耳穴治疗腰痛的临床评估与机理研究
摘要
腰痛是一种常见的临床症状综合征,严重干扰人们的工作和生活,非手术治疗是最常用的治疗手段。如何对现有的治疗方法和技术进行客观评价,是目前重要的指标。以往常仅评价单一因素,然而评价临床效果涉及多种指标。如腰痛经过治疗的效果可依据疼痛状况、腰椎活动度、下肢放射痛等多方面的指标进行评价。单因素指标分别从各个侧面反映治疗效果,而综合评价是将多个指标用数学方法制定出恰当的评价模型以求得到对各种治疗效果总的印象或综合的评定。
目的：运用综合评价法,比较耳穴压丸法和常规治疗腰痛的疗效。方法：对150例腰痛患者(皆为“可减轻的移位综合征”),使用耳穴压丸法治疗50例,使用物理治疗50例及耳穴压丸法合并物理治疗50例。采用“视觉模拟评分法”(VAS)对治疗前和治疗后所得的疼痛评分,以及对腰椎活动度、下肢放射痛指标,治疗当天前及一星期、三星期、半年后的有效率进行比较分析,并在比较临床效果各分指标的基础上引进综合评价模型对三组治疗效果进行综合分析。结果：治疗前,耳穴压丸法组的VAS疼痛评分(6.68±1.483)、常规治疗组的评分(6.6±1.669)及耳穴压丸法合并物理治疗的评分(6.91±1.825)进行组间比较,无显着差异(P>0.05)。经五天治疗之后,耳穴压丸法法合并物理治疗组的VAS疼痛评分均较耳穴压丸法及常规治疗组低(P<0.05),但进行耳穴压丸与物理治疗组的VAS疼痛评分比较,虽然在疼痛分数有下降,但统计上却无显着意义(P=0.16)。说明耳穴压丸合并物理治疗法组的疗效优于耳穴压丸组,优于物理治疗组较好。在腰椎前屈和后伸功能及下肢放射痛的改善上,合并治疗优于耳穴压丸法组也明显好于常规治疗组(P<0.01)。用综合指数评价法进行综合分析,治疗前三组比较无显着差异(P>0.05)；治疗7天后,三组比较有显着差异(P<0.001)。合并治疗组高于耳穴压丸法组高于常规治疗组。结论：耳穴压丸法合并理学治疗腰部力学性疼痛效果显着且见效较快。
肉眼观察躯体矢状面的弯曲和伸展活动是临床评价腰痛的一个指标。但是,简单的肉眼观察不能对相关的肌肉运动和骨盆与脊椎相互作用进行精确的评价。腰椎旁肌肉的肌电图显示,腰痛患者和无腰痛患者肌肉运动有差异。临床上髋部肌电图活动较少评价,如臀大肌和股二头肌活动,主因为侵入性检测。腰椎骨结构、韧带和胸腰筋膜共同组成一个完整的系统,称肌筋膜系统,此系统允许腰部和盆腔在躯干矢状弯曲和伸展时负重转动。临床上评价躯干矢状弯曲和伸展时,腰椎旁肌肉,臀大肌和股二头肌的相互关系以及对照慢性腰痛患者和无腰痛者有所不同,有助于未来评价对慢性腰痛患者功能性恢复的影响。基于目前可得到的知识和临床经验,我们得知肌激痛点也可能引起连带性腰痛。大多数肌激痛点引起腰痛的病例与受伤有关。有许多潜在病因可使[隐性肌激痛点]活化成为[活性肌激痛点],造成肌筋膜腰痛。因此,为了根除肌筋膜腰痛且避免其再发,最重要是应找出并治疗潜在病因。值得未来进一步探讨。
Low back pain is a common clinical syndrome. Seriously interfered with people's work and life. Non-surgical treatment is the most commonly used treatment. How to existing treatment methods and technology for objective evaluation. In order to always evaluate only a single factor. Evaluation of clinical results, however, involve a variety of indicators. If the effect of low back pain can be treated based on pain in the lumbar activity, sciatica and many other indicators for evaluation. Single-factor indices from different perspectives reflect the therapeutic effect. The comprehensive evaluation is the number of indicators used mathematical methods to develop an appropriate evaluation model in order to get a variety of treatment effect overall impression or integrated assessment.
