针刺后溪、足临泣结合推拿治疗颈型颈椎病的临床疗效观察

发布时间：2018-06-23 16:16

本文选题：颈型颈椎病 + 后溪　；参考：《广州中医药大学》2016年硕士论文

【摘要】：颈椎病,脊柱疾病的一种常见类型,目前在临床上非常常见。现代西医学经过多年的研究发现:其发病机制主要体现在两个方面:一是颈椎椎间盘组织退行性变;二是由椎间盘组织退行性变引起的继发性椎间关节退行性变。就症状学而言,颈椎病的主要症状是颈、肩、枕部不适,以酸痛、胀麻、散在压痛点、僵硬感为主要表现。近些年来,我国社会经济取得了飞速发展,随之而来的是人们的生活、工作方式发生了历史性的改变。手机、电脑等现代通讯手段的普遍普及,低头族随处可见,导致近几年来颈椎病发病率逐年升高,并且越来越年轻化。1992年,第二届颈椎病专题座谈会在山东青岛顺利召开,在这次专题座谈会上,结合颈椎附近主要为脊髓、神经、血管等解剖组织器官的生理特性,颈椎病也容易侵犯附近的脊髓、神经、血管等临床发现,大会制定了新的颈椎病分型标准,与会专家一致同意将颈椎病分为六个类型,第一型是颈型颈椎病,第二型是神经根型颈椎病,第三型是脊髓型颈椎病,第四型是椎动脉型颈椎病,第五型是交感神经型颈椎病,第六型是混合型颈椎病。在这六型颈椎病中,颈型是颈椎病的最初阶段,所以颈型颈椎病症状在六型当中是最轻的,所以如果治疗及时并且治疗得当,症状缓解速度比较快,并且疗效突出且治疗时间也相对的缩短。反之,颈型颈椎病很容易发展为其他类型的颈椎病。对于颈型颈椎病的治疗,传统中医学与现代西医学均有很多不同的治疗手段,并且都具有一定的疗效。针刺和推拿是传统中医学治疗颈型颈椎病特色疗法,八脉交会穴在脊柱疾病中应用非常广泛,后溪、足临泣对于治疗脊柱相关疾病具有很好的疗效,值得进一步的研究与应用。本人导师彭旭明教授师从岭南针灸大家靳瑞教授和张家维教授,长期从事脊柱相关疾病的临床研究工作。本课题主要以中医基础理论为依据,结合导师多年的临床经验,通过针刺八脉交会穴之后溪、足临泣配合推拿治疗颈型颈椎病的临床实验研究,探讨八脉交会穴之后溪、足临泣结合推拿治疗颈型颈椎病的临床实践意义,能够为他人进行颈型颈椎病的临床实践和科学研究提供一些有价值的参考依据和必要的素材。目的:本课题以循证医学为原则,进行了一项自身前后比较临床试验研究,对颈型颈椎病患者进行以八脉交会穴之后溪、足临泣进行针刺结合推拿治疗,通过对比治疗前后颈型颈椎病颈痛程度、症状等的改变,用统计学的方法对观察的结果进行处理和分析,观察针刺八脉交会穴之后溪、足临泣配合推拿治疗颈型颈椎病的疗效及其安全性作出评价,探讨八脉交会穴之"后溪、足临泣"结合推拿治疗颈型颈椎病的作用机理,为针刺结合推拿治疗颈型颈椎病提供更多的循证医学证据,为今后的进一步研究夯实基础,同时为颈型颈椎病的治疗提供一种新的途径,以拓展针刺结合推拿疗法的疾病谱。方法:首先选择60例符合观察条件的颈型颈椎病患者,这些患者均来自广州中医药大学第一附属医院推拿科门诊。依据统计学原理,本课题组采用简单随机方法,将60例符合条件的颈型颈椎病患者按照随机原则分为两组,一组为治疗组,人数30人,另一组为对照组,人数30人。治疗方案方面:两组患者都采用常规推拿手法治疗,时间大概20分钟,手法选择上主要是揉、推、一指禅、(?)、拿、拨、按、摇等常见的推拿手法。对照组只采用常规推拿手法治疗,治疗组在对照组的基础上结合针刺八脉交会穴之后溪、足临泣两个穴位,留针时间15分钟。治疗周期方面:隔天治疗一次,连续治疗6次作为一个疗程,本实验全程进行两个疗程的临床观察。观察指标方面:主要采用临床研究常用的观察量表进行临床观察:一是NPQ颈痛量表,二是简化的McGill疼痛询问量表(SF-MPQ)。具体做法为治疗前进行一次NPQ颈痛量表和简化的McGill疼痛询问量表(SF-MPQ)评定,两个疗程治疗结束后再进行一次NPQ颈痛量表和简化的McGill疼痛询问量表(SF-MPQ)评定,然后对比治疗前后量表的相关数据从而得出结果。临床疗效方面:本课题组以NPQ颈痛量表的减分率作为临床疗效评价的客观指标。临床控制:评分下降≥75%;显著进步:50%≤评分下降75%;进步:25≤评分下降50%;无效:评分下降25%。收集到的相关数据本课题组使用统计软件SPSS19.0软件进行统计分析,依据统计分析结果,评价治疗组和对照组的临床疗效。结果:1、一般资料比较:在性别、年龄、病程方面,治疗组和对照组的差异均没有统计学意义;治疗前NPQ颈痛量表和简化的McGill疼痛询问量表(SF-MPQ)评分方面,治疗组和对照组的差异均没有统计学意义;所以两组患者存在可比性。2、临床疗效比较:采用针刺八脉交会穴之后溪、足临泣结合推拿治疗的治疗组和单纯采用推拿治疗的对照组均有良好的治疗效果。治疗组针刺八脉交会穴之后溪、足临泣结合推拿治疗的总有效率为96.67%;对照组单纯推拿治疗的总有效率为80.00%,根据结果分析,治疗组在总有效率方面明显优于对照组,组间比较P0.05,有统计学意义。3、NPQ颈痛量表评分比较:采用配对t,治疗组和对照组在治疗前的评分和治疗后的评分p0.05,有统计学意义;采用独立t,治疗后治疗组和对照组评分p0.05,有统计学意义,说明在改善NPQ颈痛量表评分方面,采用针刺八脉交会穴之后溪、足临泣结合推拿治疗的治疗组优于单纯采用推拿治疗的对照组。4、简化的McGill疼痛询问量表评分比较:采用配对t,治疗组和对照组在治疗前的评分和治疗后的评分p0.05,有统计学意义;采用独立t,治疗后治疗组和对照组评分p0.05,有统计学意义,说明在改善简化的McGill疼痛询问量表评分方面,采用针刺八脉交会穴之后溪、足临泣结合推拿治疗的治疗组优于单纯采用推拿治疗的对照组。5、治疗组和对照组在为期两个疗程的观察过程中,都没有出现不良反应和意外事件。结论:针刺八脉交会穴之后溪、足临泣配合推拿治疗颈型颈椎病有明显的优势,与单纯推拿治疗相比,主要体现在减轻患者颈部不适感力度更大、止痛效果更强、疗效更加突出、总有效率大大提高。说明八脉交会穴作为腧穴特定穴中的一种常用类型,其作用值得进一步挖掘,八脉交会穴作为沟通联系十二正经与奇经八脉的桥梁,其沟通内外、联络脏腑、调节气血阴阳的作用有着非常突出的地位。后溪和足临泣作为八脉交会穴,后溪属于手太阳小肠经,通督脉,足临泣属于足少阳胆经,通带脉,后溪通督脉和足临泣通带脉理论临床指导意义非凡,值得临床医师在临床工作当中进一步挖掘精髓并推广应用,更好的吧祖国医学传承下去。
[Abstract]:Cervical spondylosis (cervical spondylosis), a common type of spinal disease, is very common in clinical practice. After years of research in modern western medicine, it is found that the pathogenesis is mainly in two aspects: one is the degeneration of the cervical intervertebral disc, and the two is the secondary degeneration of the intervertebral joint caused by the degeneration of the intervertebral disc. The main symptoms of cervical spondylosis are the discomfort of the neck, shoulder and pillow, with sore pain, swelling and numbness, scattered at the point of tenderness and stiffness as the main manifestation. In