穴注夹脊穴治疗原发性骨质疏松腰腿痛的临床观察
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摘要
目的
观察穴位注射夹脊穴治疗原发性骨质疏松症(primary osteoporosis,POP)及改善骨质疏松腰腿痛上的临床疗效,以及其对患者骨密度(bone massdensity,BMD)、碱性磷酸酶(alkaline phosphatase,ALP)、血Ca、血P、尿ca/cr、疼痛评分等多项指标的调节作用,从而探讨穴位注射夹脊穴改善骨质疏松腰腿痛的治疗机制,并为穴位注射法治疗骨质疏松腰腿痛提供临床根据。
方法
全部90例研究对象均为武汉市中西医结合医院住院及门诊就诊病人,根据病史、症状及体征按照POP的诊断标准,诊断为POP,并按就诊先后顺序,以查随机表的办法,随机分为夹脊穴注组,补肾健脾穴注组和药物对照组三组,每组各30例。夹脊穴穴注组取穴:双侧夹脊穴T11、L1、L3、L5、S2(单周),T10、T12、L2、L4、s1(双周)。补肾健脾穴注组取穴:双侧脾俞、肾俞、足三里、三阴交、血海。所有穴位均每穴注射约1mL复方当归注射液稀释液,隔日1次。治疗3次为一疗程,连续治疗12个疗程,随访2月。药物对照组口服强骨胶囊,每次1粒,每日3次,饭后温开水服用,治疗6天为一疗程,连续治疗12个疗程,随访2月。治疗前后分别观察BMD值、血ALP,血Ca、血P、尿Ca/cr及疼痛评分,并于治疗后评定疗效。
结果
夹脊穴注组,补肾健脾穴注组和药物对照组治疗后均有效。总有效率夹脊穴注组与补肾健脾穴注组比较差异有显著性意义(P＜0.05);夹脊穴注组与药物对照组比较差异有非常显著性意义(P＜0.01);而补肾健脾穴注组与药物对照组比较差异无显著性意义(P＞0.05)。提示夹脊穴注组治疗POP疗效最佳。
疼痛评分比较:3组患者治疗前后对比,差异均有非常显著性意义。治疗后夹脊穴注组分别与补肾健脾穴注组、药物对照组比较,差异均有非常显著性意义(P＜0.01);补肾健脾穴注组与药物组对照比较,差异有非常显著性意义(P＜0.01)。提示夹脊穴注组止痛效果最好,补肾健脾穴注组比药物对照组好。
骨密度测定值比较:3组患者治疗前后骨密度测定值对比,夹脊穴注组BMD值差异有非常显著性意义(P＜0.01),药物对照组、补肾健脾穴注组BMD值差异有显著性意义(P＜0.05);治疗后对比,夹脊穴注组与药物对照组比较差异有非常显著性意义(P＜0.01),补肾健脾穴注组与药物对照组比较差异有显著性意义(P＜0.05)。提示夹脊穴注组改善BMD效果最佳。
血ALP的比较:治疗后3组ALP均有所增加,治疗前后比较均无显著性差异(P＞0.05);治疗后三组比较无显著性差异(P＞0.05)。考虑可能与疗程过短有关。
血ca、血P比较:治疗后3组均可升高血Ca、降低血P。对于升高血ca及降低血P,夹脊穴注组和药物对照组对比有显著性意义(P＜0.05)。提示穴注夹脊穴对钙、磷代谢有一定调节作用。
尿Ca/Cr比较:各组治疗后均可降低尿Ca/Cr,各组组间比较差异无显著性意义(P＞0.05)。三组均可通过降低尿Ca/Cr调节骨代谢。
结论
穴注夹脊穴治疗原发性骨质疏松症疗效确切,并在原发性骨质疏松腰腿痛镇痛效果及提高骨密度上,优于补肾健脾组及药物治疗组,对钙、磷代谢有一定调节作用,并可降低尿Ca/Cr,从而调节骨代谢,提高骨密度。
Objective
To observe clinical therapeutic effect of primary osteoporosis treated with acupointinjection of Jiaji points, and to observe clinical therapeutic effect of acupointinjection of Jiaji points on pain in waist and lower extremities due to primary osteoporosis. And the influence on the bone mass density(BMD), alkaline Phosphatase(ALP), Calcium and Phosphonium in the blood, Calcium/Creatinine (Ca/Cr) in the Urine, and the cumulative scores of pain. To discuss the therapeutic mechanism of primary osteoporosis improved with acupointinjection of Jiaji points. And offer the basis of clinical treatment about primary osteoporosis treated with acupointinjection of Jiaji points.