Objective:Using a comprehensive evaluation method. Comparison of ear pressure pills and conventional treatment of the efficacy of low back pain. Methods:150 cases of low back pain patients (both "reduce the shift syndrome"), the use of ear pressure pill Treating 50 cases,50 cases of the use of conventional physical therapy,50 cases with combined treatment. Treatment before and after treatment each day using the "visual analog scale" VAS) pain score obtained, and the activity of the lumbar spine, sciatica indicators, seven days,3weeks and half year after the effective treatment of a comparative analysis, and to compare the clinical effects sub-index comprehensive evaluation model based on the introduction of the three groups to conduct a comprehensive analysis of treatment effect. Results:Before treatment, combined treatment pain score (6.91+1.825), ear pressure pill Law Group VAS pain score (6.68±1.483) and conventional physical treatment group score (6.6±1.669) between the three groups, there was no significant difference P> 0.05, by 7 days of treatment, After the days of combines treatment VAS pain scores is lower than ear pressure pill Law Group VAS pain scores and were lower than those of conventional therapy (P all<0.05), indicating that combind therapy group and ear pressure pill Law Group better effect. In the lumbar flexion and extension function and sciatica after the improvement, the ear pressure pill France group also significantly better than conventional therapy group (P all<0.01). Composite index evaluation method using a comprehensive analysis. Pre-treatment groups showed no significant difference (, P> 0.05); treatment five days after the three groups was statistically significant (P<0.001). Composite Index combines add ear pressure method group was better than the average level of conventional treatment group and ear pressure group along. Conclusion:Treating with Ear Pressure mechanical lumbar pain and results are obvious and quick results.
Visual observation of the body sagittal bending and stretching activities are an indicator of the clinical evaluation of low back pain. However, the simple visual inspection can not be related to muscle movement and the hip and spine, a precise evaluation of the interaction.In the sagittal plane in patients with low back pain when bending and stretching the hip and spine showed interaction (also known as the waist-pelvic rhythm). Adjacent lumbar muscle EMG show that patients with low back pain in patients with and without low back pain, muscle movement are different. But rarely the same time, evaluation of the hip extensor EMG activities, such as the gluteus maximus and biceps femoris activity. Because lumbar bone structures, ligaments and thoracolumbar fascia together form a complete system, this system allows the waist and pelvis in the sagittal trunk bend and stretch when the load rotation. Evaluation of sagittal trunk bend and stretch, the lumbar vertebrae adjacent muscles, the gluteus maximus and biceps femoris of the mutual relations. In addition, the control of chronic low back pain in patients with and without low back pain were different, the evaluation of chronic low back pain in patients with active MTrPs that cause LBP are usually activated as a consequence of other etiological lesions. Therefore, it is important to determine and treat the underlying pathological lesions in order to avoid recurrence of myofascial LBP. If the underlying pathological lesion is unable to be identified and the pain in MTrPs is very severe, we may still have to suppress the active MTrP for pain control. To inactivate MTrPs, need more further study to support.