recent years, the social and economic development in China has made rapid development, followed by the people's life, the way of work has changed historically. The modern communication means such as hand machine and computer are popularized, and the low head family is everywhere. It can be seen that the incidence of cervical spondylosis in recent years has increased year by year, and more and more young.1992 years, the second session of the Symposium on cervical spondylosis was held in Qingdao, Shandong. In this symposium, the physiological characteristics of the spinal cord, nerve, blood vessel and other organs were mainly dissected near the cervical vertebra, and the cervical spondylosis was also easily encroached on the nearby ridge. The General Assembly agreed to divide the cervical spondylosis into six types: cervical spondylosis of the neck, the second type of cervical spondylosis of the nerve root type, the third type of cervical spondylotic myelopathy, the fourth type of vertebral artery type cervical spondylosis, and the fifth type of sympathetic cervical spondylosis, and the fifth type of sympathetic cervical spondylosis. The six type is mixed cervical spondylosis. In the six type of cervical spondylosis, the neck type is the initial stage of the cervical spondylosis, so the symptoms of cervical spondylosis are the lightest in type six, so if the treatment is timely and properly treated, the symptom remission rate is faster, and the curative effect is prominent and the treatment time is relatively shortened. Conversely, cervical spondylosis is easy to hair. For the treatment of cervical spondylosis, there are many different treatments for the treatment of cervical spondylosis, both traditional Chinese medicine and modern western medicine have different therapeutic methods, and they all have a certain effect. Acupuncture and massage are the traditional Chinese medicine treatment of cervical spondylosis, and the eight pulse rendezvous acupoints are widely used in spinal column diseases. In the treatment of spinal related diseases, it is very effective and worthy of further research and application. Professor Peng Xuming, my tutor, has been engaged in the clinical research of spinal related diseases for a long time from Professor Jin Rui and Zhang Jiawei of South of the Five Ridges. This subject is based on the basic theory of traditional Chinese medicine and combined with the clinical experience of many years. The clinical practical significance of the treatment of cervical spondylosis of cervical spondylosis after the acupuncture and massage treatment of cervical spondylotic cervical spondylosis after the acupuncture of the eight pulse rendezvous acupoint of the eight pulse is discussed. The clinical practical significance of the treatment of cervical spondylosis of the cervical vertebra after the eight Mai rendezvous acupoints and the combination of the foot and face with the massage can provide some valuable reference for the clinical practice and scientific research of the cervical spondylosis of the cervical spondylosis. Objective: with the principle of evidence-based medicine, a comparative clinical trial of the cervical spondylosis of cervical spondylosis was carried out with the treatment of acupuncture combined with massage for cervical spondylosis of cervical spondylosis, and