开四关联合腹针治疗腰椎间盘突出症的临床观察

发布时间：2018-01-14 03:04

本文关键词：开四关联合腹针治疗腰椎间盘突出症的临床观察　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:腰椎间盘突出症(LDH)是一种常见疾病,在针灸科和骨科中就诊率高,青壮年多发,且逐渐呈现年轻化。除有明确手术指征的病人外,保守治疗为本病的主要治疗手段,但复发率高。腹针疗法临床应用广泛,已经证实对多种疾病疗效显著,具有其他疗法所无法替代的优点。开四关调和气血阴阳,对多种疾病均有效。本文通过设计随机对照试验,探讨开四关联合腹针治疗LDH的临床疗效,为开四关联合腹针治疗LDH提供临床依据,并进一步明确开四关的早期镇痛效果。方法:严格根据纳入条件,选取2016年5月至2017年2月在广东省中医院及广州中医药大学第一附属医院针灸科或骨科门诊就诊的60例病人;将其随机分为两组,治疗组、对照组各30例病人。治疗组先在四关穴上行提插捻转泻法后留针,随后开始腹针治疗,而对照组只给予腹针治疗。两组均要求病人卧硬板床休息2周,每次治疗留针30分钟,前3次每日1次,之后2日1次,6-10次为1疗程。采用腰椎功能评分(下腰痛评分系统)、直观疼痛模拟量表(VAS评分)作为疗效评价指标,分别于首次治疗30分钟后、前3次治疗后、1个疗程治疗的前后各进行一次VAS评分,于1个疗程治疗的前后进行JOA评分,并根据治疗前后JOA下腰痛评分的改善率来评定最后的临床疗效。将所得数据由专人在excel上建立数据库,使用SPSS22.0软件对数据进行比较分析。结果:1.首次治疗后30min,两组VAS评分与治疗前比较均具有明显差异(P0.01),而两组间的VAS评分比较提示具有显著性差异(P0.01),但治疗组治疗前后的差值明显大于对照组。治疗3次后,两组VAS评分与治疗前比较均具有显著性差异(P0.01),两组组间VAS评分比较具有显著性差异(P0.01),但两组治疗前后差值经统计学分析,无明显差异性。2.1个疗程后,两组的JOA及VAS评分与治疗前比较,差异具有统计学意义(P0.01)。3.1个疗程后,两组间JOA及VAS评分比较,VAS评分的差异不具有统计意义(P0.05),JOA评分的差异具有统计学意义(P0.05)。4.疗效评价:治疗组30例病例中,临床治愈9例,显效13例,有效6例,无效2例,临床总有效率达93.33%。对照组30例病例中,临床治愈5例,显效8例,有效13例,无效4例,临床总有效率达86.67%。经秩和检验z=-2.129,P0.05,两组结果具有显著性差异。结论:开四关联合腹针及单纯腹针疗法均可在一定程度上改善LDH患者的腰椎功能及减轻疼痛症状,结果提示治疗组的临床疗效优于对照组。同时通过分析两组在不同治疗次数后VAS评分的差异可得知,开四关联合腹针方法在缓解疼痛方面优于单纯腹针方法,且即时止痛效果显著。本次研究的治疗方法表明开四关镇痛起效迅速,且具有患者痛苦少、操作简单易行等优点,也进一步明确了腹针治疗LDH的临床疗效,值得临床进一步推广应用。
[Abstract]:Objective: Lumbar disc herniation (LDH) is a common disease, in acupuncture and orthopedic departments, the rate of medical treatment is high, young adults more, and gradually showing younger, except for patients with clear indications of surgery. Conservative treatment is the main treatment of this disease, but the recurrence rate is high. Abdominal acupuncture therapy has been widely used in clinical practice, has been proved to be effective in many diseases. It has the advantage that other therapies can not be replaced. It is effective for many diseases by combining Qi-Xin-yang with Kaisiguan. This article discusses the clinical effect of Kaisiguan combined with abdominal acupuncture in the treatment of LDH by designing a randomized controlled trial. To provide the clinical basis for the treatment of LDH with the combination of open four customs and abdominal acupuncture, and to further clarify the early analgesic effect of opening four customs. Methods: strictly according to the condition of inclusion. From May 2016 to February 2017, 60 patients were selected from the Department of Acupuncture or Orthopaedics, Department of Acupuncture or Orthopedics, Guangzhou University of traditional Chinese Medicine and the first affiliated Hospital of Guangzhou University of Chinese Medicine. It was randomly divided into two groups, treatment group, control group of 30 patients. The patients in the control group were only treated with abdominal acupuncture. The patients in both groups were required to rest in a hard bed for 2 weeks for 30 minutes each time, once a day for the first three times, and once after 2nd. The lumbar function score (low back pain scoring system) and visual pain simulation scale (VAS) were used to evaluate the efficacy of the treatment for 30 minutes after the first treatment. After the first three treatments, one VAS score was performed before and after one course of treatment, and the JOA score was performed before and after one course of treatment. According to the improvement rate of low back pain score under JOA before and after treatment, the final clinical curative effect was evaluated. SPSS22.0 software was used to compare and analyze the data. Results: 1. 30 minutes after the first treatment, the VAS scores of the two groups were significantly different from those before treatment (P 0.01). The comparison of VAS scores between the two groups indicated that there was a significant difference between the two groups, but the difference before and after treatment in the treatment group was significantly higher than that in the control group. After 3 times of treatment, the difference was significantly higher in the treatment group than in the control group. The VAS scores of the two groups were significantly different from those before treatment (P 0.01), and the VAS scores between the two groups were significantly different (P 0.01). However, the difference between the two groups before and after treatment had no significant difference. 2.1 courses later, the JOA and VAS scores of the two groups were compared with those before treatment. The difference was statistically significant (P 0.01). After 3.1 courses of treatment, the difference of JOA and VAS scores between the two groups was not statistically significant (P 0.05). The difference of JOA score was statistically significant (P 0.05). Evaluation of curative effect: in the treatment group, 9 cases were clinically cured, 13 cases were markedly effective, 6 cases were effective and 2 cases were ineffective. The total clinical effective rate was 93.33. In the control group, 5 cases were cured, 8 cases were effective, 13 cases were effective, and 4 cases were ineffective. The total clinical effective rate was 86.67%. Conclusion: the combination of abdominal acupuncture and abdominal acupuncture can improve the lumbar spine function and relieve pain in LDH patients to some extent. The results suggest that the clinical efficacy of the treatment group is better than that of the control group. At the same time, by analyzing the difference of VAS score between the two groups after different treatment times, we can know. The treatment method of this study shows that the analgesic effect of open four customs combined with abdominal acupuncture is rapid and the pain is less in patients than in simple abdominal acupuncture. The advantages of simple operation and easy operation also confirmed the clinical effect of abdominal acupuncture on LDH, which is worthy of further clinical application.
【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】：2017
【分类号】：R246.9

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