目的：运用综合评价法,比较耳穴压丸法和常规治疗腰痛的疗效。方法：对150例腰痛患者(皆为“可减轻的移位综合征”),使用耳穴压丸法治疗50例,使用物理治疗50例及耳穴压丸法合并物理治疗50例。采用“视觉模拟评分法”(VAS)对治疗前和治疗后所得的疼痛评分,以及对腰椎活动度、下肢放射痛指标,治疗当天前及一星期、三星期、半年后的有效率进行比较分析,并在比较临床效果各分指标的基础上引进综合评价模型对三组治疗效果进行综合分析。结果：治疗前,耳穴压丸法组的VAS疼痛评分(6.68±1.483)、常规治疗组的评分(6.6±1.669)及耳穴压丸法合并物理治疗的评分(6.91±1.825)进行组间比较,无显着差异(P>0.05)。经五天治疗之后,耳穴压丸法法合并物理治疗组的VAS疼痛评分均较耳穴压丸法及常规治疗组低(P<0.05),但进行耳穴压丸与物理治疗组的VAS疼痛评分比较,虽然在疼痛分数有下降,但统计上却无显着意义(P=0.16)。说明耳穴压丸合并物理治疗法组的疗效优于耳穴压丸组,优于物理治疗组较好。在腰椎前屈和后伸功能及下肢放射痛的改善上,合并治疗优于耳穴压丸法组也明显好于常规治疗组(P<0.01)。用综合指数评价法进行综合分析,治疗前三组比较无显着差异(P>0.05)；治疗7天后,三组比较有显着差异(P<0.001)。合并治疗组高于耳穴压丸法组高于常规治疗组。结论：耳穴压丸法合并理学治疗腰部力学性疼痛效果显着且见效较快。
肉眼观察躯体矢状面的弯曲和伸展活动是临床评价腰痛的一个指标。但是,简单的肉眼观察不能对相关的肌肉运动和骨盆与脊椎相互作用进行精确的评价。腰椎旁肌肉的肌电图显示,腰痛患者和无腰痛患者肌肉运动有差异。临床上髋部肌电图活动较少评价,如臀大肌和股二头肌活动,主因为侵入性检测。腰椎骨结构、韧带和胸腰筋膜共同组成一个完整的系统,称肌筋膜系统,此系统允许腰部和盆腔在躯干矢状弯曲和伸展时负重转动。临床上评价躯干矢状弯曲和伸展时,腰椎旁肌肉,臀大肌和股二头肌的相互关系以及对照慢性腰痛患者和无腰痛者有所不同,有助于未来评价对慢性腰痛患者功能性恢复的影响。基于目前可得到的知识和临床经验,我们得知肌激痛点也可能引起连带性腰痛。大多数肌激痛点引起腰痛的病例与受伤有关。有许多潜在病因可使[隐性肌激痛点]活化成为[活性肌激痛点],造成肌筋膜腰痛。因此,为了根除肌筋膜腰痛且避免其再发,最重要是应找出并治疗潜在病因。值得未来进一步探讨。
Low back pain is a common clinical syndrome. Seriously interfered with people's work and life. Non-surgical treatment is the most commonly used treatment. How to existing treatment methods and technology for objective evaluation. In order to always evaluate only a single factor. Evaluation of clinical results, however, involve a variety of indicators. If the effect of low back pain can be treated based on pain in the lumbar activity, sciatica and many other indicators for evaluation. Single-factor indices from different perspectives reflect the therapeutic effect. The comprehensive evaluation is the number of indicators used mathematical methods to develop an appropriate evaluation model in order to get a variety of treatment effect overall impression or integrated assessment.
Objective:Using a comprehensive evaluation method. Comparison of ear pressure pills and conventional treatment of the efficacy of low back pain. Methods:150 cases of low back pain patients (both "reduce the shift syndrome"), the use of ear pressure pill Treating 50 cases,50 cases of the use of conventional physical therapy,50 cases with combined treatment. Treatment before and after treatment each day using the "visual analog scale" VAS) pain score obtained, and the activity of the lumbar spine, sciatica indicators, seven days,3weeks and half year after the effective treatment of a comparative analysis, and to compare the clinical effects sub-index comprehensive evaluation model based on the introduction of the three groups to conduct a comprehensive analysis of treatment effect. Results:Before treatment, combined treatment pain score (6.91+1.825), ear pressure pill Law Group VAS pain score (6.68±1.483) and conventional physical treatment group score (6.6±1.669) between the three groups, there was no significant difference P> 0.05, by 7 days of treatment, After the days of combines treatment VAS pain scores is lower than ear pressure pill Law Group VAS pain scores and were lower than those of conventional therapy (P all<0.05), indicating that combind therapy group and ear pressure pill Law Group better effect. In the lumbar flexion and extension function and sciatica after the improvement, the ear pressure pill France group also significantly better than conventional therapy group (P all<0.01). Composite index evaluation method using a comprehensive analysis. Pre-treatment groups showed no significant difference (, P> 0.05); treatment five days after the three groups was statistically significant (P<0.001). Composite Index combines add ear pressure method group was better than the average level of conventional treatment group and ear pressure group along. Conclusion:Treating with Ear Pressure mechanical lumbar pain and results are obvious and quick results.
