针刺配合扳推法治疗脊柱侧弯的临床观察
摘要
目的:观察针刺配合扳推法治疗脊柱侧弯的临床疗效。
方法:临床观察于2006.3-2006.12在南方医科大学附属医院和香港天佑堂、昊域、良方等中医诊所完成。32例脊柱侧弯病人接受针刺和扳推法治疗,先用基本手法放松脊柱椎旁软组织,直至背腰部发热后,再用一指禅沿督脉和膀胱经的第一侧线由上而下疏通经脉2遍,点压夹脊穴、三焦俞、肾俞、气海俞和胸腰部阿是穴,待脊柱软组织松解后,针对脊柱变形的程度运用扳推法纠正;然后选胸腰部双侧夹脊穴(主要为侧弯锥体的双侧夹脊穴)、凹侧大肠俞、双委中为主穴针刺治疗,再根据不同证型选用配穴:寒湿型加腰阳关,瘀血型加双膈俞、双血海,肾虚型加双肾俞、命门、双志室。观察周期为1个疗程(治疗为隔日1次,每次扳推法15分钟,针刺留针30分钟,3个月为一疗程)。观察指标为每位患者治疗前后Cobb角的角度变化情况,然后评定疗效。
结果:32例脊柱侧弯患者中,15例获得临床痊愈,总有效率为84.38%。32例脊柱侧弯病人治疗前后的Cobb角变化有显著性差异(P＜0.01)。针刺治疗过程中所有患者均未有特殊不适。
结论:针刺配合扳推法,能够有效地改善脊柱侧弯患者的脊柱畸形症状。
[Objective]To observe the clinical efficacy of treating scoliosis by the method of acupuncture and pulling manipulation.
[Method]The clinical observation will be completely solved in the subordinate hospital of Southern Medical University and the Hong Kong clinic:such as tianyoutang,Hao yu,liangfang during 2006.3 to 2006.12.32 cases of scoliosis patients receiving acupuncture and massage treatment,using the basic massage method firstly,such as rolling manipulation(Gunfa),circular rubbing manipulation (Mofa) to relax the spinal soft tissue until the patients feel their haunch fever.And then using another method,pushing manipulation with one-finger(Yizhichan Tuifa) from up to down for two times to press the areas along the circulation of DU meridian and the first branch of bladder meridian in the back aspect,digits-pressing manipulation(Dianfa) pressing the Jiaji(EX-B2) Points,sanjiaoshu(BL22), Shenshu(BL23),qihaishu(BL24),and ashi points in the chest-waist areas.After the spinal soft tissue release,according to the extent of the Cobb of the spinal deformation,use the pulling manipulation,one method of the massage to correct the deformation.Then puncture the bilateral chest-waist Jiaji Points(especially the bilateral Jiaji Points of the abnormal vertebra),the concave side Dachangshu(BL25) point,and the double Weizhong(BL40) points.In addition,select some adjunct points according to the theory of syndrome differentiation:with Yaoyangguan(DU3) for the cold-dampness type;With double Geshu(BL17),double Xuehai(SP10) for the stagnation of the blood type;With Mingmen(DU4),double shenshu(BL23),double zhishi(BL52) for the kidney deficiency type.The Observation cycle is for a course of treatment(treatment one time for every two days, massage firstly for 15 minutes,then acupuncture and retaining needle for 30 minutes, three months for a course of treatment).Observations of indicators are the Cobb angle changes,and then assess efficacy.
[Results]In 32 cases of scoliosis patients,15 cases were clinical cure and the total effective rate was 84.38 percent.The difference of the Cobb angle(before and after treatment changes) of 32 cases of scoliosis patients was significant(P＜0.01). All the patients were not any discomfort during the treatment.
[Conclusion]Acupuncture with pulling manipulation can effectively improve the symptoms of spinal deformity in scoliosis patients.
