog scale, VAS)
(2)行为疼痛测定表(behavioral rating scale, BRS-6)
(3)McGill疼痛量表(包括PRI知觉、PRI感情和PRI总分)
(4)临床疗效评价
参考国家中医药管理局《中医病证诊断疗效标准》中胸椎小关节紊乱疗效评定标准制定,具体如下：
临床治愈：症状完全消失,活动自如,胸椎偏歪纠正,棘突压痛消失,随访半年无复发；
好转：症状体征基本消失,胸椎偏歪纠正,棘突压痛减轻,但深呼吸或者咳嗽时仍有轻微疼痛；
无效：症状及体征无明显改善。
结果
1、本研究过程中未出现中止、剔除和脱漏病例,全部完成了临床研究。
2、治疗前,经卡方检验比较治疗组和对照组之间性别构成不具有统计学差异(P>0.05),经两独立样本t检验和Mann-Whitney U检验比较两组间治疗前年龄、视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分均无统计学差异(P>0.05)。因此,治疗组和对照组具有可比性。
3、治疗后,治疗组和对照组治疗后视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分均明显优于治疗前,且经两相关样本Wilcoxon符合秩检验比较,治疗前后具有显著性差异(P<0.01)。
4、治疗后,治疗组的治疗后视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分及治疗前后评分差均优于对照组,且经两独立样本Mann-Whitney U检验比较,治疗组和对照组均具有显著性差异(P<0.01)。
5、治疗后,治疗组的临床治愈率及总有效率均明显高于对照组,且经两独立样本Mann-Whitney U检验比较,治疗组和对照组间的临床疗效具有显著性差异(P<0.01)。
结论
通过对新易筋疗法治疗胸椎小关节紊乱的症状、体征、生活质量及临床疗效的客观评价,本研究表明：新易筋疗法和单纯的传统针刺治疗胸椎小关节紊乱虽都能缓解患者疼痛,改善患者生活质量,但新易筋疗法的的疗效更加显著,而且其临床治愈率和总有效率均明显高于对照组。因此,新易筋疗法是一种操作简便、疗效迅速、疗程短、有效防止复发、新的更有效的治疗胸椎小关节紊乱的方法,同时也为筋膜学理论提高了部分临床支持。
Background
Thoracic facet joint disorders (TFJD) are mainly caused by the dislocation of the thoracic vertebral facet joint and rib joint due to various reasons, stretching the soft tissue to stimulate the nerves and leading to the main symptoms of thoracodorsal pain. In general, it mainly occurs in the upper or middle thoracic vertebras, and more common in the athletes. Thoracic facet joints are formed by the thoracic vertebral facet joint and rib joint. The connections of the joints are often stable, the activity scope of the joints are very small, and usually not easy to cause damage. As the soft tissue around the thoracic vertebra is very weak, if people use computers, to bend over a desk, or maintain a single position for long time, especially in terms of the athletes, need a training to conduct a long-term action, the spinal ligament would turn to fatigue and relaxation, the activity of the vertebras would increase, the spinal facet joints would deviation from the normal position and dislocation, they would cause the clinical symptoms finally. If the dislocations only occur between the articular surface of the joints, they usually cannot be displayed by the X-ray. Thoracic facet joint disorders is a common clinical disease, the incidence rate is showing a young, fast-growing trend. With the growing popularity of computers, they are changing people's life and work styles. Thoracic facet joint disorders will gradually become the most common disease in the modern life, and will bring great burden and pressure both for people and societ. Therefore, studying how to treat thoracic facet joint disorders is of great significance.
Currently there is no generally accepted and effective treatment method for thoracic facet joint disorders both in China and abroad. Western medicine treatment mainly given analgesics for pain relief based on symptomatic treatment, such as aspirin, indomethacin, and they also given them some other drugs for supported therapy,such as vasodilator drugs, muscle relaxant's drugs, neurotrophic or regulation drugs, physical therapy and so on. If the disease is very severe, it could give procaine hydrochloride or prednisolone for local injection. Although these treatments can relieve pain temporarily, the effects are not very significant, and easy to relapse.
In traditional Chinese medicine, the thoracic facet joint disorders is classified into "chest pain"or "back pain", but also "tendons out of the slot, bone staggered joint", which is a terminology of traditional Chinese medicine. It not only is a disease name, but also can reflect the change of the pathogenesis. "bone staggered joint" generally divided into two cases. One is different losses between joints induce the normal anatomical structure form a small staggered joint. The other serious one is that suture is Uneven or subluxation, which can be displayed in X-ray and pain are more obvious. "Tendons out of the slot" means when injury, tendon and other soft tissue slippage, or changes in the anatomical location, which affects mobility, even appear more intense pain and affect the normal work and life. It has close relationship between "tendons out of the slot" and "bone staggered joint". Injury by "tendons out of the slot" can induce interlocking suture dislocation of bone suture. Dislocation of bone suture can also induce tendon injury. So treatment on "bone staggered joint" in Golden Mirror of Medicine thought that massage treatment should be first used to cure muscle injury. Therefore, in traditional Chinese medicine, acupuncture and massage treat the thoracic facet joint disorder has particular advantages. It is mainly formed a combination of integrated the massage with acupuncture, cupping, topical, needle knife and so on. All of them had unique effects.
In recent years, by three-dimensionally reconstructing connective tissue (fascia) in the trunk and limbs of the human body as well as tracing back to tissue origins in light of biological evolution and developmental biology, Prof. Yuan developed fasciology, which states that the human body can be divided into two systems. One is a supporting-storing system consisting of undifferentiated non-specific connective tissues, including loose connective and adipose tissue. The other system is a functional system consisting of a variety of differentiated functional cells, which is surrounded and supported by the fascial frame of the supporting-storing system. In fasciology, connective tissues that link all parts of the human body compose the anatomical basis of meridian. Acupuncture point means a place that rich in nerve receptor with intense bioinformation and connective tissue of competent cell. Therefore, "acupuncture point" and "un-acupuncture point" only differ at quantitative of the bioinformation, but not qualitative, which means that acupuncture point filled our whole body. Though stimulating the acupuncture point, fascia tissue could generate intense bioinformation in the supporting-storing system, and stimulate the function regulation (activity of tissue and cells) and life regulation (repair and regenerate of tissue and cells) of body, finally promoting repair the function system. Therefore, though high-intensity stimulating fascia tissue in the supporting-storing system could promote repairing of body function based on the fasciology theory.