Methods
All 90 Target of studying is the patients who go to the clinic of the hospital. All of them are made a definite diagnosis of POP. Ninty patients were divided randomly into Jiaji points group, Tonifying the kidney and strengthening the spleen group, and Medicament group, with 30 cases in each group. Changes of their BMD , alkaline Phosphatase,Calcium and Phosphonium in the blood, Calcium/Creatinine in the Urine,and cumulative scores of pain after treatment were investigated.
Results
The treatment of Jiaji points group, Tonifying the kidney and strengthening the spleen group, and Medicament group is effective. the Jiaji points group and onifying the kidney and strengthening the spleen group show a significant difference in the total effective rate(P<0. 05); and the difference between onifying the kidney and strengthening the spleen group and the medicalment group is very significant (P<0. 01); the contrast between the Jiaji points group and the medicalment group do not show significant difference. It is show that the jiaji group has the best curative effect.
The contrast of the pain grades in all the three groups: before and after the therapies, the pain grades of patients in each group can have a significant difference. After the therapies, we compare the jiaji points group with Tonifying the kidney and strengthening the spleen group and with Medicament group separately to have the difference between pain grades. Both the difference results have shown significant levels(P<0.01).By the comparison between Tonifying the kidney and strengthening the spleen group and Medicament group,the difference is also signcificant (P<0.01). It is show that as to the analgesia effect, the jiaji points group is the best, and the Tonifying the kidney and strengthening the spleen group is better than the medicament group.
The contrast of the BMD in all the three groups: Before and after the therapies, the difference of BMP value in the jiaji points group is very significant (P<0. 01), and the medicament group has significant difference (P<0. 05) as well as Tonifying the kidney and strengthening the spleen group. After the therapies, the difference between the jiaji points group and the medicament group is very significant (P<0. 01),and Tonifying the kidney and strengthening the spleen group is significantly different from the medicament group (P<0. 05). It is show that the jiaji points group ameliorates BMD the best.
The contrast of ALP in blood: after the therapies, all the 3 groups have got some augmentation. Before and after the therapies, there is no signicifant difference in every group (P>0.5). Consider: the insignificance is possibly due to the too short duration of the therapies.
The contrast of Ca and P in blood: After the therapies, all the three groups can improve Ca concentration and diminish P concentration. As to the augement of Ca and diminution fo P in blood, the difference between the jiaji points group and the medicament group is significant(P<0. 05). It is show that the jiaji points group adapt the metabolization of Ca and P in a certain extent.
The contrast of Ca/Cr in urine: Every group of the three can diminish Ca/Cr in urine after the therapies without significant difference (P>0. 05). All the three groups can adapt the osseous metabolization by diminution of Ca/Cr in urine.
Conclusion
Acupointinjection has definite therapeutic effect on primary osteoporosis, and the analgestic effect at injecting Jiaji points is better than injecting the points of Tonifying the kidney and strengthening the spleen, and Medicament group .
观察穴位注射夹脊穴治疗原发性骨质疏松症(primary osteoporosis,POP)及改善骨质疏松腰腿痛上的临床疗效,以及其对患者骨密度(bone massdensity,BMD)、碱性磷酸酶(alkaline phosphatase,ALP)、血Ca、血P、尿ca/cr、疼痛评分等多项指标的调节作用,从而探讨穴位注射夹脊穴改善骨质疏松腰腿痛的治疗机制,并为穴位注射法治疗骨质疏松腰腿痛提供临床根据。