方法:临床观察于2006.3-2006.12在南方医科大学附属医院和香港天佑堂、昊域、良方等中医诊所完成。32例脊柱侧弯病人接受针刺和扳推法治疗,先用基本手法放松脊柱椎旁软组织,直至背腰部发热后,再用一指禅沿督脉和膀胱经的第一侧线由上而下疏通经脉2遍,点压夹脊穴、三焦俞、肾俞、气海俞和胸腰部阿是穴,待脊柱软组织松解后,针对脊柱变形的程度运用扳推法纠正;然后选胸腰部双侧夹脊穴(主要为侧弯锥体的双侧夹脊穴)、凹侧大肠俞、双委中为主穴针刺治疗,再根据不同证型选用配穴:寒湿型加腰阳关,瘀血型加双膈俞、双血海,肾虚型加双肾俞、命门、双志室。观察周期为1个疗程(治疗为隔日1次,每次扳推法15分钟,针刺留针30分钟,3个月为一疗程)。观察指标为每位患者治疗前后Cobb角的角度变化情况,然后评定疗效。
结果:32例脊柱侧弯患者中,15例获得临床痊愈,总有效率为84.38%。32例脊柱侧弯病人治疗前后的Cobb角变化有显著性差异(P＜0.01)。针刺治疗过程中所有患者均未有特殊不适。
结论:针刺配合扳推法,能够有效地改善脊柱侧弯患者的脊柱畸形症状。
[Objective]To observe the clinical efficacy of treating scoliosis by the method of acupuncture and pulling manipulation.
[Method]The clinical observation will be completely solved in the subordinate hospital of Southern Medical University and the Hong Kong clinic:such as tianyoutang,Hao yu,liangfang during 2006.3 to 2006.12.32 cases of scoliosis patients receiving acupuncture and massage treatment,using the basic massage method firstly,such as rolling manipulation(Gunfa),circular rubbing manipulation (Mofa) to relax the spinal soft tissue until the patients feel their haunch fever.And then using another method,pushing manipulation with one-finger(Yizhichan Tuifa) from up to down for two times to press the areas along the circulation of DU meridian and the first branch of bladder meridian in the back aspect,digits-pressing manipulation(Dianfa) pressing the Jiaji(EX-B2) Points,sanjiaoshu(BL22), Shenshu(BL23),qihaishu(BL24),and ashi points in the chest-waist areas.After the spinal soft tissue release,according to the extent of the Cobb of the spinal deformation,use the pulling manipulation,one method of the massage to correct the deformation.Then puncture the bilateral chest-waist Jiaji Points(especially the bilateral Jiaji Points of the abnormal vertebra),the concave side Dachangshu(BL25) point,and the double Weizhong(BL40) points.In addition,select some adjunct points according to the theory of syndrome differentiation:with Yaoyangguan(DU3) for the cold-dampness type;With double Geshu(BL17),double Xuehai(SP10) for the stagnation of the blood type;With Mingmen(DU4),double shenshu(BL23),double zhishi(BL52) for the kidney deficiency type.The Observation cycle is for a course of treatment(treatment one time for every two days, massage firstly for 15 minutes,then acupuncture and retaining needle for 30 minutes, three months for a course of treatment).Observations of indicators are the Cobb angle changes,and then assess efficacy.
[Results]In 32 cases of scoliosis patients,15 cases were clinical cure and the total effective rate was 84.38 percent.The difference of the Cobb angle(before and after treatment changes) of 32 cases of scoliosis patients was significant(P＜0.01). All the patients were not any discomfort during the treatment.
[Conclusion]Acupuncture with pulling manipulation can effectively improve the symptoms of spinal deformity in scoliosis patients.
引文
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[2]王汉林主编.小儿先天性骨与关节畸形.北京:中国医药科技出版社,1994:157.
[3]尹兴华,李良.特发性脊柱侧弯患者两侧肌肉的组织化学观察.临床解剖学杂志,1987,5(4)214-217
[4]蒋永艳,刘树芬,沈志鹏等.脊柱侧凸对肺功能的影响及临床意义.医学信息,1995.2,8(2)81-83
[5]Loder RT,Urquhart A,Grazlano G,et al.Variability in Cobb angle measurements in children with congenital scoliosis.J Bone Joint Surg(Br),1995,77(5):768-708.