The new Yi-Jin therapy is a system of standardized treatment of thoracic facet joint disorder treatment based on the fasciology theory, combined with the treatment concept of "tendons out of the slot, bone staggered joint". Firstly, the maximum joint angle cross-stretch, pulling and rotating to stimulate the joint capsule of connective tissue capsule and deep fascia sense receptors; Sencodly, through traditional methods such as acupuncture needles, and floating around the lesion given fascia connective tissue septum organizations and high-intensity stimulation of cutaneous nerve; Finally, and through the manual reduction so that the "reset bones, tendons go trough", so as to achieve effective treatment of the disease and prevent recurrence of the goal.
This clinical study is to use the simple random control principle, compared with traditional acupuncture to observe the new Yijin thoracic facet joint disorder therapy clinical efficacy, and to explore a new therapeutic method of thoracic facet joint disorders.
Objective
Used simple randomized controlled clinical study, compared with traditional acupuncture, to observe the clinical effects of the new Yi-Jin therapy on the thoracic facet joint disorders. To seek a new, more effective treatment method for thoracic facet joint disorders, and it could provide some clinical evidences for the fasciology theory.
Methods
1. In the study, all the thoracic facet joint disorders patients were chosen from HONGKONG Sunlight Treatment Centre.80 cases were randomly divided into a treatment group (n=40) and a control group(n=40) by a simple randomized principle.
2. The treatment group was treatment with the new Yi-jin therapy, and the control group was treatment with the traditional acupuncture therapy. Both of them selected the same acupuncture points and the same period of treatment. After one time of therapy, the patient had a rest for two days. Three times were a period of treatment.
3. Rating standard
(1) visual analogue scale (visual analog scale, VAS)
(2) Determination of the table of pain behavior (behavioral rating scale, BRS-6)
(3) McGill Pain Questionnaire (including the PRI perception scores, PRI feeling scores and PRI total score)
(4) Clinical Evaluation
Reference Syndrome Diagnostic efficacy standards of TCM which was put out by State Administration of Traditional Chinese Medicine in the efficacy evaluation of thoracic facet joint disorders standards as follows:
Clinical cure:the symptoms disappeared completely, move with esea, thoracic skew correctted, spinous process tenderness disappeared.
Improved:the symptoms disappeared mostly, thoracic skew correctted, spinous process tenderness lessened, but still had mild pain when deep breathing and coughing;
Invalid:there were no significant improvement both in symptoms and signs.
Results
1. This study does not appear during the suspension, removed and lacuna cases, all completed a clinical study.
2. Before treatment, compared by chi square test between the treatment and control groups was not statistically different gender composition (P> 0.05), by two independent samples t test or Mann-Whitney U test to compare the two groups before treatment, age, visual analog scale, pain behavior Determination of the table, PRI perception, PRI feelings and no significant difference between PRI scores (P> 0.05). Thus, treatment and control groups were comparable.
3. After treatment, the treatment group and control group after treatment visual analog scale, pain behavior measurement table, PRI perception, PRI and the PRI out of the feelings are much better than before treatment and compared by Wilcoxon one-sample test before and after treatment was significant differences (P<0.01).
4. After treatment, the treatment group after treatment, visual analog scale, pain behavior measurement table, PRI perception, PRI and PRI scores and emotional scores before and after treatment are worse than the control group, and by two independent samples Mann-Whitney U test to compare the treatment group and the control group were significant differences (P<0.01).
5. After treatment, the clinical cure rate in treatment group and the total effective rate was significantly higher, and compared by two independent samples Mann-Whitney U test, the treatment group and clinical efficacy of the control group was significant difference (P<0.01).
Conclusion
Though objective evaluation of the clinical efficacy, this study showed that both the new Yi-Jin therapy and the traditional acupuncture therapy could relieve pain in the thoracic facet joint disorders patients and improve the quality of life, but the new Yi-Jin therapy had the more efficacy and the clinical cure rate and total effective rate was significantly higher. Therefore, the new Yi-Jin therapy is a simple, rapid effect, short course, prevent recurrence, new and more effective treatment method of thoracic facet joint disorders, and this study also could provide some clinical evidences for the fasciology theory.