the changes of neck pain and symptoms of cervical spondylosis before and after contrast treatment. The results of the observation were treated and analyzed. The effect and safety of the treatment of cervical spondylosis of cervical spondylosis after the acupuncture combined with massage were observed, and the mechanism of the treatment of cervical spondylosis of cervical type was discussed, and the treatment of cervical spondylosis of cervical type by acupuncture combined with massage was provided. More evidence-based medical evidence provides a new way for the treatment of cervical spondylosis with a new way for the treatment of cervical spondylosis in order to expand the disease spectrum of acupuncture combined with massage therapy. Methods: first of all, 60 patients with cervical spondylosis, which conform to the conditions of observation, were selected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine. According to the statistical principle, we divided 60 cases of cervical spondylosis of the cervical spondylosis into two groups according to the random principle. One group was the treatment group, the number was 30, the other group was the control group, the number of 30 people. The two groups of patients were treated with conventional massage, with a time of about 20 points. The control group was treated with conventional massage. The control group was only treated with conventional massage. The treatment group was combined with the control group on the basis of the acupuncture of the eight pulse rendezvous acupoint, two points and 15 minutes. The treatment cycle was treated the other day and 6 consecutive treatment. As a course of treatment, two courses of clinical observation were carried out in the whole course of the experiment. Observation index: the main clinical observation scale was mainly used for clinical observation: one was the NPQ neck pain scale, and the two was a simplified McGill pain questionnaire (SF-MPQ). The specific practice was to make a NPQ neck pain scale and simplified McGill pain before treatment. After two courses of treatment, a NPQ neck pain scale and a simplified McGill pain questionnaire (SF-MPQ) were evaluated after the two course of treatment, and then the results were compared with the related data before and after the treatment. The clinical effect: the subject group took the reduction rate of the NPQ neck pain scale as an objective index for the evaluation of clinical efficacy. Clinical control: the score decreased more than 75%; significant progress: 50% or less score dropped 75%; progress: 25 or less score dropped 50%; null and void: the related data collected by the score drop 25%. were statistically analyzed by the statistical software SPSS19.0 software, and the clinical efficacy of the treatment group and the control group was evaluated according to the statistical analysis results. Results: 1, general data ratio Comparison: there was no significant difference between the treatment group and the control group in gender, age and course of disease. There was no significant difference between the treatment group and the control group before the NPQ neck pain scale and the simplified McGill pain questionnaire (SF-MPQ), so there was a comparability of.2 in the two groups, and the clinical efficacy was compared with the acupuncture eight