弧刃针刀综合疗法治疗腰椎间盘突出症的临床研究
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摘要
目的观察弧刃针刀综合疗法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效,探讨其作用机制。方法将76例LDH患者随机分为传统针刀组和弧刃针刀组,每组38例。传统针刀组给予传统针刀,弧刃针刀组给予弧刃针刀综合疗法,均治疗4周。治疗期间刀口线与脊柱平行刺入,以避免大量肌纤维组织受损,针刀刺入达骨面即止,注意避开重要血管。观察两组患者治疗前后及随访3个月日本骨科协会腰疼痛评分量表(JOA)、Oswestry功能障碍指数问卷评分量表(ODI)和视觉模拟(VAS)评分的变化;检测两组治疗前后及随访3个月血清IL-6、C-反应蛋白(CRP)和超氧化物歧化酶(SOD)的含量;比较两组有效率、随访12个月复发率及不良反应发生率。结果传统针刀组完成33例,弧刃针刀组完成35例。弧刃针刀组总有效率[97. 1%(34/35)]高于传统针刀组[81. 8%(27/33),χ2=8. 891,P=0. 027]。与本组治疗前比较,治疗后及随访3个月两组患者JOA评分和SOD含量升高(P <0. 05,P <0. 01),ODI、VAS评分和IL-6、CRP含量降低(P <0. 05,P <0. 01),且弧刃针刀组优于传统针刀组(P <0. 05,P <0. 01)。治疗后3个月和12个月的随访中,弧刃针刀组复发率均低于同期传统针刀组(χ2=9. 357,P=0. 004;χ2=12. 863,P=0. 002)。治疗过程中传统针刀组出现1例局部皮肤红肿、化脓、伤口难于愈合,经对口服抗生素及换药处理后症状好转。传统针刀组出现3例、弧刃针刀组出现1例皮下瘀青,经对症热敷后消失,其他未见明显不良反应。结论弧刃针刀综合疗法融合"针"、"刀"、"线"和"药物注射"四种功能于一体,可明显改善LDH患者的临床症状和血清IL-6、CRP、SOD含量。
Objective To observe the clinical effects of arc edge needle-scalpel( AENS) comprehensive therapy in treating lumbar disc herniation( LDH) and explore its mechanism. Methods Totally 76 LDH patients were assigned to the traditional needle-scalpel group and the AENS group,38 cases in each group. The traditional needle-scalpel was administered to patients in the traditional needle-scalpel group. Patients in the AENS group received AENS comprehensive therapy.The treatment course was 4 weeks for all. In order to avoid the damage of a large number of muscle fiber tissues,needle knife insertion should be stopped when it reaches the bone surface. Attention should be paid to avoid important blood vessels. The Japanese Orthopaedic Association( JOA),the Oswestry Disability Index( ODI) and Visual Analogue Scale( VAS) were observed in the two groups before and after treatment and 3-month follow-up. The content of interleukins-6( IL-6),C-reactive protein( CRP) and superoxide dismutase( SOD) were detected in the two groups before and after treatment and 3-month follow-up. The effectiverate,recurrence rate at 12-month follow-up and incidence of adverse reactions in the two groups were compared. Results Finally 33 cases in the traditional needle-scalpel group completed the trial,and 35 cases in the AENS group completed treatment. The total efficiency rate was 97. 1%( 34/35) in the AENS group,which was better than 81. 8%( 27/33) in the traditional needle-scalpel group( χ2= 8. 891,P = 0. 027). Compared with before treatment,the JOA score and SOD content were decreased(P < 0. 05,P < 0. 01),the ODI,VAS score and the IL-6 CRPcontent were decreased(P < 0. 05,P < 0. 01) in the two groups,and the AENS group was better than the traditional needle-scalpel group(P < 0. 05,P < 0. 01) after treatment and 3-month follow-up. The recurrence rate of the AENS group was lower than that in the traditional needle-scalpel group at the end of the 3 rd and 12 th month follow-up( χ2= 9. 357,P = 0. 004; χ2= 12. 863,P = 0. 002). During the treatment,local skin redness,maturation,and poor healing wound occured in 1 case of the traditional needle-scalpel group,symptoms improved after treatment with oral antibiotics and replacement. Subcutaneous bruising occured in 3 patients of the traditional needle-scalpel group and 1 patient in the AENS group. After the hot application of the disease disappeared,no other obvious adverse reactions were observed.Conclusion AENS comprehensive therapy was integrated by " needle", " scalpel ", " embedded wire " and " drug injection",and it could improve the clinical symptoms,the serum IL-6,CRP,SOD content of LDH patients.