胸椎小关节紊乱(thoracic facet joint disorders, TFJD)主要是指由于各种原因导致的胸椎关节突关节和肋椎关节的错位,牵拉软组织刺激神经而产生以胸背痛为主症的病证,一般多发于上中胸段,运动员多见。胸椎小关节由胸椎后关节和肋椎关节组成,从理论上讲,胸椎的连接比较稳定,并且活动度小,一般不易引起损伤。由于胸椎周围的软组织比较薄弱,长时间使用电脑、伏案或保持单一姿势特别是对于运动员来讲,需长期进行某一个训练动作使脊柱的韧带过度疲劳而变松弛、椎体间的活动度增大,可产生脊柱小关节偏离正常位置造成错位,从而引起临床症状。由于错位只发生在脊柱关节面之间,所以通常情况下X线无法显示紊乱情况。胸椎小关节紊乱是临床的常见病,其发病率正呈现出年轻化、快速增长的趋势。随着电脑的不断普及,人们的工作生活方式的改变,胸椎小关节紊乱将逐渐成为现代生活中最为常见的疾病之一,并且将给个人及社会带来巨大负担和压力。因此,研究如何治疗胸椎小关节紊乱具有重要的意义。
目前,国内外对于胸椎小关节紊乱的治疗尚无公认的、确切的治疗方法。西医治疗主要以对症治疗为主,主要给予止痛剂缓解疼痛,如阿司匹林、消炎痛等药物,并辅以扩张血管药、解筋类药物、神经营养和条件药物、物理治疗等,严重者可给予局部注射盐酸普鲁卡因、强的松龙等。这些治疗方法虽能暂时缓解疼痛,但疗效都不甚显著,容易复发。
祖国医学认为,胸椎小关节紊乱,属于中医学“胸痛”、“背痛”范畴,也属于“骨错缝、筋出槽”范畴。“骨错缝,筋出槽”是中医特有的名词,它既属于病名,又属于病机变化。“骨错缝”一方面是指骨关节之间,由于不同的损失,使正常的解剖结构发生了微小错缝。这种改变的半脱位很轻,所以在线摄片上目前还不能得到反映。但解剖结构病理改变以后,影响到生理机能,故出现肿胀疼痛；另一方面是指比较严重的骨缝发生参差不齐或半脱位,在X线摄片上可以显示,肿胀疼痛也比较显著。“筋出槽”是指受损伤时,肌键等软组织发生滑脱或解剖位置有变化,从而影响活动功能,甚者出现较剧烈的疼痛,影响正常的工作和生活。因此,祖国医学中的针灸推拿治疗胸椎小关节紊乱具有独特的优势,现主要形成了以推拿手法为主,针灸、拔罐、外敷、针刀、中药等相结合的综合治疗方法,并取得了一定的疗效。
近年来,原林教授通过对人体筋膜结缔组织进行标记和三维重建,并进一步对人体非特异性结缔组织的生物进化和发育生物学进行追踪溯源,提出了“筋膜学理论”。它认为人体是由两个系统组成,即由全身非特异性筋膜结缔组织支架构成的支持与储备系统和被该支架支持和包绕的功能细胞构成的功能系统。其中全身的筋膜结缔组织支架构成了中医经络的物质基础,“穴位”是指在人体的结缔组织聚集处进行针刺操作时能够产生较强生物学信息的部位。全身各处“穴位”与“非穴位”没有质的区别而只有所含生物信息量的差异,即全身各处都是“穴位”。通过针刺穴位,对局部结缔组织进行机械牵拉刺激可产生较强的生物学信息(如局部细胞组织的牵拉刺激和损伤刺激信息、感觉神经信息、细胞释放的活性物质等),而且这种刺激越强所产生的生物学信息量也越大,从而起到对人体机体修复作用。因此,筋膜学认为通过对筋膜结缔组织高强度的刺激可对机体病变起到修复作用。
新易筋疗法正是基于筋膜学理论,并结合“骨错缝、筋出槽”的治疗理念,提出的一种系统的标准化的治疗胸椎小关节紊乱的治疗方法。首先,通过跨关节的最大角度的牵拉、拔伸和旋转刺激关节囊囊内筋膜结缔组织及深感觉感受器；然后,通过传统针刺和浮针等方法给予病变部位周围的肌间隔筋膜结缔组织及皮神经高强度的刺激,最后,再通过手法复位使“骨复位,筋归槽”,从而达到有效治疗疾病并防止复发的目的。
本临床研究就是采用简单随机对照原则,通过与传统针刺比较,观察新易筋疗法治疗胸椎小关节紊乱的临床疗效,以探索一种新的治疗胸椎小关节紊乱的方法。
目的
通过简单随机对照临床研究,与传统针刺比较,对新易筋疗法治疗胸椎小关节紊乱的临床疗效的观察,并通过对胸椎小关节紊乱患者治疗前后的临床表现积分比较来分析新易筋疗法对患者症状、体征及生活质量的影响,以寻求一种新的更有效的治疗胸椎小关节紊乱的方法。同时也为筋膜学理论提高部分临床支持。
方法
1、本研究所有病例均来源于香港日光诊疗中心胸椎小关节紊乱患者,收集时间为2008年10月至2010年11月,共80例。采用随机对照原则,将其分为治疗组和对照组,两组各40例。
2、治疗方法
(1)治疗组：给予新易筋疗法治疗,具体操作如下：①手法推拿：患者俯卧位,医生站于患侧。外展患者患侧上肢45。后用手握住肘关节,另一只手掌跟于肩胛上角内侧,肩关节旋内后最大角度的用力牵拉、拔伸和旋转肩关节3周,然后使肩关节旋外再最大角度的用力牵拉、拔伸和旋转肩关节3周。转至患者的健侧,用手掌跟部按住患侧肩胛下角内侧,屈患侧膝关节至最大角度后用另一只胳膊抱住膝关节,先逆时针最大角度用力牵拉、拔伸和旋转髋关节3周,然后再顺时针最大角度用力牵拉、拔伸和旋转髋关节3周。再转至患者的患侧,同样方法,最大角度用力牵拉、拔伸和旋转健侧髋关节。然后用掌跟部沿着脊柱自上而下推理数次。②传统针刺：针刺部位为患侧肩胛间区和肩胛骨区压痛点处,常规消毒后,选用一次性直径为0.30mm,长度为40mm的毫针,针尖向下与皮肤呈约30。进针,施以捻转手法得气后,留针15～30 min,每隔5-10 min捻转针体数次。③浮针：针刺部位为患侧肩胛间区压痛最厉害的部位,常规消毒后,选用一次性5 ml注射器针头,针尖朝下迅速刺入皮下后,左右晃动针体数下后,留针15-20 min,每隔5-10 min晃动针体1-2次。④推拿与固定：医生站于患侧,将患侧屈肘90。后尽可能的将上肢内收使前臂后部贴于后背。先用大拇指按于患侧肩胛上角,虎口朝向健侧,另一只手握住患侧踝关节屈膝90。,最大角度的旋转膝关节。然后再分别用大拇指按住肩胛骨下角、用掌跟按于患侧肩胛间区,先后以同样方法旋转膝关节。最后用医用棉花垫与患侧肩胛间区,并用医用胶布压紧后牢固固定胶布。每次治疗后休息2天,连续治疗3次,3次为一个疗程。满一个疗程后立即对其进行评分和临床疗效评价。
(2)对照组：仅给予传统针刺治疗,未给予推拿、浮针及固定治疗,针刺部位与疗程均同治疗组。
3、评分标准
(1)视觉模拟评分(visual analog scale, VAS)
(2)行为疼痛测定表(behavioral rating scale, BRS-6)
(3)McGill疼痛量表(包括PRI知觉、PRI感情和PRI总分)
(4)临床疗效评价
参考国家中医药管理局《中医病证诊断疗效标准》中胸椎小关节紊乱疗效评定标准制定,具体如下：
临床治愈：症状完全消失,活动自如,胸椎偏歪纠正,棘突压痛消失,随访半年无复发；
好转：症状体征基本消失,胸椎偏歪纠正,棘突压痛减轻,但深呼吸或者咳嗽时仍有轻微疼痛；
无效：症状及体征无明显改善。
结果
1、本研究过程中未出现中止、剔除和脱漏病例,全部完成了临床研究。
2、治疗前,经卡方检验比较治疗组和对照组之间性别构成不具有统计学差异(P>0.05),经两独立样本t检验和Mann-Whitney U检验比较两组间治疗前年龄、视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分均无统计学差异(P>0.05)。因此,治疗组和对照组具有可比性。
3、治疗后,治疗组和对照组治疗后视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分均明显优于治疗前,且经两相关样本Wilcoxon符合秩检验比较,治疗前后具有显著性差异(P<0.01)。
4、治疗后,治疗组的治疗后视觉模拟评分、行为疼痛测定表、PRI知觉、PRI感情和PRI总分及治疗前后评分差均优于对照组,且经两独立样本Mann-Whitney U检验比较,治疗组和对照组均具有显著性差异(P<0.01)。
5、治疗后,治疗组的临床治愈率及总有效率均明显高于对照组,且经两独立样本Mann-Whitney U检验比较,治疗组和对照组间的临床疗效具有显著性差异(P<0.01)。
结论
通过对新易筋疗法治疗胸椎小关节紊乱的症状、体征、生活质量及临床疗效的客观评价,本研究表明：新易筋疗法和单纯的传统针刺治疗胸椎小关节紊乱虽都能缓解患者疼痛,改善患者生活质量,但新易筋疗法的的疗效更加显著,而且其临床治愈率和总有效率均明显高于对照组。因此,新易筋疗法是一种操作简便、疗效迅速、疗程短、有效防止复发、新的更有效的治疗胸椎小关节紊乱的方法,同时也为筋膜学理论提高了部分临床支持。
Background
Thoracic facet joint disorders (TFJD) are mainly caused by the dislocation of the thoracic vertebral facet joint and rib joint due to various reasons, stretching the soft tissue to stimulate the nerves and leading to the main symptoms of thoracodorsal pain. In general, it mainly occurs in the upper or middle thoracic vertebras, and more common in the athletes. Thoracic facet joints are formed by the thoracic vertebral facet joint and rib joint. The connections of the joints are often stable, the activity scope of the joints are very small, and usually not easy to cause damage. As the soft tissue around the thoracic vertebra is very weak, if people use computers, to bend over a desk, or maintain a single position for long time, especially in terms of the athletes, need a training to conduct a long-term action, the spinal ligament would turn to fatigue and relaxation, the activity of the vertebras would increase, the spinal facet joints would deviation from the normal position and dislocation, they would cause the clinical symptoms finally. If the dislocations only occur between the articular surface of the joints, they usually cannot be displayed by the X-ray. Thoracic facet joint disorders is a common clinical disease, the incidence rate is showing a young, fast-growing trend. With the growing popularity of computers, they are changing people's life and work styles. Thoracic facet joint disorders will gradually become the most common disease in the modern life, and will bring great burden and pressure both for people and societ. Therefore, studying how to treat thoracic facet joint disorders is of great significance.