[6]Fernando AM,Robert BW,John EL,et al.Measurement accuracy in congenital scoliosis.J Bone Joint Surg(Br),2001,83(1):42-45.
[7]史建静,许崇永,赵晓君.全下肢及全脊柱成像技术的临床应用.放射学实践,2005,20(9):833-834
[8]Storer SK,Vitale MG,Hyman JE,et al.Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation versus hook constructs.J Pediatr Orthop,2005,25(4):415-419.
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[10]梁显球,黄绍贤,余斌,陈志军.广东省肇庆市城区幼儿脊柱侧凸普查及防治.中国妇幼保健,2005,20,1496-2497
[11]Lipton GE,Guille JT,Kumar SJ.Surgical treatment of scoliosis in Marfan syndrome:guidelines for a successful outcome.J Pediatr Orthop,2002,22:292-297.
[12]许志勇,吴焕淦,周丽斌,安广青.神经根痛及针灸治疗的机理探析.现代康复,2000.12,4(12)1890-1891
[13]桂水午.针灸治疗血瘀证的临床和实验研究.上海中医药杂志,1996.8:42
[14]李楚芬.脊椎旁电针刺激对脊髓反射放电的影响.针刺研究,1984(2):117
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[3].何善健.一对孪生姐妹脊柱侧凸畸形报告及文献复习.中国脊柱脊髓杂志.2003,13(5),265-306.
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[6]．袁元杏．特发性脊柱侧弯2例的家谱分析[J]．中山医科大学学报．1998,19(增刊)：封3．
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[8].Salehi LB, Mangino M, De Serio S. Assignment of a locus for autosomal dominant idiopathic scoliosis (IS) to human chromosome 17pll. Hum Genet.2002, 111 (4-5): 401-404.
[9]. Zorkoltseva IV, Liubinski OA, Sharipov RN, et al.Analysis of polymorphism of the number of tandemrepeats in the aggrecan gene exon G3in the families with idiopathic scoliosis [in Russian]. Genetika.2002, 38:259-263.
[10]. Justice CM, Miller NH, Marosy B.Familial idiopathic scoliosis:evidence of an X-linked susceptibility locus.Spine. 2003, 28(6):589-594.
[11].Bashiardes S,Veile R, Allen M.SNTGl.the gene encodinggammal-syn-trophin:a candidate gene for idiopathic scoliosis. Hum Genet. 2004,115(1):81-89.
[12].Morcuende JA, Minhas R, Dolan L. Allelic variants of human melatonin 1A receptor in patients with familial adolescent idiopathic scoliosis.Spine. 2003, 28 (17):2025-2028.
[13].Hagglund G, Karlberg J, Willner S.Growth in girls with adolescent idiopathic scoliosis. Spine. 1992, 17: 108-111.
[14].Skogland LB,Miller JA. The length and proportions of the thoracolumbar spine in children with idiopathic scoliosis.Acta Orthop Scand. 1981, 52: 177-185.
[15].Upadhyay SS, Hsu LC, Ho EK, et al. Disproportionate body growth in girls with adolescent idiopathic scoliosis.A longitudnal study.Spine.1991,16(8 Suppl):S343-347.
[16].Risser J,Ferguson AB.Scoliosis:its prognosis.J Bone Joint Surg.1936,18:667-670.
[17].Loncar,Dusek M,Pecina M,Prebeg Z.Alongitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis[J].Clin Orthop.1991,(270):278-282.
[18].Goldberg CJ.Adolescent idiopathic scoliosis Early menarche,normal growth.Spine.1993,18:529-535.
[19].朱锋.生长发育异常和青少年特发性脊柱侧凸.脊柱外科杂志.2003,1(4):237-239.