方法
全部90例研究对象均为武汉市中西医结合医院住院及门诊就诊病人,根据病史、症状及体征按照POP的诊断标准,诊断为POP,并按就诊先后顺序,以查随机表的办法,随机分为夹脊穴注组,补肾健脾穴注组和药物对照组三组,每组各30例。夹脊穴穴注组取穴:双侧夹脊穴T11、L1、L3、L5、S2(单周),T10、T12、L2、L4、s1(双周)。补肾健脾穴注组取穴:双侧脾俞、肾俞、足三里、三阴交、血海。所有穴位均每穴注射约1mL复方当归注射液稀释液,隔日1次。治疗3次为一疗程,连续治疗12个疗程,随访2月。药物对照组口服强骨胶囊,每次1粒,每日3次,饭后温开水服用,治疗6天为一疗程,连续治疗12个疗程,随访2月。治疗前后分别观察BMD值、血ALP,血Ca、血P、尿Ca/cr及疼痛评分,并于治疗后评定疗效。
结果
夹脊穴注组,补肾健脾穴注组和药物对照组治疗后均有效。总有效率夹脊穴注组与补肾健脾穴注组比较差异有显著性意义(P＜0.05);夹脊穴注组与药物对照组比较差异有非常显著性意义(P＜0.01);而补肾健脾穴注组与药物对照组比较差异无显著性意义(P＞0.05)。提示夹脊穴注组治疗POP疗效最佳。
疼痛评分比较:3组患者治疗前后对比,差异均有非常显著性意义。治疗后夹脊穴注组分别与补肾健脾穴注组、药物对照组比较,差异均有非常显著性意义(P＜0.01);补肾健脾穴注组与药物组对照比较,差异有非常显著性意义(P＜0.01)。提示夹脊穴注组止痛效果最好,补肾健脾穴注组比药物对照组好。
骨密度测定值比较:3组患者治疗前后骨密度测定值对比,夹脊穴注组BMD值差异有非常显著性意义(P＜0.01),药物对照组、补肾健脾穴注组BMD值差异有显著性意义(P＜0.05);治疗后对比,夹脊穴注组与药物对照组比较差异有非常显著性意义(P＜0.01),补肾健脾穴注组与药物对照组比较差异有显著性意义(P＜0.05)。提示夹脊穴注组改善BMD效果最佳。
血ALP的比较:治疗后3组ALP均有所增加,治疗前后比较均无显著性差异(P＞0.05);治疗后三组比较无显著性差异(P＞0.05)。考虑可能与疗程过短有关。
血ca、血P比较:治疗后3组均可升高血Ca、降低血P。对于升高血ca及降低血P,夹脊穴注组和药物对照组对比有显著性意义(P＜0.05)。提示穴注夹脊穴对钙、磷代谢有一定调节作用。
尿Ca/Cr比较:各组治疗后均可降低尿Ca/Cr,各组组间比较差异无显著性意义(P＞0.05)。三组均可通过降低尿Ca/Cr调节骨代谢。
结论
穴注夹脊穴治疗原发性骨质疏松症疗效确切,并在原发性骨质疏松腰腿痛镇痛效果及提高骨密度上,优于补肾健脾组及药物治疗组,对钙、磷代谢有一定调节作用,并可降低尿Ca/Cr,从而调节骨代谢,提高骨密度。
Objective
To observe clinical therapeutic effect of primary osteoporosis treated with acupointinjection of Jiaji points, and to observe clinical therapeutic effect of acupointinjection of Jiaji points on pain in waist and lower extremities due to primary osteoporosis. And the influence on the bone mass density(BMD), alkaline Phosphatase(ALP), Calcium and Phosphonium in the blood, Calcium/Creatinine (Ca/Cr) in the Urine, and the cumulative scores of pain. To discuss the therapeutic mechanism of primary osteoporosis improved with acupointinjection of Jiaji points. And offer the basis of clinical treatment about primary osteoporosis treated with acupointinjection of Jiaji points.
Methods
All 90 Target of studying is the patients who go to the clinic of the hospital. All of them are made a definite diagnosis of POP. Ninty patients were divided randomly into Jiaji points group, Tonifying the kidney and strengthening the spleen group, and Medicament group, with 30 cases in each group. Changes of their BMD , alkaline Phosphatase,Calcium and Phosphonium in the blood, Calcium/Creatinine in the Urine,and cumulative scores of pain after treatment were investigated.
Results
The treatment of Jiaji points group, Tonifying the kidney and strengthening the spleen group, and Medicament group is effective. the Jiaji points group and onifying the kidney and strengthening the spleen group show a significant difference in the total effective rate(P<0. 05); and the difference between onifying the kidney and strengthening the spleen group and the medicalment group is very significant (P<0. 01); the contrast between the Jiaji points group and the medicalment group do not show significant difference. It is show that the jiaji group has the best curative effect.
The contrast of the pain grades in all the three groups: before and after the therapies, the pain grades of patients in each group can have a significant difference. After the therapies, we compare the jiaji points group with Tonifying the kidney and strengthening the spleen group and with Medicament group separately to have the difference between pain grades. Both the difference results have shown significant levels(P<0.01).By the comparison between Tonifying the kidney and strengthening the spleen group and Medicament group,the difference is also signcificant (P<0.01). It is show that as to the analgesia effect, the jiaji points group is the best, and the Tonifying the kidney and strengthening the spleen group is better than the medicament group.