Currently there is no generally accepted and effective treatment method for thoracic facet joint disorders both in China and abroad. Western medicine treatment mainly given analgesics for pain relief based on symptomatic treatment, such as aspirin, indomethacin, and they also given them some other drugs for supported therapy,such as vasodilator drugs, muscle relaxant's drugs, neurotrophic or regulation drugs, physical therapy and so on. If the disease is very severe, it could give procaine hydrochloride or prednisolone for local injection. Although these treatments can relieve pain temporarily, the effects are not very significant, and easy to relapse.
In traditional Chinese medicine, the thoracic facet joint disorders is classified into "chest pain"or "back pain", but also "tendons out of the slot, bone staggered joint", which is a terminology of traditional Chinese medicine. It not only is a disease name, but also can reflect the change of the pathogenesis. "bone staggered joint" generally divided into two cases. One is different losses between joints induce the normal anatomical structure form a small staggered joint. The other serious one is that suture is Uneven or subluxation, which can be displayed in X-ray and pain are more obvious. "Tendons out of the slot" means when injury, tendon and other soft tissue slippage, or changes in the anatomical location, which affects mobility, even appear more intense pain and affect the normal work and life. It has close relationship between "tendons out of the slot" and "bone staggered joint". Injury by "tendons out of the slot" can induce interlocking suture dislocation of bone suture. Dislocation of bone suture can also induce tendon injury. So treatment on "bone staggered joint" in Golden Mirror of Medicine thought that massage treatment should be first used to cure muscle injury. Therefore, in traditional Chinese medicine, acupuncture and massage treat the thoracic facet joint disorder has particular advantages. It is mainly formed a combination of integrated the massage with acupuncture, cupping, topical, needle knife and so on. All of them had unique effects.
In recent years, by three-dimensionally reconstructing connective tissue (fascia) in the trunk and limbs of the human body as well as tracing back to tissue origins in light of biological evolution and developmental biology, Prof. Yuan developed fasciology, which states that the human body can be divided into two systems. One is a supporting-storing system consisting of undifferentiated non-specific connective tissues, including loose connective and adipose tissue. The other system is a functional system consisting of a variety of differentiated functional cells, which is surrounded and supported by the fascial frame of the supporting-storing system. In fasciology, connective tissues that link all parts of the human body compose the anatomical basis of meridian. Acupuncture point means a place that rich in nerve receptor with intense bioinformation and connective tissue of competent cell. Therefore, "acupuncture point" and "un-acupuncture point" only differ at quantitative of the bioinformation, but not qualitative, which means that acupuncture point filled our whole body. Though stimulating the acupuncture point, fascia tissue could generate intense bioinformation in the supporting-storing system, and stimulate the function regulation (activity of tissue and cells) and life regulation (repair and regenerate of tissue and cells) of body, finally promoting repair the function system. Therefore, though high-intensity stimulating fascia tissue in the supporting-storing system could promote repairing of body function based on the fasciology theory.
The new Yi-Jin therapy is a system of standardized treatment of thoracic facet joint disorder treatment based on the fasciology theory, combined with the treatment concept of "tendons out of the slot, bone staggered joint". Firstly, the maximum joint angle cross-stretch, pulling and rotating to stimulate the joint capsule of connective tissue capsule and deep fascia sense receptors; Sencodly, through traditional methods such as acupuncture needles, and floating around the lesion given fascia connective tissue septum organizations and high-intensity stimulation of cutaneous nerve; Finally, and through the manual reduction so that the "reset bones, tendons go trough", so as to achieve effective treatment of the disease and prevent recurrence of the goal.
This clinical study is to use the simple random control principle, compared with traditional acupuncture to observe the new Yijin thoracic facet joint disorder therapy clinical efficacy, and to explore a new therapeutic method of thoracic facet joint disorders.
Objective
Used simple randomized controlled clinical study, compared with traditional acupuncture, to observe the clinical effects of the new Yi-Jin therapy on the thoracic facet joint disorders. To seek a new, more effective treatment method for thoracic facet joint disorders, and it could provide some clinical evidences for the fasciology theory.
Methods
1. In the study, all the thoracic facet joint disorders patients were chosen from HONGKONG Sunlight Treatment Centre.80 cases were randomly divided into a treatment group (n=40) and a control group(n=40) by a simple randomized principle.
2. The treatment group was treatment with the new Yi-jin therapy, and the control group was treatment with the traditional acupuncture therapy. Both of them selected the same acupuncture points and the same period of treatment. After one time of therapy, the patient had a rest for two days. Three times were a period of treatment.
3. Rating standard
(1) visual analogue scale (visual analog scale, VAS)
(2) Determination of the table of pain behavior (behavioral rating scale, BRS-6)
(3) McGill Pain Questionnaire (including the PRI perception scores, PRI feeling scores and PRI total score)
(4) Clinical Evaluation
Reference Syndrome Diagnostic efficacy standards of TCM which was put out by State Administration of Traditional Chinese Medicine in the efficacy evaluation of thoracic facet joint disorders standards as follows:
Clinical cure:the symptoms disappeared completely, move with esea, thoracic skew correctted, spinous process tenderness disappeared.