Objective To observe the clinical effects of arc edge needle-scalpel( AENS) comprehensive therapy in treating lumbar disc herniation( LDH) and explore its mechanism. Methods Totally 76 LDH patients were assigned to the traditional needle-scalpel group and the AENS group,38 cases in each group. The traditional needle-scalpel was administered to patients in the traditional needle-scalpel group. Patients in the AENS group received AENS comprehensive therapy.The treatment course was 4 weeks for all. In order to avoid the damage of a large number of muscle fiber tissues,needle knife insertion should be stopped when it reaches the bone surface. Attention should be paid to avoid important blood vessels. The Japanese Orthopaedic Association( JOA),the Oswestry Disability Index( ODI) and Visual Analogue Scale( VAS) were observed in the two groups before and after treatment and 3-month follow-up. The content of interleukins-6( IL-6),C-reactive protein( CRP) and superoxide dismutase( SOD) were detected in the two groups before and after treatment and 3-month follow-up. The effectiverate,recurrence rate at 12-month follow-up and incidence of adverse reactions in the two groups were compared. Results Finally 33 cases in the traditional needle-scalpel group completed the trial,and 35 cases in the AENS group completed treatment. The total efficiency rate was 97. 1%( 34/35) in the AENS group,which was better than 81. 8%( 27/33) in the traditional needle-scalpel group( χ2= 8. 891,P = 0. 027). Compared with before treatment,the JOA score and SOD content were decreased(P < 0. 05,P < 0. 01),the ODI,VAS score and the IL-6 CRPcontent were decreased(P < 0. 05,P < 0. 01) in the two groups,and the AENS group was better than the traditional needle-scalpel group(P < 0. 05,P < 0. 01) after treatment and 3-month follow-up. The recurrence rate of the AENS group was lower than that in the traditional needle-scalpel group at the end of the 3 rd and 12 th month follow-up( χ2= 9. 357,P = 0. 004; χ2= 12. 863,P = 0. 002). During the treatment,local skin redness,maturation,and poor healing wound occured in 1 case of the traditional needle-scalpel group,symptoms improved after treatment with oral antibiotics and replacement. Subcutaneous bruising occured in 3 patients of the traditional needle-scalpel group and 1 patient in the AENS group. After the hot application of the disease disappeared,no other obvious adverse reactions were observed.Conclusion AENS comprehensive therapy was integrated by " needle", " scalpel ", " embedded wire " and " drug injection",and it could improve the clinical symptoms,the serum IL-6,CRP,SOD content of LDH patients.
引文
[1]Fang Y,Qiu J,Jiang ZB,et al.Associations of Caspase-3gene polymorphism with lumbar disc herniation[J].Kaohsiung J Med Sci,2016,32(11):552-558.
[2]胡有谷主编.腰椎间盘突出症[M].第3版.北京:人民卫生出版社,2004:3.
[3]Liu C,Zhou Y.Percutaneous endoscopic lumbar diskectomy and minimally invasive transforaminal lumbar interbody fusion for recurrent lumbar disk herniation[J].World Neurosurg,2017,98(2):14-20.
[4]肖爱伟,姜贵云,勾丽洁,等.下肢持续皮牵引治疗老年腰椎间盘突出症患者的疗效及安全性观察[J].中华物理医学与康复杂志,2014,36(12):946-947.
[5]边永娜,张田香,任小烨,等.334例药品不良反应的医院质控负性指标监控分析[J].中国医院管理,2016,36(1):68-69.
[6]王学昌.弧刃针刀[P].中国专利:CN2012205907990,2012-11-12.
[7]王学昌.弧刃针[P].中国专利:CN2012206568077,2012-12-04.