pulse. After rendezvous acupoint, the treatment group of foot facing weeping combined with massage therapy and the control group with simple massage treatment have good therapeutic effect. The total effective rate of the treatment group after acupuncture at the eight Mai rendezvous point is 96.67%, and the total effective rate of the simple massage treatment in the control group is 80%, according to the result analysis, the treatment group. The total efficiency was obviously better than that of the control group. The comparison between the group and the control group was P0.05, with a statistically significant.3, the NPQ neck pain scale was compared with the paired t, and the score of the treatment group and the control group was statistically significant before the treatment and the score of P0.05 after the treatment; the independent T, the treatment group and the control group, P0.05, were statistically significant, indicating that the changes were statistically significant. On the score of good NPQ neck pain scale, the treatment group with acupuncture of eight pulse rendezvous acupoint, foot facing weeping and massage therapy is superior to that of the control group.4 simply using the massage therapy, and the simplified McGill pain inquiry scale score is compared: the paired t, the score of the treatment group and the control group before the treatment and the score after the treatment are P0.05, with statistical significance. With the use of independent T, the post treatment group and the control group were P0.05, with statistical significance, indicating that in improving the simplified McGill pain enquiry scale, the treatment group with the acupuncture of the eight pulse rendezvous acupoint, the foot facing weeping and the massage treatment group was better than the control group with the simple massage therapy,.5, the treatment group and the control group were two treatments in the treatment group. During the course of observation, there was no adverse reaction and accident. Conclusion: after the acupuncture of the eight pulse point acupoint, there is a obvious advantage in the treatment of cervical spondylosis of the neck type. Compared with the simple massage therapy, it is mainly reflected in reducing the intensity of the neck discomfort, the effect of pain relieving is stronger, the curative effect is more prominent and the total efficiency is more effective. The function of the eight pulse rendezvous acupoint, as a common type of acupoint in the acupoint, deserves further excavation. The eight pulse rendezvous acupoint is a bridge between the twelve meridians and the eight veins of the Qi meridian. It has a very prominent position to communicate inside and outside, to contact the viscera, to regulate the role of Qi and blood Yin and Yang. The meridian belongs to the hand sun small intestine meridian, through the supervision vein, the foot facing weeping belongs to the foot Shaoyang gallbladder meridian, through the belt pulse, the post brooding meridian and the foot Lin weeping the pulse theory clinical guidance significance is remarkable, deserves the clinician to further excavate the essence and popularize the application in the clinical work, better the motherland medicine inherits.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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