Improved:the symptoms disappeared mostly, thoracic skew correctted, spinous process tenderness lessened, but still had mild pain when deep breathing and coughing;
Invalid:there were no significant improvement both in symptoms and signs.
Results
1. This study does not appear during the suspension, removed and lacuna cases, all completed a clinical study.
2. Before treatment, compared by chi square test between the treatment and control groups was not statistically different gender composition (P> 0.05), by two independent samples t test or Mann-Whitney U test to compare the two groups before treatment, age, visual analog scale, pain behavior Determination of the table, PRI perception, PRI feelings and no significant difference between PRI scores (P> 0.05). Thus, treatment and control groups were comparable.
3. After treatment, the treatment group and control group after treatment visual analog scale, pain behavior measurement table, PRI perception, PRI and the PRI out of the feelings are much better than before treatment and compared by Wilcoxon one-sample test before and after treatment was significant differences (P<0.01).
4. After treatment, the treatment group after treatment, visual analog scale, pain behavior measurement table, PRI perception, PRI and PRI scores and emotional scores before and after treatment are worse than the control group, and by two independent samples Mann-Whitney U test to compare the treatment group and the control group were significant differences (P<0.01).
5. After treatment, the clinical cure rate in treatment group and the total effective rate was significantly higher, and compared by two independent samples Mann-Whitney U test, the treatment group and clinical efficacy of the control group was significant difference (P<0.01).
Conclusion
Though objective evaluation of the clinical efficacy, this study showed that both the new Yi-Jin therapy and the traditional acupuncture therapy could relieve pain in the thoracic facet joint disorders patients and improve the quality of life, but the new Yi-Jin therapy had the more efficacy and the clinical cure rate and total effective rate was significantly higher. Therefore, the new Yi-Jin therapy is a simple, rapid effect, short course, prevent recurrence, new and more effective treatment method of thoracic facet joint disorders, and this study also could provide some clinical evidences for the fasciology theory.
引文
[1]杨琳,高英茂.格式解剖学[M].第38版.沈阳：辽宁教育出版社,1999.
[2]柏树令.系统解剖学[M].第五版.北京：人民卫生出版社.2001.
[3]徐达传.系统解剖学[M].第2版.北京：高等教育出版社.2003.
[4]严隽陶.推拿学[M].河南科技出版社.2005,08：43.
[5]马奎云.颈源性疾病诊断治疗学[M].郑州：河南科技出版社.2005：310-318.
[6]李云庆.临床应用解剖学[M].郑州：河南科学技术出版社.2006.
[7]钟开武.关节松动技术治疗胸椎小关节紊乱[J].云南中医中药杂志.2002,23(2)：22-23.
[8]赵永祥.刮痧拔罐为主治疗胸椎小关节紊乱[J].中国中医基础医学杂志.2006,12(3)：227.
[9]黄明,王华军.胸椎小关节紊乱症的治疗现状和命名商榷[J].按摩与导引.2008,24(4)：36-37.
[10]孔令胜,余润明.按压整复胸椎小关节紊乱症42例[J].安徽中医学院学报.1995,14(2)：17.
[11]刘仁毅.浅谈脊柱“骨错缝”理论及其临床治疗[J].实用中西医结合临床.2005,5(6)：62-63.
[12]孙进和,安娜,曲美琴.胸背部涂擦扶他林加手法复位治疗胸椎小关节错缝18例[J].中国民间疗法.2010,18(10)：29-30.
[13]蔡永峰.手法配合贴敷治疗胸椎小关节紊乱[J].中国医药导报.2009(21)：157.
[14]陈桂莲.中频电疗配合手法治疗胸椎小关节紊乱症[J].华南预防医学.2003,29(4)：64.
[15]杨利华.中药离子导入结合手法治疗胸椎小关节紊乱综合征58例[J].江西中医药.2008,39(11)：47.
[16]庞建兵.推拿配合中频治疗胸椎小关节紊乱症100例体会[J].按摩与导引.2009(8)：39.
[17]邹瑾.电针配合手法复位治疗胸椎小关节紊乱症体会[J].针灸临床杂志.2009,25(11)：29.
[18]胡伟民,周红梅,姜玉英,等.局部阻滞加手法治疗急性胸椎小关节紊乱症[J].中国临床康复.2004,8(23)：4717.
[19]李伟广.推拿配合穴位注射治疗胸椎小关节紊乱症[J].按摩与导引.2005,21(6)：35-36.
[20]伍先光,易瑛,等.正骨推拿加穴位封闭治疗顽固性呃逆12例[J].按摩与导引.2002,18(2)：24.
[21]万勇,刘洁,陈爱萍,等.CT引导下局部注射治疗胸椎小关节综合征2例[J].中国康复.2009,24(6)：430.
[22]雷迈.胸椎小关节紊乱症的康复治疗[J].按摩与导引.2006,22(12)：21.
[23]杨芳,郭玉林,杜玉书,等.采用关节松动术治疗胸椎小关节紊乱20例[J].实用骨科杂志.2004,10(5)：476.
[24]姜永庆.小切口软组织松解术治疗胸椎后关节紊乱症[J].中国临床康复.2003,7(14)：2065.
[25]汪芹,黄顺贤.“骨错缝”“筋出槽”理论的临床认识[J].现代中医药.2009(4)：60-61.
[26]沈则民.壮督活血舒筋汤合手法治疗胸椎小关节紊乱52例——附单用手法治疗30例对照[J].浙江中医杂志.2003,38(8)：346.
[27]张泰鹃.胸椎小关节紊乱综合征的症治[J].中国自然医学杂志.2001,3(4)：248-249.
[28]刑京禹,王晓艳.胸椎小关节紊乱的推拿辨证[J].中国民间疗法.2010,18(1)：58-59.
[29]曹郑云.理气定痛汤配合手法治疗胸椎小关节紊乱症52例[J].河北中医.2004,26(11)：820.
[30]郑忠国.周氏通阳活血汤配合手法治疗胸椎小关节紊乱39例[J].浙江中医杂志.2000,35(5)：201.
[31]沈则民.壮督活血舒筋汤合手法治疗胸椎小关节紊乱52例——附单用手法治疗30例对照[J].浙江中医杂志.2003,38(8)：346.
[32]秦峰.经络整脊法治疗胸椎关节功能紊乱综合征21例[J].中国民间疗法.2001,9(1)：13.
[33]周文敏,陈勉,林熙文.林如高理筋手法治疗胸椎小关节紊乱665例[J].中国中医骨伤科杂志.2004,12(2)：21-22.