[8]王学昌,都帅刚,程少丹,等.弧刃针刀治疗重症肩周炎所致神经痛73例临床研究[J].中国实用神经疾病杂志,2016,19(23):956-957.
[9]程少丹,王学昌,张洋,等.弧刃针刀治疗轻中度腕管综合征的随机对照研究[J].中国中医骨伤科杂志,2017,25(4):5-9.
[10]王学昌,程少丹,刘延青,等.弧刃针治疗踝管综合征的疗效观察[J].中国疼痛医学杂志,2017,23(10):798-800.
[11]宣蜇人主编.软组织外科学(上)[M].上海:文汇出版社,2009:20.
[12]吴绪平,张天民主编.针刀临床治疗学[M].北京:中国医药科技出版社,2007:63.
[13]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:36-37.
[14]Fujiwara A,Kobayashi N,Saiki K,et al.Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index,Roland-Morris Disability Questionnaire and short-form 36[J].Spine,2003,28(14):1601-1607.
[15]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可行性[J].中国脊柱脊髓杂志,2005,15(4):242-244.
[16]Million R,Hall W,Nilsen KH,et al.Assessment of the progress of the back pain patient[J].Spine,1982,7(4):204-212.
[17]伍小敏,吴跃,杜忠举,等.骶管神经阻滞联合腰部核心肌力训练治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2017,39(2):154-156.
[18]Yang R,Wang LQ,Liu Y.Antitumor activities of widelyused Chinese Herb-Licorice[J].Chin Herb Med,2014,6(4):274-281.
[19]王延玲.不同针刺治疗方法对腰椎间盘突出症的疗效观察[J].中国针灸,2013,33(7):605-608.
[20]吴萍,周逸伦,徐铭阳,等.穴位埋线法治疗腰椎间盘突出症疗效的系统评价[J].中国中医急症,2017,26(8):1330-1332.
[21]路飞,叶新苗.针刀治疗腰椎间盘突出症96例[J].长春中医药大学学报,2015,31(2):383-385.
[22]周楠,房敏,朱清广,等.推拿手法治疗腰椎间盘突出症腰背伸肌群生物力学特性评价研究[J].中华中医药杂志,2012,27(3):562-566.
[23]许金海,王晶,叶洁,等.益气化瘀补肾法治疗腰椎间盘突出症的随机对照临床研究[J].世界科学技术-中医药现代化,2013,15(5):1074-1080.
[24]陈新用,梁裕,曹鹏,等.手术治疗腰椎间盘突出症的长期疗效及其影响因素[J].中国脊柱脊髓杂志,2012,22(8):717-721.
[25]Gun WL,Ryu JH,Kim JD,et al.Comparison of lumbar discectomy alone and lumbar discectomy with direct repair of pars defect for patients with disc herniation and spondylolysis at the nearby lumbar segment[J].Spine J,2015,15(10):2172-2181.
[26]张月兰,代名彩.中药熏蒸联合超短波治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2015,37(2):122-124.
[27]Linda MP,Elina S,Line MJ,et al.Serum levels of the pro-inflammatory interleukins 6(IL-6)and-8(IL-8)in patients with lumbar radicular pain due to disc herniation:A 12-month prospective study[J].Brain Beha Immun,2015,46(5):132-136.
[28]钟秀莲,牛淑芳,王庆秧.活血通痹散离子导入配合牵引疗法改善腰椎间盘突出症功能障碍的作用[J].中国实验方剂学杂志,2014,20(13):205-209.
[29]施加加,罗艳,王洪军,等.坐骨神经松动术对腰椎间盘突出症患者日常生活活动能力的影响察[J].中华物理医学与康复杂志,2017,37(9):691-693.
[2]胡有谷主编.腰椎间盘突出症[M].第3版.北京:人民卫生出版社,2004:3.
[3]Liu C,Zhou Y.Percutaneous endoscopic lumbar diskectomy and minimally invasive transforaminal lumbar interbody fusion for recurrent lumbar disk herniation[J].World Neurosurg,2017,98(2):14-20.
[4]肖爱伟,姜贵云,勾丽洁,等.下肢持续皮牵引治疗老年腰椎间盘突出症患者的疗效及安全性观察[J].中华物理医学与康复杂志,2014,36(12):946-947.