[20].Wever DJ,Veldhuizen AG,Klein JP,et al.A biomechanical analysis of the vertebral and rib deformities in structural scoliosis.Eur Spine J.1999,8:252-260.
[21].Taylor JR.Scoliosis and growth patterns of asymmetry in normal vertebral growth.Acta Orthop Scand.1983,54:596-602.
[22].Porter RW.Idiopathic scoliosis:The relation between the vertebral canal and the vertebral bodies.Spine.2000,25:1360-1366.
[23].Dickson RA,Lanston JO,Archer,et al.Combinde medien and coronal plane arymretry:the essential lesion of progrecsive idiopatbic scoliosis.J Bone Joint Surg[Br].1983,65:358.
[24].Lowe TG,Edgar M,Margulise JY,et al.Etiology of idiopathic scoliosis:current trends in research.J Bone Joint Surg Am.2000,82:1157-1158.25.Goto M,Kawakami N,Azegami H,et al.Buckling and bone modeling as factors in the development of idiopathic scoliosis.Spine.2003,28:364-371.
[26].Azegami H,Murachi S,Kitoh J,et al.Etiology of idiopathic scoliosis.Clin Orthop,1998,357:229-236.
[27].Enneking WF,Harrington P.Pathological changes in scoliosis.J Bone Joint surg.1969,51:165.
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[2]王汉林主编.小儿先天性骨与关节畸形.北京:中国医药科技出版社,1994:157.
[3]尹兴华,李良.特发性脊柱侧弯患者两侧肌肉的组织化学观察.临床解剖学杂志,1987,5(4)214-217
[4]蒋永艳,刘树芬,沈志鹏等.脊柱侧凸对肺功能的影响及临床意义.医学信息,1995.2,8(2)81-83
[5]Loder RT,Urquhart A,Grazlano G,et al.Variability in Cobb angle measurements in children with congenital scoliosis.J Bone Joint Surg(Br),1995,77(5):768-708.
[6]Fernando AM,Robert BW,John EL,et al.Measurement accuracy in congenital scoliosis.J Bone Joint Surg(Br),2001,83(1):42-45.
[7]史建静,许崇永,赵晓君.全下肢及全脊柱成像技术的临床应用.放射学实践,2005,20(9):833-834
[8]Storer SK,Vitale MG,Hyman JE,et al.Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation versus hook constructs.J Pediatr Orthop,2005,25(4):415-419.
[9]Lippman CR,Spence CA,Youssef AS,et al.Correction of adult scoliosis via a posterior-only approach.Neurosurg Focus,2003,14(1):e5.
[10]梁显球,黄绍贤,余斌,陈志军.广东省肇庆市城区幼儿脊柱侧凸普查及防治.中国妇幼保健,2005,20,1496-2497
[11]Lipton GE,Guille JT,Kumar SJ.Surgical treatment of scoliosis in Marfan syndrome:guidelines for a successful outcome.J Pediatr Orthop,2002,22:292-297.
[12]许志勇,吴焕淦,周丽斌,安广青.神经根痛及针灸治疗的机理探析.现代康复,2000.12,4(12)1890-1891
[13]桂水午.针灸治疗血瘀证的临床和实验研究.上海中医药杂志,1996.8:42
[14]李楚芬.脊椎旁电针刺激对脊髓反射放电的影响.针刺研究,1984(2):117
[15]王升旭,赖新生,杨哲.华佗夹脊穴镇痛的临床及机理研究进展.广州中医药大学学报,1998.12,15增刊70-74
[1].Willner S,Nilsson KO,Kastrup K,et al.Growth hormone and somatomedin A in girls with adolescent idiopathic scoliosis.Acta Paediat Scandinavica.1976,65:547.
[2].Wynne DR.Familial(idiopathic)scoliosis:a family survey.J Bone Joint Surg(British).1968,50(2):24.
[3].何善健.一对孪生姐妹脊柱侧凸畸形报告及文献复习.中国脊柱脊髓杂志.2003,13(5),265-306.