[34]俞乐,李远明,林伟锋.林应强教授正骨手法治疗胸椎小关节紊乱的临床观察[J].广东医学.2008,29(7)：1225-1226.
[35]许树柴,刘军.罗金官运用罗氏正骨法诊治胸椎小关节紊乱症的经验[J].江苏中医药.2006,27(11)：14-15.
[36]王霞.双掌逆推法治疗胸椎小关节紊乱症52例[J].山东中医杂志.2003,22(4)：219-220.
[37]曹阳.运动整复胸椎后关节[J].中国疗养医学.2007,16(11)：674-675.
[38]陈洪江.叠压法为主治疗胸椎小关节错缝症36例[J].实用中医药杂志.2006,22(10)：640-641.
[39]李建军,陈立谷,张雪莲,等.手法整复胸椎小关节错缝115例[J].中国中医急症.2008,17(8)：1154-1155.
[40]黄仲海,黄光荣.手法为主治疗胸椎小关节紊乱症200例[J].广西中医药.2005,28(2)：29-30.
[41]章振永,张巧玲,付小红.针刺合手法治疗胸椎小关节紊乱42例[J].中国针灸.2005,25(7)：464.
[42]洪东方,朱崇瑞.旋转按压法结合针刺阳陵泉治疗胸椎后关节紊乱40例[J].吉林中医药.2010,30(10)：886-887.
[43]叶田.针灸治疗胸椎椎小关节紊乱60例[J].黑龙江医药.2009,22(2)：205-206.
[44]陈志令.针刺并手法治疗胸椎小关节错位引起心血管功能变化86例[J].中外健康文摘.2009,8(18)：109-110.
[45]孙西霞.针刀序贯疗法治疗胸椎小关节紊乱症[J].社区医学杂志.2005,3(5)：82.
[46]邵炯.针刀配合推拿治疗胸椎小关节紊乱72例[J].上海针灸杂志.2006,25(8)：34-35.
[47]陆永辉,邓倪.针罐结合治疗胸椎小关节紊乱36例[J].针灸临床杂志.2004,20(8)：11.
[48]吕亚南.伤科指针点穴及胸椎仰卧顶按复位法治疗胸椎小关节错缝51例[J].陕西中医.2001,22(9)：560-561.
[49]李军胜.点穴、推拿治疗胸椎小关节紊乱症50例[J].按摩与导引.2005,21(5)：12-13.
[50]李雪珍,高宏,金英杰.腕踝针配合手法治疗胸椎小关节紊乱30例[J].针灸临床杂志.2006,22(1)：7-8.
[51]徐君强,张玉民.综合治疗胸椎错位及其小关节紊乱152例[J].现代康复.1999,3(8)：941.
[52]陈永源,莫锦全,周永顶.综合疗法治疗胸椎小关节紊乱症[J].光明中医.2006,21(9)：55-57.
[53]王烨.针灸配合中药熏洗治疗胸椎小关节紊乱综合征67例[J].针灸临床杂志.2007(2)：13.
[54]黄建萍.中西医结合治疗胸椎小关节紊乱症[J].齐齐哈尔医学院学报.2010(8)：1252.
[55]李忠仁主编.《实验针灸学》中国中医药出版社,2003年1月1版.
[56]李仲廉主编.《临床疼痛治疗学》天津科学技术出版社,2005年4月第3版.
[57]Bai Y, Yuan L, Soh K S, et al. Possible applications for fascial anatomy and fasciaology in traditional Chinese medicine [J]. J Acupunct Meridian Stud.2010, 3(2):125-132.
[58]原林,王军,王春雷,等.人体内新的功能系统--支持储备及自体监控系统新学说[J].科技导报.2006,24(6)：85-89.
[59]原林,钟世镇.人体自体检测与调控系统(筋膜学)--经络有关的解剖学基础 [J].天津中医药.2004,21(5)：356-359.
[60]杨春,李东飞,戴景兴,等.异体脂肪源干细胞移植对大鼠的抗衰老作用[J].解剖学报.2010,41(1)：87-92.
[61]原林,姚大卫,唐雷,等.针灸经穴的数字解剖学研究[J].解剖学报.2004,35(4)：337-343.
[62]徐明.针灸治疗坐骨神经痛的临床和实验研究.北京：中国中医研究院,1990.
[63]赵欣敏.电针促进坐骨神经痛损伤后再生及功能恢复的实验研究.南京：南京中医药大学,1999.
[1]王奕斌.抱抖法治疗胸椎后关节紊乱疗效观察[J].按摩与导引.2008,24(3)：41.
[2]白卫民,张会景.手法推拿结合中药艾灸治疗运动员胸椎小关节紊乱症[J].中医正骨.2009,21(8)：63.
[3]汪芹,黄顺贤.“骨错缝”“筋出槽”理论的临床认识[J].现代中医药.2009(4)：60-61.
[4]梁燕梅,袁倩,王会丽.电针配合整骨治疗肋间神经痛30例[J].针灸临床杂志.2010(5).
[5]黄卿,窦思东,黄清豹.脊椎矫正复位术治疗胸椎小关节紊乱94例临床观察[J].亚太传统医药.2010,6(9)：64-65.
[6]崔树松,刘正德.扩胸扳法治疗胸椎小关节功能紊乱症[J].按摩与导引.2001,17(3)：28.
[7]王甫刚.手法配合中药治疗急性胸椎小关节紊乱症[J].中国民间疗法.2009,17(8)：24.
[8]章振永,张巧玲,付小红.针刺合手法治疗胸椎小关节紊乱42例[J].中国针灸.2005,25(7)：464.
[9]邵炯.针刀配合推拿治疗胸椎小关节紊乱72例[J].上海针灸杂志.2006,25(8)：34-35.
[10]杨春,李东飞,戴景兴,等.异体脂肪源干细胞移植对大鼠的抗衰老作用[J].解剖学报.2010,41(1)：87-92.
[11]原林,焦培峰,唐雷,等.中医经络理论的物质基础--结缔组织、筋膜和自体监控系统(筋膜学)[J].中国基础科学.2005,7(3)：44-47.
[12]Bai Y, Yuan L, Soh K S, et al. Possible applications for fascial anatomy and fasciaology in traditional Chinese medicine [J]. J Acupunct Meridian Stud.2010, 3(2):125-132.
[13]黄泳,原林,贺振泉,等.经络腧穴与筋膜学的相关性探讨——数字人研究 的启发[J].中国针灸.2006,26(11)：785-788.
[14]原林,钟世镇.人体自体检测与调控系统(筋膜学)--经络有关的解剖学基础[J].天津中医药.2004,21(5)：356-359.
[15]冉启锋,原林,黄泳.基于筋膜学理论探求腧穴作用机制的思路[J].中国中医药科技.2009,16(5)：399-400.
