消髓化核汤结合针刺治疗破裂型腰椎间盘突出症的临床研究

发布时间：2018-01-05 03:33

本文关键词：消髓化核汤结合针刺治疗破裂型腰椎间盘突出症的临床研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过临床研究,观察消髓化核汤结合针刺治疗破裂型腰椎间盘突出症的临床疗效及椎间盘重吸收程度,并与单独服用消髓化核汤和单独使用针刺治疗对比。探讨中药结合针刺治疗腰椎间盘突出症是否可以提高临床疗效,并分析中医体系中这两大方面的传统保守治疗对于破裂型腰椎间盘突出症的优势与不足。方法:将2015年5月至2016年11月期间,在苏州市中医医院和新加坡仁大中医诊所被诊断为破裂型腰椎间盘突出症的病人,通过纳入及排除标准,选出60例患者,根据其个人意愿,分为消髓化核汤为主的中药组(20例)、针刺组(20例)和消髓化核汤结合针刺的中药结合针刺组(20例),采取随访的形式,根据患者治疗前和治疗2个月后的自身情况,根据J0A评分和MRI影像学改变如实记录数据,进行统计学处理。结果:(1)中药组、针刺组和中药结合针刺组治疗均可显著提高患者的J0A评分(P0.05),而中药结合针刺组J0A评分的改善率高于其余两组(P0.05)。根据J0A评分的疗效评估,中药组疗效优良7例,总的优良率为35%(7/20);针刺组疗效优良2例,总的优良率为10%(2/20);中药结合针刺组疗效优良9例,总的优良率为45%(9/20)。(2)中药组、针刺组和中药结合针刺组治疗均可使突出物缩小(P0.05),而中药结合针刺组突出物的吸收率高于其余两组(P0.05)。根据吸收程度,中药组完全吸收1例,明显吸收1例,部分吸收15例,几乎不变1例,突出体积增大2例,总的吸收率为85%(17/20);针刺组完全吸收0例,明显吸收4例,部分吸收12例,几乎不变1例,突出体积增大3例,总的吸收率为80%(16/20);中药结合针刺组完全吸收2例,明显吸收5例,部分吸收11例,几乎不变0例,突出体积增大2例,总的吸收率为90%(18/20)。结论:(1)治疗后3组患者的J0A评分较治疗前均明显提高;腰椎间盘突出程度较治疗前均缩小。说明通过保守治疗,腰椎间盘突出症的临床症状及椎间盘突出程度均能够取得良好的转归。(2)中药结合针刺组J0A评分提高比例及突出物缩小程度最大;中药组次之,稍微弱于中药结合针刺组;而针刺组最低。说明中药和针刺治疗腰椎间盘突出症均能取得良好疗效,但两者结合能协同增加疗效。
[Abstract]:Objective: to observe the clinical effect of Xiaomuanhuahe decoction combined with acupuncture in treating ruptured lumbar disc herniation and the degree of disc reabsorption. And compared with the treatment of Xiaoliaohuanhe decoction alone and acupuncture alone, to explore whether the combination of traditional Chinese medicine and acupuncture can improve the clinical efficacy of lumbar disc herniation. And analyze the advantages and disadvantages of traditional conservative treatment in these two aspects of traditional Chinese medicine system for ruptured lumbar disc herniation. Methods: from May 2015 to November 2016. Patients diagnosed as ruptured lumbar disc herniation in Suzhou traditional Chinese Medicine Hospital and Singapore Renda TCM Clinic selected 60 patients according to their personal wishes through inclusion and exclusion criteria. The patients were divided into two groups: the traditional Chinese medicine group (20 cases) and the acupuncture group (20 cases) and the group (20 cases) and the group (20 cases) were followed up. According to the patient's condition before treatment and 2 months after treatment, according to J0A score and MRI imaging changes, the data were recorded truthfully and statistically. Results: 1) Chinese medicine group. The treatment of acupuncture group and Chinese medicine combined with acupuncture group can significantly improve the J0A score of patients (P0.05). The improvement rate of J0A score in the TCM combined with acupuncture group was higher than that in the other two groups (P 0.05). According to the evaluation of J0A score, 7 cases of the TCM group were good, and the total excellent and good rate was 35% / 20%. In the acupuncture group, the curative effect was good in 2 cases, and the total excellent and good rate was 10% 20%. There were 9 cases of excellent curative effect in Chinese medicine combined with acupuncture group. The total excellent and good rate was 45% 20 / 20. 2) Chinese medicine group, acupuncture group and traditional Chinese medicine combined with acupuncture group could reduce the protrusions (P0.05). However, the absorptivity of protrusions in TCM combined with acupuncture group was higher than that in the other two groups. According to the degree of absorption, 1 case was completely absorbed, 1 case was obviously absorbed, 15 cases were partially absorbed, and 1 case was almost unchanged. The volume of protrusion increased in 2 cases, and the total absorptivity was 85 / 20%. In the acupuncture group, there were 0 cases of complete absorption, 4 cases of obvious absorption, 12 cases of partial absorption, almost 1 case of no change, and 3 cases of enlarged protrusion volume. The total absorption rate was 80% 16 / 20%. In the combination of Chinese medicine and acupuncture group, 2 cases were completely absorbed, 5 cases were obviously absorbed, 11 cases were partially absorbed, almost 0 cases were unchanged, and 2 cases were enlarged protruding volume. The total absorptivity was 90 / 20. Conclusion the J0A score of the three groups after treatment was significantly higher than that before treatment. The degree of lumbar disc herniation was smaller than that before treatment. The clinical symptoms of lumbar disc herniation and the degree of disc herniation can achieve good outcome. The Chinese medicine group was the second, slightly weaker than the traditional Chinese medicine combined with acupuncture group; The acupuncture group is the lowest. It shows that both Chinese medicine and acupuncture can achieve good curative effect on lumbar disc herniation, but the combination of both can increase the curative effect synergistically.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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