[5]边永娜,张田香,任小烨,等.334例药品不良反应的医院质控负性指标监控分析[J].中国医院管理,2016,36(1):68-69.
[6]王学昌.弧刃针刀[P].中国专利:CN2012205907990,2012-11-12.
[7]王学昌.弧刃针[P].中国专利:CN2012206568077,2012-12-04.
[8]王学昌,都帅刚,程少丹,等.弧刃针刀治疗重症肩周炎所致神经痛73例临床研究[J].中国实用神经疾病杂志,2016,19(23):956-957.
[9]程少丹,王学昌,张洋,等.弧刃针刀治疗轻中度腕管综合征的随机对照研究[J].中国中医骨伤科杂志,2017,25(4):5-9.
[10]王学昌,程少丹,刘延青,等.弧刃针治疗踝管综合征的疗效观察[J].中国疼痛医学杂志,2017,23(10):798-800.
[11]宣蜇人主编.软组织外科学(上)[M].上海:文汇出版社,2009:20.
[12]吴绪平,张天民主编.针刀临床治疗学[M].北京:中国医药科技出版社,2007:63.
[13]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:36-37.
[14]Fujiwara A,Kobayashi N,Saiki K,et al.Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index,Roland-Morris Disability Questionnaire and short-form 36[J].Spine,2003,28(14):1601-1607.
[15]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可行性[J].中国脊柱脊髓杂志,2005,15(4):242-244.
[16]Million R,Hall W,Nilsen KH,et al.Assessment of the progress of the back pain patient[J].Spine,1982,7(4):204-212.
[17]伍小敏,吴跃,杜忠举,等.骶管神经阻滞联合腰部核心肌力训练治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2017,39(2):154-156.
[18]Yang R,Wang LQ,Liu Y.Antitumor activities of widelyused Chinese Herb-Licorice[J].Chin Herb Med,2014,6(4):274-281.
[19]王延玲.不同针刺治疗方法对腰椎间盘突出症的疗效观察[J].中国针灸,2013,33(7):605-608.
[20]吴萍,周逸伦,徐铭阳,等.穴位埋线法治疗腰椎间盘突出症疗效的系统评价[J].中国中医急症,2017,26(8):1330-1332.
[21]路飞,叶新苗.针刀治疗腰椎间盘突出症96例[J].长春中医药大学学报,2015,31(2):383-385.
[22]周楠,房敏,朱清广,等.推拿手法治疗腰椎间盘突出症腰背伸肌群生物力学特性评价研究[J].中华中医药杂志,2012,27(3):562-566.
[23]许金海,王晶,叶洁,等.益气化瘀补肾法治疗腰椎间盘突出症的随机对照临床研究[J].世界科学技术-中医药现代化,2013,15(5):1074-1080.
[24]陈新用,梁裕,曹鹏,等.手术治疗腰椎间盘突出症的长期疗效及其影响因素[J].中国脊柱脊髓杂志,2012,22(8):717-721.
[25]Gun WL,Ryu JH,Kim JD,et al.Comparison of lumbar discectomy alone and lumbar discectomy with direct repair of pars defect for patients with disc herniation and spondylolysis at the nearby lumbar segment[J].Spine J,2015,15(10):2172-2181.
[26]张月兰,代名彩.中药熏蒸联合超短波治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2015,37(2):122-124.
[27]Linda MP,Elina S,Line MJ,et al.Serum levels of the pro-inflammatory interleukins 6(IL-6)and-8(IL-8)in patients with lumbar radicular pain due to disc herniation:A 12-month prospective study[J].Brain Beha Immun,2015,46(5):132-136.
[28]钟秀莲,牛淑芳,王庆秧.活血通痹散离子导入配合牵引疗法改善腰椎间盘突出症功能障碍的作用[J].中国实验方剂学杂志,2014,20(13):205-209.
[29]施加加,罗艳,王洪军,等.坐骨神经松动术对腰椎间盘突出症患者日常生活活动能力的影响察[J].中华物理医学与康复杂志,2017,37(9):691-693.