The contrast of the BMD in all the three groups: Before and after the therapies, the difference of BMP value in the jiaji points group is very significant (P<0. 01), and the medicament group has significant difference (P<0. 05) as well as Tonifying the kidney and strengthening the spleen group. After the therapies, the difference between the jiaji points group and the medicament group is very significant (P<0. 01),and Tonifying the kidney and strengthening the spleen group is significantly different from the medicament group (P<0. 05). It is show that the jiaji points group ameliorates BMD the best.
The contrast of ALP in blood: after the therapies, all the 3 groups have got some augmentation. Before and after the therapies, there is no signicifant difference in every group (P>0.5). Consider: the insignificance is possibly due to the too short duration of the therapies.
The contrast of Ca and P in blood: After the therapies, all the three groups can improve Ca concentration and diminish P concentration. As to the augement of Ca and diminution fo P in blood, the difference between the jiaji points group and the medicament group is significant(P<0. 05). It is show that the jiaji points group adapt the metabolization of Ca and P in a certain extent.
The contrast of Ca/Cr in urine: Every group of the three can diminish Ca/Cr in urine after the therapies without significant difference (P>0. 05). All the three groups can adapt the osseous metabolization by diminution of Ca/Cr in urine.
Conclusion
Acupointinjection has definite therapeutic effect on primary osteoporosis, and the analgestic effect at injecting Jiaji points is better than injecting the points of Tonifying the kidney and strengthening the spleen, and Medicament group .
引文
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[1]欧阳钢等.不同刺激方法对原发性骨质疏松症骨密度的影响.中国针灸,2004,24(1):49-50
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[8]杨大志等.合用神阙穴贴药治疗原发性骨质疏松症的临床疗效.现代医药卫 生,2004,20(24):2614-2615
[9]潘文宇,李艳慧.针刺加火针治疗绝经后骨质疏松56例.中医药学刊,2003,21(5):811-812
[10]金肖青等.电针治疗原发性骨质疏松症临床32例分析.中医药学刊,2003,21(4):516
[11]蔡红.不同治疗频次对原发性骨质疏松症骨密度的影响.中国针灸,2003,2 3(1):15-16
[12]冯秉玮等.原发性骨质疏松的诊断现状.内蒙古医学杂志,2004,36(1):37-40
[13]林志苇等.肾俞埋线对绝经后骨质疏松症临床疼痛的疗效观察.针灸临床杂志,2004,20(12):7-8
[14]杨莉.温针灸为主治疗骨质疏松症腰背痛43例.实用中医药杂志,200521(1):28
[15]刘广霞.针灸督脉为主治疗老年性骨质疏松症28例临床报道[J].中国针灸,2000,20(9):529.
[16]欧阳钢,谢碧红.论原发性骨质疏松症从脾胃论治.南京中医药大学学报(自然科学版),2000,16(5):269-270
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[18]贾育松.穴位注射治疗绝经后骨质疏松症初探.中国骨质疏松杂志,2003,9(2):171
[19]周晓莉等.“双固-通”针灸疗法对绝经后骨质疏松症骨密度的影响.湖北中医杂志,2005,27(6):49-50
[20]王东岩等.针刺背俞穴对原发性骨质疏松症腰骨密度的影响[J].安徽中医临床杂志,2001,1 3(1):26-27.
[21]王东岩等.针刺背部俞穴对骨质疏松症腰椎骨密度的影响[J].湖北中医杂志,2001,23(2):6.
[22]吴明霞等.针灸对骨质疏松患者骨密度作用的临床研究[J].福建中医学院学报,2000,10(4):33-34.
[23]陈丽仪,郭元琦.温针为主治疗绝经后骨质疏松症临床观察[J].针灸临床杂志,2000,16(8):35.
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[25]郑沛仪.穴位注射治疗原发性骨质疏松症之腰腿痛[J].中国中医药信息杂志,2000,7(5):79
[26]潘霞,王东岩.黄芪注射液穴位注射治疗原发性骨质疏松症34例.陕西中医,2004,25(12):1133-1134
[27]熊芳丽,肖亚平.耳针治疗中老年妇女骨质疏松症60例临床观察[J].贵阳中医学院学报,2000,22(2):33-34.
[28]周斌.放血疗法治疗原发性骨质疏松症腰背痛54例临床观察[J].针灸临床杂志,2002,18(4):33
[29]翁明,艾双春.神阙穴贴药对原发性骨质疏松症患者降钙素的影响.天津中医药2003,20(5):48-49
[30]艾双春等.神阙穴贴药对原发性骨质疏松症超声穿透速度的影响.中国针灸,2003,23(1):17-18
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