Visual observation of the body sagittal bending and stretching activities are an indicator of the clinical evaluation of low back pain. However, the simple visual inspection can not be related to muscle movement and the hip and spine, a precise evaluation of the interaction.In the sagittal plane in patients with low back pain when bending and stretching the hip and spine showed interaction (also known as the waist-pelvic rhythm). Adjacent lumbar muscle EMG show that patients with low back pain in patients with and without low back pain, muscle movement are different. But rarely the same time, evaluation of the hip extensor EMG activities, such as the gluteus maximus and biceps femoris activity. Because lumbar bone structures, ligaments and thoracolumbar fascia together form a complete system, this system allows the waist and pelvis in the sagittal trunk bend and stretch when the load rotation. Evaluation of sagittal trunk bend and stretch, the lumbar vertebrae adjacent muscles, the gluteus maximus and biceps femoris of the mutual relations. In addition, the control of chronic low back pain in patients with and without low back pain were different, the evaluation of chronic low back pain in patients with active MTrPs that cause LBP are usually activated as a consequence of other etiological lesions. Therefore, it is important to determine and treat the underlying pathological lesions in order to avoid recurrence of myofascial LBP. If the underlying pathological lesion is unable to be identified and the pain in MTrPs is very severe, we may still have to suppress the active MTrP for pain control. To inactivate MTrPs, need more further study to support.
引文
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10. 白玉龙and胡永善,卧床休息作为下背痛的基础治疗：有利还是有害?颈腰痛杂志,2006,27(2)：156-158
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2. Malanga GA and N. SF., Non-operative treatment of low back pain[J]. Mayo Clin Proc,1999,74: 1135-48
3. Liu, J., T. Wen, and W. Su, Prevalence of low back pain among Chinese air-force pilot[J]. J Chin Aviat Med Assoc,1999,12:77-83
4. Mah, C, Low back pain and associated factors among nursing staff in a medical center[J]. Taipei: National Defense Medical College,2001
5. Mayer, T. and R. Gatchel, Functional restoration for spinal disorders:the sports medicine approach[J]. 1988, Lea & Febiger
6. Rittweger, J., et al., Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise:A randomized controlled trial[J]. Spine,2002,27(17):1829-1834
7. Nickel, R., et al., Health-related quality of life and somatization in patients with long-term low back pain:a prospective study with 109 patients[J]. Spine,2001,26(20):2271
8. Hollingworth, W., et al., Self reported health status and magnetic resonance imaging findings in patients with low back pain[J]. European Spine Journal,1998,7(5):369-375
9. Vega, C, et al., NSAIDs and Manipulation Ineffective for Acute Low Back Pain:A Best Evidence Review[J]. Lancet,2007, (370):1638-1643
10. 白玉龙and胡永善,卧床休息作为下背痛的基础治疗：有利还是有害?颈腰痛杂志,2006,27(2)：156-158
11. Nachemson, A. and S.J. Bigos, the low back adult orthopedics[J].1984:843-937
12. Von Korff, M., Studying the natural history of back pain[J]. Spine,1994,19(18 Suppl):2041S
13. Alcouffe, J., et al., Analysis by sex of low back pain among workers from small companies in the Paris area:severity and occupational consequences [J]. British Medical Journal,1999,56(10):696
14. Matsui, H., et al., Risk indicators of low back pain among workers in Japan:association of familial and physical factors with low back pain[J]. Spine,1997,22(11):1242
15. 戴力扬,腰背痛的流行病学[J].颈腰痛杂志,2000,21(002)：162-164
16. Bendix, A., et al., Active treatment programs for patients with chronic low back pain:a prospective, randomized, observer-blinded study[J]. European Spine Journal,1995,4(3):148-152
17. Andersson, G, Epidemiological features of chronic low-back pain[J]. The Lancet,1999,354(9178): 581-585
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