[16]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志.2008,14(4)：312-314.
[17]王军,王春雷,沈宝林,等.用筋膜学说解读经络实质和物质基础[J].中国针灸.2007,27(8)：583-585.
[18]姜雪梅,张学全,原林.结缔组织在针刺力学信号转导中的作用和研究进展[J].针刺研究.2009,34(2)：136-139.
[19]陈锦明,卢阳佳,黄泳,等.基于结缔组织探讨针刺镇痛的机制[J].现代中西医结合杂志.2010(3)：388-390.
[20]Langevin H M. Connective tissue:a body-wide signaling network?[J]. Med Hypotheses.2006,66(6):1074-1077.
[21]Langevin H M, Yandow J A. Relationship of acupuncture points and meridians to connective tissue planes[J]. Anat Rec.2002,269(6):257-265.
[22]叶衍庆.魏指薪医师的伤科手法的应用指征及疗效机制[C]//上海市伤科研究所.伤科论文汇编(第三辑).上海：上海科学技术出版社,1964：53275.
[2]柏树令.系统解剖学[M].第五版.北京：人民卫生出版社.2001.
[3]徐达传.系统解剖学[M].第2版.北京：高等教育出版社.2003.
[4]严隽陶.推拿学[M].河南科技出版社.2005,08：43.
[5]马奎云.颈源性疾病诊断治疗学[M].郑州：河南科技出版社.2005：310-318.
[6]李云庆.临床应用解剖学[M].郑州：河南科学技术出版社.2006.
[7]钟开武.关节松动技术治疗胸椎小关节紊乱[J].云南中医中药杂志.2002,23(2)：22-23.
[8]赵永祥.刮痧拔罐为主治疗胸椎小关节紊乱[J].中国中医基础医学杂志.2006,12(3)：227.
[9]黄明,王华军.胸椎小关节紊乱症的治疗现状和命名商榷[J].按摩与导引.2008,24(4)：36-37.
[10]孔令胜,余润明.按压整复胸椎小关节紊乱症42例[J].安徽中医学院学报.1995,14(2)：17.
[11]刘仁毅.浅谈脊柱“骨错缝”理论及其临床治疗[J].实用中西医结合临床.2005,5(6)：62-63.
[12]孙进和,安娜,曲美琴.胸背部涂擦扶他林加手法复位治疗胸椎小关节错缝18例[J].中国民间疗法.2010,18(10)：29-30.
[13]蔡永峰.手法配合贴敷治疗胸椎小关节紊乱[J].中国医药导报.2009(21)：157.
[14]陈桂莲.中频电疗配合手法治疗胸椎小关节紊乱症[J].华南预防医学.2003,29(4)：64.
[15]杨利华.中药离子导入结合手法治疗胸椎小关节紊乱综合征58例[J].江西中医药.2008,39(11)：47.
[16]庞建兵.推拿配合中频治疗胸椎小关节紊乱症100例体会[J].按摩与导引.2009(8)：39.
[17]邹瑾.电针配合手法复位治疗胸椎小关节紊乱症体会[J].针灸临床杂志.2009,25(11)：29.
[18]胡伟民,周红梅,姜玉英,等.局部阻滞加手法治疗急性胸椎小关节紊乱症[J].中国临床康复.2004,8(23)：4717.
[19]李伟广.推拿配合穴位注射治疗胸椎小关节紊乱症[J].按摩与导引.2005,21(6)：35-36.
[20]伍先光,易瑛,等.正骨推拿加穴位封闭治疗顽固性呃逆12例[J].按摩与导引.2002,18(2)：24.
[21]万勇,刘洁,陈爱萍,等.CT引导下局部注射治疗胸椎小关节综合征2例[J].中国康复.2009,24(6)：430.
[22]雷迈.胸椎小关节紊乱症的康复治疗[J].按摩与导引.2006,22(12)：21.
[23]杨芳,郭玉林,杜玉书,等.采用关节松动术治疗胸椎小关节紊乱20例[J].实用骨科杂志.2004,10(5)：476.
[24]姜永庆.小切口软组织松解术治疗胸椎后关节紊乱症[J].中国临床康复.2003,7(14)：2065.
[25]汪芹,黄顺贤.“骨错缝”“筋出槽”理论的临床认识[J].现代中医药.2009(4)：60-61.
[26]沈则民.壮督活血舒筋汤合手法治疗胸椎小关节紊乱52例——附单用手法治疗30例对照[J].浙江中医杂志.2003,38(8)：346.
[27]张泰鹃.胸椎小关节紊乱综合征的症治[J].中国自然医学杂志.2001,3(4)：248-249.
[28]刑京禹,王晓艳.胸椎小关节紊乱的推拿辨证[J].中国民间疗法.2010,18(1)：58-59.
[29]曹郑云.理气定痛汤配合手法治疗胸椎小关节紊乱症52例[J].河北中医.2004,26(11)：820.
[30]郑忠国.周氏通阳活血汤配合手法治疗胸椎小关节紊乱39例[J].浙江中医杂志.2000,35(5)：201.
[31]沈则民.壮督活血舒筋汤合手法治疗胸椎小关节紊乱52例——附单用手法治疗30例对照[J].浙江中医杂志.2003,38(8)：346.
[32]秦峰.经络整脊法治疗胸椎关节功能紊乱综合征21例[J].中国民间疗法.2001,9(1)：13.
[33]周文敏,陈勉,林熙文.林如高理筋手法治疗胸椎小关节紊乱665例[J].中国中医骨伤科杂志.2004,12(2)：21-22.
[34]俞乐,李远明,林伟锋.林应强教授正骨手法治疗胸椎小关节紊乱的临床观察[J].广东医学.2008,29(7)：1225-1226.
[35]许树柴,刘军.罗金官运用罗氏正骨法诊治胸椎小关节紊乱症的经验[J].江苏中医药.2006,27(11)：14-15.
[36]王霞.双掌逆推法治疗胸椎小关节紊乱症52例[J].山东中医杂志.2003,22(4)：219-220.
[37]曹阳.运动整复胸椎后关节[J].中国疗养医学.2007,16(11)：674-675.
[38]陈洪江.叠压法为主治疗胸椎小关节错缝症36例[J].实用中医药杂志.2006,22(10)：640-641.
[39]李建军,陈立谷,张雪莲,等.手法整复胸椎小关节错缝115例[J].中国中医急症.2008,17(8)：1154-1155.
[40]黄仲海,黄光荣.手法为主治疗胸椎小关节紊乱症200例[J].广西中医药.2005,28(2)：29-30.
[41]章振永,张巧玲,付小红.针刺合手法治疗胸椎小关节紊乱42例[J].中国针灸.2005,25(7)：464.