[4].Kesling KL,Reinlcer KA.Scoliosis in twins:A meta-analysis of the literature and report of six cases.Spine.1997,22(17):2009-2014.
[5].Burwell RG.Aetiology of idiopathic scoliosis:current concepts.Pediatr Rehabil.2003,6(3-4):137-170.
[6]．袁元杏．特发性脊柱侧弯2例的家谱分析[J]．中山医科大学学报．1998,19(增刊)：封3．
[7]. Wise CA, Barnes R, Gillum J, et al. Localization of susceptibility to familial idiopathic scoliosis. Spine.2000, 25:2372-2380.
[8].Salehi LB, Mangino M, De Serio S. Assignment of a locus for autosomal dominant idiopathic scoliosis (IS) to human chromosome 17pll. Hum Genet.2002, 111 (4-5): 401-404.
[9]. Zorkoltseva IV, Liubinski OA, Sharipov RN, et al.Analysis of polymorphism of the number of tandemrepeats in the aggrecan gene exon G3in the families with idiopathic scoliosis [in Russian]. Genetika.2002, 38:259-263.
[10]. Justice CM, Miller NH, Marosy B.Familial idiopathic scoliosis:evidence of an X-linked susceptibility locus.Spine. 2003, 28(6):589-594.
[11].Bashiardes S,Veile R, Allen M.SNTGl.the gene encodinggammal-syn-trophin:a candidate gene for idiopathic scoliosis. Hum Genet. 2004,115(1):81-89.
[12].Morcuende JA, Minhas R, Dolan L. Allelic variants of human melatonin 1A receptor in patients with familial adolescent idiopathic scoliosis.Spine. 2003, 28 (17):2025-2028.
[13].Hagglund G, Karlberg J, Willner S.Growth in girls with adolescent idiopathic scoliosis. Spine. 1992, 17: 108-111.
[14].Skogland LB,Miller JA. The length and proportions of the thoracolumbar spine in children with idiopathic scoliosis.Acta Orthop Scand. 1981, 52: 177-185.
[15].Upadhyay SS, Hsu LC, Ho EK, et al. Disproportionate body growth in girls with adolescent idiopathic scoliosis.A longitudnal study.Spine.1991,16(8 Suppl):S343-347.
[16].Risser J,Ferguson AB.Scoliosis:its prognosis.J Bone Joint Surg.1936,18:667-670.
[17].Loncar,Dusek M,Pecina M,Prebeg Z.Alongitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis[J].Clin Orthop.1991,(270):278-282.
[18].Goldberg CJ.Adolescent idiopathic scoliosis Early menarche,normal growth.Spine.1993,18:529-535.
[19].朱锋.生长发育异常和青少年特发性脊柱侧凸.脊柱外科杂志.2003,1(4):237-239.
[20].Wever DJ,Veldhuizen AG,Klein JP,et al.A biomechanical analysis of the vertebral and rib deformities in structural scoliosis.Eur Spine J.1999,8:252-260.
[21].Taylor JR.Scoliosis and growth patterns of asymmetry in normal vertebral growth.Acta Orthop Scand.1983,54:596-602.
[22].Porter RW.Idiopathic scoliosis:The relation between the vertebral canal and the vertebral bodies.Spine.2000,25:1360-1366.
[23].Dickson RA,Lanston JO,Archer,et al.Combinde medien and coronal plane arymretry:the essential lesion of progrecsive idiopatbic scoliosis.J Bone Joint Surg[Br].1983,65:358.
[24].Lowe TG,Edgar M,Margulise JY,et al.Etiology of idiopathic scoliosis:current trends in research.J Bone Joint Surg Am.2000,82:1157-1158.25.Goto M,Kawakami N,Azegami H,et al.Buckling and bone modeling as factors in the development of idiopathic scoliosis.Spine.2003,28:364-371.
[26].Azegami H,Murachi S,Kitoh J,et al.Etiology of idiopathic scoliosis.Clin Orthop,1998,357:229-236.
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