[42]洪东方,朱崇瑞.旋转按压法结合针刺阳陵泉治疗胸椎后关节紊乱40例[J].吉林中医药.2010,30(10)：886-887.
[43]叶田.针灸治疗胸椎椎小关节紊乱60例[J].黑龙江医药.2009,22(2)：205-206.
[44]陈志令.针刺并手法治疗胸椎小关节错位引起心血管功能变化86例[J].中外健康文摘.2009,8(18)：109-110.
[45]孙西霞.针刀序贯疗法治疗胸椎小关节紊乱症[J].社区医学杂志.2005,3(5)：82.
[46]邵炯.针刀配合推拿治疗胸椎小关节紊乱72例[J].上海针灸杂志.2006,25(8)：34-35.
[47]陆永辉,邓倪.针罐结合治疗胸椎小关节紊乱36例[J].针灸临床杂志.2004,20(8)：11.
[48]吕亚南.伤科指针点穴及胸椎仰卧顶按复位法治疗胸椎小关节错缝51例[J].陕西中医.2001,22(9)：560-561.
[49]李军胜.点穴、推拿治疗胸椎小关节紊乱症50例[J].按摩与导引.2005,21(5)：12-13.
[50]李雪珍,高宏,金英杰.腕踝针配合手法治疗胸椎小关节紊乱30例[J].针灸临床杂志.2006,22(1)：7-8.
[51]徐君强,张玉民.综合治疗胸椎错位及其小关节紊乱152例[J].现代康复.1999,3(8)：941.
[52]陈永源,莫锦全,周永顶.综合疗法治疗胸椎小关节紊乱症[J].光明中医.2006,21(9)：55-57.
[53]王烨.针灸配合中药熏洗治疗胸椎小关节紊乱综合征67例[J].针灸临床杂志.2007(2)：13.
[54]黄建萍.中西医结合治疗胸椎小关节紊乱症[J].齐齐哈尔医学院学报.2010(8)：1252.
[55]李忠仁主编.《实验针灸学》中国中医药出版社,2003年1月1版.
[56]李仲廉主编.《临床疼痛治疗学》天津科学技术出版社,2005年4月第3版.
[57]Bai Y, Yuan L, Soh K S, et al. Possible applications for fascial anatomy and fasciaology in traditional Chinese medicine [J]. J Acupunct Meridian Stud.2010, 3(2):125-132.
[58]原林,王军,王春雷,等.人体内新的功能系统--支持储备及自体监控系统新学说[J].科技导报.2006,24(6)：85-89.
[59]原林,钟世镇.人体自体检测与调控系统(筋膜学)--经络有关的解剖学基础 [J].天津中医药.2004,21(5)：356-359.
[60]杨春,李东飞,戴景兴,等.异体脂肪源干细胞移植对大鼠的抗衰老作用[J].解剖学报.2010,41(1)：87-92.
[61]原林,姚大卫,唐雷,等.针灸经穴的数字解剖学研究[J].解剖学报.2004,35(4)：337-343.
[62]徐明.针灸治疗坐骨神经痛的临床和实验研究.北京：中国中医研究院,1990.
[63]赵欣敏.电针促进坐骨神经痛损伤后再生及功能恢复的实验研究.南京：南京中医药大学,1999.
[1]王奕斌.抱抖法治疗胸椎后关节紊乱疗效观察[J].按摩与导引.2008,24(3)：41.
[2]白卫民,张会景.手法推拿结合中药艾灸治疗运动员胸椎小关节紊乱症[J].中医正骨.2009,21(8)：63.
[3]汪芹,黄顺贤.“骨错缝”“筋出槽”理论的临床认识[J].现代中医药.2009(4)：60-61.
[4]梁燕梅,袁倩,王会丽.电针配合整骨治疗肋间神经痛30例[J].针灸临床杂志.2010(5).
[5]黄卿,窦思东,黄清豹.脊椎矫正复位术治疗胸椎小关节紊乱94例临床观察[J].亚太传统医药.2010,6(9)：64-65.
[6]崔树松,刘正德.扩胸扳法治疗胸椎小关节功能紊乱症[J].按摩与导引.2001,17(3)：28.
[7]王甫刚.手法配合中药治疗急性胸椎小关节紊乱症[J].中国民间疗法.2009,17(8)：24.
[8]章振永,张巧玲,付小红.针刺合手法治疗胸椎小关节紊乱42例[J].中国针灸.2005,25(7)：464.
[9]邵炯.针刀配合推拿治疗胸椎小关节紊乱72例[J].上海针灸杂志.2006,25(8)：34-35.
[10]杨春,李东飞,戴景兴,等.异体脂肪源干细胞移植对大鼠的抗衰老作用[J].解剖学报.2010,41(1)：87-92.
[11]原林,焦培峰,唐雷,等.中医经络理论的物质基础--结缔组织、筋膜和自体监控系统(筋膜学)[J].中国基础科学.2005,7(3)：44-47.
[12]Bai Y, Yuan L, Soh K S, et al. Possible applications for fascial anatomy and fasciaology in traditional Chinese medicine [J]. J Acupunct Meridian Stud.2010, 3(2):125-132.
[13]黄泳,原林,贺振泉,等.经络腧穴与筋膜学的相关性探讨——数字人研究 的启发[J].中国针灸.2006,26(11)：785-788.
[14]原林,钟世镇.人体自体检测与调控系统(筋膜学)--经络有关的解剖学基础[J].天津中医药.2004,21(5)：356-359.
[15]冉启锋,原林,黄泳.基于筋膜学理论探求腧穴作用机制的思路[J].中国中医药科技.2009,16(5)：399-400.
[16]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志.2008,14(4)：312-314.
[17]王军,王春雷,沈宝林,等.用筋膜学说解读经络实质和物质基础[J].中国针灸.2007,27(8)：583-585.
[18]姜雪梅,张学全,原林.结缔组织在针刺力学信号转导中的作用和研究进展[J].针刺研究.2009,34(2)：136-139.
[19]陈锦明,卢阳佳,黄泳,等.基于结缔组织探讨针刺镇痛的机制[J].现代中西医结合杂志.2010(3)：388-390.
[20]Langevin H M. Connective tissue:a body-wide signaling network?[J]. Med Hypotheses.2006,66(6):1074-1077.
[21]Langevin H M, Yandow J A. Relationship of acupuncture points and meridians to connective tissue planes[J]. Anat Rec.2002,269(6):257-265.
[22]叶衍庆.魏指薪医师的伤科手法的应用指征及疗效机制[C]//上海市伤科研究所.伤科论文汇编(第三辑).上海：上海科学技术出版社,1964：53275.